Medication Therapy Management after Hospitalization in CKD: A Randomized Clinical Trial.

Background And Objectives: CKD is characterized by remarkably high hospitalization and readmission rates. Our study aim was to test a medication therapy management intervention to reduce subsequent acute care utilization.

Design, Setting, Participants, & Measurements: The CKD Medication Intervention Trial was a single-blind (investigators), randomized clinical trial conducted at Providence Health Care in Spokane, Washington.

Medication Intervention for Chronic Kidney Disease Patients Transitioning from Hospital to Home: Study Design and Baseline Characteristics.

Background: The hospital readmission rate in the population with chronic kidney disease (CKD) is high and strategies to reduce this risk are urgently needed.

Methods: The CKD-Medication Intervention Trial (CKD-MIT; www.clinicaltrials.

Predicting potential postdischarge adverse drug events and 30-day unplanned hospital readmissions from medication regimen complexity.

Objectives: To determine whether medication regimen complexity (MRC) could predict likelihood for occurrence of potential adverse drug events (ADEs), unplanned 30-day hospital readmission, or 30-day emergency department use in patients transitioning from hospital to home care.

Methods: Hospital discharge medication lists and medication lists constructed during visits to patients' homes were analyzed for 213 participants. MRC was quantified with the Medication Regimen Complexity Index (MRCI).

Type 2 translational research for CKD.

Strategies to effectively treat people with CKD have been identified by conventional clinical research. Despite this evidence, awareness, screening, detection, diagnosis, risk factor control, treatment, and outcomes remain substandard. Translating clinical evidence into actionable measures that reduce the burden of CKD is a pressing need.

Polypharmacy in older adults at home: what it is and what to do about it-implications for home healthcare and hospice, part 2.

Polypharmacy-the use of more medications than are clinically indicated-is a problem that affects many older adults. Adults aged 65 years and older make up approximately 13% of the population, but they consume nearly one third of all prescriptions dispensed. Older adults are more prone to adverse drug reactions and drug-drug interactions because of physiological changes and multiple comorbidities.

Polypharmacy in older adults at home: what it is and what to do about it--implications for home healthcare and hospice.

Polypharmacy--the use of more medications than are clinically indicated--is a problem that affects many older adults. Adults aged 65 years and older make up approximately 13% of the population, but they consume nearly one third of all prescriptions dispensed. Older adults are more prone to adverse drug reactions and drug-drug interactions due to physiological changes and multiple comorbidities.

Point-of-care screening to identify cognitive impairment in older adults.

Objective: To explore associations between results of a rapid screening tool for cognitive impairment and individual patient characteristics in a sample of patients receiving outpatient anticoagulation therapy who were not previously diagnosed with a dementia.

Design: Descriptive, nonexperimental, cross-sectional study.

Setting: Pharmacist-managed anticoagulation clinic in Spokane, WA, from June 2006 to March 2007.

Review of linagliptin for the treatment of type 2 diabetes mellitus.

Background: Linagliptin is a dipeptidyl peptidase-4 inhibitor that was approved in 2011 by the US Food and Drug Administration as a treatment adjunctive to diet and exercise for the improvement of glycemic control in adults with type 2 diabetes mellitus (T2DM).

Objective: The purpose of this article is to review the pharmacology, pharmacokinetic properties, efficacy, tolerability including drug-drug interactions, contraindications/precautions, and dosage and administration of linagliptin, and the potential role of linagliptin in the management of glycemia in adults with T2DM.

Methods: MEDLINE (1966-January 12, 2012), PubMed (1950-January 12, 2012), Science Direct (1994-January 12, 2012), Web of Science (1980-January 12, 2012), and the American Diabetes Association Scientific Abstracts (2008-2011) were searched using the term linagliptin.

Transitional care: exploring the home healthcare nurse's role in medication management.

During times of transition, the pharmaceutical care patients receive is often suboptimal and wrought with danger. Home healthcare nurses play a pivotal and important role in providing transitional care to patients by identifying and resolving medication discrepancies. Nurses must partner with pharmacists, physicians, and others involved with care transitions to decrease the likelihood of patients experiencing untoward health consequences associated with medications.

Clinical review of treatment options for select nonmotor symptoms of Parkinson's disease.

Background: Parkinson's disease (PD) is associated with a host of nonmotor symptoms, including psychosis, cognitive impairment, depression, sleep disturbance, swallowing disorders, gastrointestinal symptoms, and autonomic dysfunction. The nonmotor symptoms of PD have the potential to be more debilitating than the motor features of the disorder.

Objective: The aim of this article was to review treatment options for the nonmotor manifestations of PD, including pharmacologic and nonpharmacologic interventions.

Nurse identified hospital to home medication discrepancies: implications for improving transitional care.

Care transitions are clinically dangerous times, particularly for older adults with complex health problems. This article describes the most common medication discrepancies identified by nurses during patients' (n = 101) hospital to home transition. Findings indicated that medication discrepancies were astoundingly widespread, with 94% of the participants having at least 1 discrepancy.

Pharmacologic management of the older patient with type 2 diabetes mellitus.

Background: Pharmacologic options for the treatment of elderly patients with type 2 diabetes mellitus (T2DM) are the same as in younger adults; however, treatment considerations differ in the elderly due to changes in renal and hepatic function, life expectancy, and various other clinical and practical considerations.

Objective: This article discusses geriatric considerations in the pharmacologic management of T2DM and reviews the potential clinical advantages and disadvantages of pharmacologic agents currently available for the treatment of T2DM, including oral and injectable medications.

Methods: A search of MEDLINE was conducted for articles published in English between January 1966 and September 2009 using the terms type 2 diabetes mellitus, elderly, geriatric, treatment, insulin, metformin, sulfonylurea, thiazolidinedione, alpha-glucosidase inhibitor, meglitinide, DPP-4 inhibitor, colesevelam, exenatide, and pramlintide.

Pharmacology, efficacy and safety of liraglutide in the management of type 2 diabetes.

Liraglutide is a glucagon-like peptide-1 analog with pharmacokinetic properties suitable for once-daily administration approved by the Food and Drug Administration for the treatment of patients with type 2 diabetes. Clinical trial data from large, controlled studies demonstrate the safety and efficacy of liraglutide in terms of hemoglobin A(1c) (HbA(1c)) reduction, reductions in body weight, and the drug's low risk for hypoglycemic events when used as monotherapy. Liraglutide has been studied as monotherapy and in combination with metformin, glimepiride, and rosiglitazone for the treatment of type 2 diabetes.

Prevalence of depression and use of antidepressant pharmacotherapy among ambulatory patients with diabetes mellitus in the United States.

Background: Persons with diabetes mellitus (DM) exhibit a higher rate of depressive illness than does the general US population. Despite this finding, previous research has documented a low rate of diagnosis and/or treatment with antidepressant pharmacotherapy among persons with DM.

Objective: The aim of this study was to examine the current rate of diagnosis of depression and use of antidepressant pharmacotherapy among persons with DM.

Exploring the concept of medication discrepancy within the context of patient safety to improve population health.

Medication discrepancy is a concept often used in discussions about medication safety but has neither been fully explained nor clearly defined in the literature. This article explores medication discrepancy as it relates to patient safety and population health in the management of medications. Literature review reveals 2 main aspects of discrepancies in medication management; prescribing issues and patient adherence to regimens.

Effectiveness of a pharmacist-nurse intervention on resolving medication discrepancies for patients transitioning from hospital to home health care.

Purpose: The effectiveness of a collaborative pharmacist-nurse intervention on resolving detected medication discrepancies as patients transitioned from hospital to home health care was evaluated.

Methods: Patients age 50 years or older who were transitioning from hospital to home health care with qualifying diagnoses were eligible for study inclusion. Patients were assigned to a control or intervention group based on the geographic location of the patients' home.

The relationship between anticholinergic medications and Mini-Cog scores in older adults receiving home health care.

Objectives: To describe anticholinergic use patterns in older adult home health recipients and examine their relationship to evidence of cognitive impairment.

Design: Retrospective study.

Setting: A home health care agency in Eastern Washington state.

Treatment of chorea associated with Huntington's disease: focus on tetrabenazine.

Objective: Review Huntington's disease (HD) and the role of tetrabenazine (TBZ) in treating chorea associated with this disease. Discuss the pharmacology, side-effect profile, drug interactions, precautions, and contraindications of TBZ.

Data Sources: Literature identified within MEDLINE and PubMED.

Rate of obesity in U.S. ambulatory patients with diabetes mellitus: a national assessment of office-based physician visits.

To examine the interface between obesity and type 2 diabetes mellitus we examined data from the 2005 U.S. National Ambulatory Medical Care Survey (NAMCS).

Screening for undiagnosed cognitive impairment in homebound older adults.

Objective: To screen for undetected cognitive impairment in homebound elders receiving home health care services.

Design: A cross-sectional study of adults 60 years of age and older receiving visiting nurse services. A pharmacist administered the Mini-Cog, a rapid screening test for cognitive impairment, during the enrollment home visit.

Colesevelam hydrochloride for the treatment of type 2 diabetes mellitus.

Background: Colesevelam hydrochloride is a bile acid sequestrant approved in January 2008 by the US Food and Drug Administration (FDA) for the treatment of adult patients with type 2 diabetes mellitus (DM) in combination with a sulfonylurea, metformin, and/or insulin therapy.

Objective: The purpose of this article was to review the pharmacology, pharmacokinetics, efficacy, adverse effects and tolerability, drug-drug interactions, contraindications/precautions, dosage and administration, pharmacoeconomics, and the overall role of colesevelam in the management of adult patients with type 2 DM.

Methods: A literature search using MEDLINE (1966-October 27, 2008), PubMed (1950-October 27, 2008), Science Direct (1994-October 27, 2008), Web of Science (1980-October 27, 2008), American Diabetes Association Scientific Abstracts (2004-2008), and International Pharmaceutical Abstracts (1970-October 27, 2008) was performed using the term colesevelam.

Pharmacological management of glycemic control in the geriatric patient with type 2 diabetes mellitus.

Objective: Discuss geriatric considerations in the treatment of diabetes mellitus and review the advantages and disadvantages of the various pharmacologic agents, including oral medications and insulin, currently available for the treatment of type 2 diabetes mellitus (T2DM).

Data Sources: Literature identified within MEDLINE and PubMED, with an emphasis on material published since 2000, were reviewed.

Study Selection: Overall, 67 primary study manuscripts, clinical reviews, and dosing guidelines were identified and reviewed based on their clinical relevance to the geriatric population.