Methadone Maintenance Treatment for Older Adults: Cost and Logistical Considerations.

In a demographic shift, older adults now comprise an increasing proportion of those receiving methadone maintenance treatment (MMT) for opioid use disorder. A study of MMT recipients in New York City suggests that 13% of the population is over 60 years of age. Adults ages 50-59 are among the largest age demographic, evidence that the number of older adults receiving MMT will continue to increase.

Garcinia Cambogia, Diabetic Ketoacidosis, and Pancreatitis.

[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].

Pharmacotherapy Use in Older Patients With Heart Failure and Reduced Ejection Fraction After a Skilled Nursing Facility Stay.

Background: Little is known about guideline-directed pharmacotherapy use in patients with heart failure and reduced ejection fraction (HFrEF) discharged to skilled nursing facilities (SNFs). This study aimed to describe the use of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARBs) and evidence-based β-blockers (EBBBs) among older patients with HFrEF within 90 days after the SNF admission and to identify factors associated with receipt of these medications.

Methods And Results: With the use of Minimum Data Set 3.

A Practice-Based Theory of Healing Through Therapeutic Touch: Advancing Holistic Nursing Practice.

For nearly 50 years, Therapeutic Touch (TT) has contributed to advancing holistic nursing practice and has been recognized as a uniquely human approach to healing. This narrative explores the development of a practice-based theory of healing through TT, which occurred between 2010 and 2016. Through the in-depth self-inquiry of participatory reflective dialogue in concert with constant narrative analysis, TT practitioners revealed the meaning of healing within the context of their TT practice.

Evaluation of a Standardized Perioperative Management Protocol in the Adult Hematology Anticoagulation Management Service.

Background: In North America, 250,000 patients on vitamin K antagonists require surgical procedures each year. Temporary interruption of oral anticoagulation and perioperative bridging therapy with unfractionated heparin or low-molecular-weight heparin are recommended by the American College of Chest Physicians 2012 for select patients.

Objectives: The study objectives are to evaluate adherence and nonadherence to the Johns Hopkins clinic guidelines for perioperative management of anticoagulation and identify bleeding or thromboembolic events during perioperative management of anticoagulation.

Substance Use Disorder Training Workshop for Future Interprofessional Health Care Providers.

Introduction: Rates of substance use disorders, including opioid misuse, continue to rise despite national initiatives. Because of this, health professional schools from Rhode Island joined together to design and implement a single-day interprofessional education workshop on substance use disorder training.

Methods: This workshop consists of four sessions.

Evidence To Support Continuation of Statin Therapy in Patients with Staphylococcus aureus Bacteremia.

In addition to cholesterol-lowering capabilities, statins possess anti-inflammatory and immunomodulatory effects. We sought to quantify the real-world impact of different statin exposure patterns on clinical outcomes in bacteremia. We conducted a retrospective cohort study among hospitalized patients with positive blood cultures receiving appropriate antibiotics within 48 h of culture collection (Veterans Affairs hospitals, 2002 to 2013).

Organizational Characteristics of Veterans Affairs Clinics With High and Low Utilization of Clozapine.

Objective: Twenty to thirty percent of patients with schizophrenia experience treatment resistance. Clozapine is the only medication proven effective for treatment-resistant schizophrenia. However, in most settings less than 25% of patients with treatment-resistant schizophrenia receive clozapine.

Implications of Recent Drug Approvals for Older Adults.

More than 100 medications were approved by the US Food and Drug Administration as new drugs or for new indications in 2014 and 2015. Several of the new drugs may benefit older adults, but adverse events and pharmacokinetic changes due to aging must be considered. This article will focus on three recently approved drugs that are marketed for chronic conditions that can affect older adults: suvorexant, for treatment of insomnia; edoxaban, for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation and for treatment of venous thromboembolism; and droxidopa, for treatment of symptomatic neurogenic orthostatic hypotension.

Residential Instability Among Low-Income Families: A Concept Analysis.

Residential instability is relatively common among low-income families and is associated with a host of negative outcomes, especially for children and adolescents. Psychiatric nurses, especially those in the advanced practice role, observe the consequences of residential instability within the clinical setting. Yet, to-date, the concept is somewhat vague and its essential meaning and definition remain unclear.

Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population.

Opioid rotation: A case example using methadone in spinal cord injury.

Opioid rotation is a practice used when patients with chronic pain have insufficient analgesia, experience unwanted opioid-related adverse reactions, or other pharmacologic challenges with their current opioid. Methadone is an opioid with unique pharmacological properties, which render it clinically distinct from other opioids. The drug's potential clinical benefits in treating nociceptive and neuropathic pain are coupled with risks of serious, life-threatening adverse reactions.

Promoting Safe Use of Medications: Providing Medication Education to Seniors Receiving Meals on Wheels.

Study Objectives: To assess whether pharmacist-provided medication education and counseling to Meals on Wheels (MOW) participants decreases medication-related preventable harm and improves adherence.

Design: Prospective, quasi-experiment.

Setting: Ambulatory congregrate dining centers.

Adherence to Guidelines for Hepatitis B, Pneumococcal, and Influenza Vaccination in Patients With Diabetes.

IN BRIEF This single-center, cross-sectional study was designed to assess adherence to national guidelines for the immunization of patients with diabetes and to evaluate predictors of vaccination with the hepatitis B, influenza, and 23-valent pneumococcal polysaccharide vaccines. In patients considered to be at increased risk for infection and infectious disease complications because of their history of diabetes, extensive nonadherence to immunization recommendations for all three vaccines was found. Nonadherence to the 2011 Advisory Committee on Immunization Practices' recommendation for hepatitis B vaccination was ubiquitous.

Responding to opioid overdose in Rhode Island: where the medical community has gone and where we need to go.

The number of opioid overdose events in Rhode Island has increased dramatically/catastrophically in the last decade; Rhode Island now has one of the highest per capita overdose death rates in the country. Healthcare professionals have an important role to play in the reduction of unintentional opioid overdose events. This article explores the medical community's response to the local opioid overdose epidemic and proposes strategies to create a more collaborative and comprehensive response.

Predictors of naloxone use for respiratory depression and oversedation in hospitalized adults.

Purpose: Results of a study to determine the established risk factors most closely associated with the use of naloxone to reverse adverse effects of opioid analgesia in a hospital population are presented.

Methods: In a retrospective case-control study at a community hospital, pharmacy dispensing records were used to identify 65 cases over a one-year period that involved the use of naloxone for the treatment of oversedation or respiratory depression and met the other inclusion criteria; another 65 patients who received opioid analgesia during the same period but did not require naloxone were identified as controls. The influence of demographics and clinical variables on the likelihood of naloxone use was analyzed by linear regression and chisquare testing.

Evaluation of differences in percentage of international normalized ratios in range between pharmacist-led and physician-led anticoagulation management services.

Background: The safety and efficacy of warfarin depend on maintaining the international normalized ratio (INR) in an established range.

Objective: The purpose was to determine whether a coordinated pharmacist-led approach improved percentage of INRs in therapeutic range in comparison to a physician-led anticoagulation management service (AMS).

Methods: A retrospective chart review was conducted for patients at a multisite primary care organization.

Living in an older adult community: a pharmacy student's experience.

Interacting with older adults is a daily practice for pharmacists. It is important to understand how medications affect their wellbeing, but there are many other factors that affect quality of life. To truly understand some of the challenges facing older adults, Emily Anastasia, a sixth-year pharmacy student at the University of Rhode Island, moved into South Bay Retirement Living, a senior living community, for an eight-day immersion experience as a special project within one of her advanced pharmacy practice experience rotations.

Impact of pharmacist-conducted medication reconciliation at discharge on readmissions of elderly patients with COPD.

Purpose: Beginning in fiscal year 2015, the Centers for Medicare and Medicaid Services will measure all-cause readmissions for patients admitted for exacerbation of chronic obstructive pulmonary disease (COPD). Hospitals will incur a payment penalty for unplanned 30-day readmissions. Elderly patients frequently present a challenge because of polypharmacy, which contributes to a greater risk for medication-related readmissions.

Clinical Outcomes in Patients with Heterogeneous Vancomycin-Intermediate Staphylococcus aureus Bloodstream Infection.

The prevalence of heterogeneous vancomycin-intermediate (hVISA) infections varies in the literature, a problem complicated by the lack of routine screening procedures; however, limited data suggest that hVISA has been associated with persistent bloodstream infections (BSI) and vancomycin failure, yet these studies have been confounded by design issues. We conducted this study to compare the characteristics of patients with BSI caused by hVISA with those with vancomycin-susceptible (VSSA) treated with vancomycin. This retrospective, multicenter matched (1:1) cohort study compared the clinical characteristics and outcomes of hVISA and VSSA.

Use of electronic personal health records to identify patients at risk for aspirin-induced gastrointestinal bleeding.

Objective(s): The aim of this paper is to describe the utility of electronic personal health records (ePHRs) to identify patients with potential risk factors for aspirin-induced upper gastrointestinal bleeding (UGIB).

Setting: ER-Card, LLC. a for-profit ePHR company located in Rhode Island from October 2008 to May 2010.

Treatment of obesity in children and adolescents.

The prevalence of childhood and adolescent obesity continues to rise in the United States (US). Immediate health consequences are being observed, and long-term risks are mounting within the pediatric population, secondary to obesity. The hallmark of prevention and treatment of obesity in children and adolescents includes lifestyle modification (i.