Abstract Point-of-care tests (POCTs) can be performed in a health-care setting outside of the cli... more Abstract Point-of-care tests (POCTs) can be performed in a health-care setting outside of the clinical laboratory. These tests are increasingly used to facilitate screening, diagnosis, monitoring, treatment, and referral decisions for a variety of acute and chronic conditions. Growing evidence demonstrates that community and ambulatory care pharmacists can use POCTs to expand pharmacy services in chronic disease management and infectious disease surveillance. Once regulatory requirements are met and logistical barriers overcome, such services can improve patient outcomes, access to care, and augment preventative public health efforts in the community. This chapter reviews how community and ambulatory care pharmacists apply POCTs to their practice to manage and screen for chronic diseases and infectious diseases and improve patient health and wellness. The chapter also highlights how performing POCT services improves health-care access and promotes public health efforts. Future opportunities for pharmacist to apply POCTs to their practice are also addressed.
Over 1000 new molecular entities (NMEs) have been introduced into the marketplace since the end o... more Over 1000 new molecular entities (NMEs) have been introduced into the marketplace since the end of World War II. These therapeutic innovations have contributed to an increase in life expectancy but have also increased the prevalence of polypharmacy and the risk for adverse drug-drug interactions. The economic burden associated with adverse drug events is estimated to exceed $100 billion in the United States alone. These adverse events are most often associated with chronic medications used to manage hypercholesterolemia, diabetes, asthma, and depression that are widely prescribed in more economically developed countries. Acute infections most often lead to the short-term prescription of antimicrobials that can increase the risk for adverse events and or therapeutic failure when co-prescribed with these agents. Likewise combination antimicrobial therapies used to manage chronic or deep-seated infections carry a high potential for drug-drug interactions. The large number of NMEs and c...
Current CMS State Operations Manual (SOM) requirements for skilled nursing facilities require a m... more Current CMS State Operations Manual (SOM) requirements for skilled nursing facilities require a minimum monthly pharmacist Drug Regimen Review, or Medication Regimen Review (MRR), as indicated by the resident's condition (F756). This includes reporting of any medication
American Journal of Pharmaceutical Education, 2018
Doctor of Pharmacy (PharmD) curriculum and establish whether performance on the multiple mini int... more Doctor of Pharmacy (PharmD) curriculum and establish whether performance on the multiple mini interview (MMI) independently predicts APPE evaluation scores. Methods. A multi-case MMI has been used in the admissions process since 2008. Students are scored anywhere from 1 to 7 (unsatisfactory to outstanding) on each interview. Traditional factors (GPA, PCAT, etc.) are also used in the admissions determination. Pearson product-moment correlation and ordinary least squares regression were used to explore the relationships between admissions data, pharmacy GPA, and APPE evaluation scores for the graduating classes of 2011-2014. These analyses identified which factors (pharmacy GPA, PCAT, MMI score, age, gender, rurality, resident status, degree, and underrepresented minority status) related to APPE performance. Results. Students (n5432) had a mean APPE score of 4.6; a mean MMI score of 5.5; mean pharmacy GPA, PCAT and age of 3.14, 73.2, 22.6 years, respectively. Pre-pharmacy GPA and pharmacy GPA positively correlated with mean APPE scores. MMI score demonstrated positive correlations with overall APPE score; including subcategories patient care, documentation, drug information/EBM, public health, and communication. MMI scores were positively related to overall APPE scores in the multivariable regression. Variables showing negative associations with APPE scores included a pre-pharmacy GPA of ,3.0 (ref5 GPA .3.5) and pharmacy school GPA of .3.0-3.5 and GPA 2.6-3.0 when compared to GPAs .3.5. Conclusion. GPA (pre-pharmacy and pharmacy) and MMI positively correlate with preceptor-rated performances in the APPE year.
Background: Experiential education designed around transitions of care (TOC) offers student pharm... more Background: Experiential education designed around transitions of care (TOC) offers student pharmacists a variety of educational activities to build their skills and confidence related to direct patient care, communication, and practice management. The purpose of this paper is to describe the development, implementation, and student perceptions of introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs) that emphasize TOC. Educational activity: Sixty students (22 IPPE and 38 APPE) completed the learning experience with the oversight of two faculty members in two, separate, large community hospitals providing pharmacy led TOC services. Each educational activity was mapped to the Pharmacists' Patient Care Process, which includes guided electronic medical record review, patient case discussions, and direct patient care (i.e. medication history collection, patient education). Other aspects of the learning experience include the use of layered learning, intention/reflection dialogues, and topic discussions. Evaluation of the learning experience occurred through review of student performance data and feedback. Critical analysis of the educational activity: Student performance data demonstrated an increase in the mean score between midpoint and final evaluation of all TOC specific competencies. Students expressed a positive learning experience as demonstrated by an approximately 3.8 overall rating of the learning experience on a 4-point scale for both IPPEs and APPEs. Analysis of open comments from students demonstrated the most beneficial aspects of the learning experience as interprofessional communication, patient communication, and a variety of patient care opportunities. Background The Centers for Medicare and Medicaid (CMS) define transitions of care (TOC) as "the movement of a patient from one care setting to another." 1 The importance of TOC grew following CMS implementation of the Hospital Readmissions Reduction Program that aimed to decrease costs associated with 30-day readmission rates. 2 As a result, institutions and clinics focus on TOC as a quality standard for cost and patient safety purposes. During TOC, patients are more vulnerable to preventable adverse drug events, and the majority of medication errors occur during this time. The Joint Commission National Patient Safety Goal 03.06.01 focuses on medication safety during TOC within hospitals, 3 and many national organizations support this goal. Studies suggest an estimated 60% of medication errors take place during
Nonadherence produces considerable health consequences and economic burden to patients and payers... more Nonadherence produces considerable health consequences and economic burden to patients and payers. One approach to improve medication nonadherence that has gained interest in recent years is the use of smartphone adherence apps. The development of smartphone adherence apps has increased rapidly since 2012; however, literature evaluating the clinical app and effectiveness of smartphone adherence apps to improve medication adherence is generally lacking. The aims of this study were to (1) provide an updated evaluation and comparison of medication adherence apps in the marketplace by assessing the features, functionality, and health literacy (HL) of the highest-ranking adherence apps and (2) indirectly measure the validity of our rating methodology by determining the relationship between our app evaluations and Web-based consumer ratings. Two independent reviewers assessed the features and functionality using a 4-domain rating tool of all adherence apps identified based on developer cl...
Journal of public health management and practice : JPHMP, Jan 16, 2016
Health care professionals must continually identify collaborative ways to combat antibiotic resis... more Health care professionals must continually identify collaborative ways to combat antibiotic resistance while improving community health and health care delivery. Clinical Laboratory Improvement Amendments of 1988 (CLIA)-waived point-of-care (POC) testing (POCT) services for infectious disease conducted in community pharmacies provide a means for pharmacists to collaborate with prescribers and/or public health officials combating antibiotic resistance while improving community health and health care delivery. To provide a comprehensive literature review that explores the potential for pharmacists to collaborate with public health professionals and prescribers using pharmacy-based CLIA-waived POCT services for infectious diseases. Comprehensive literature review. PubMed and Google Scholar were searched for manuscripts and meeting abstracts for the following key words: infectious disease, community pharmacy, rapid diagnostic tests, rapid assay, and POC tests. All relevant manuscripts a...
American journal of pharmaceutical education, Jan 25, 2016
Objective. To explore methods used by pharmacy programs to attract and sustain relationships with... more Objective. To explore methods used by pharmacy programs to attract and sustain relationships with preceptors and experiential practice sites. Methods. Interviews with eight focus groups of pharmacy experiential education experts (n=35) were conducted at two national pharmacy meetings. A semi-structured interview guide was used. Focus group interviews were recorded, transcribed verbatim, and categorically coded independently by two researchers. Codes were compared, consensus was reached through discussion, and two experiential education experts assisted with interpretation of the coded data. Results. Six themes emerged consistently across focus groups: a perceived increase in preceptor compensation, intended vs actual use of payments by sites, concern over renegotiation of established compensation, costs and benefits of experiential students, territorialism, and motives. Conclusion. Fostering a culture of collaboration may counteract potentially competitive strategies to gain sites. ...
Antifungal agents are often prescribed in critically ill patients who are receiving many other me... more Antifungal agents are often prescribed in critically ill patients who are receiving many other medications. When using systemic antifungals, clinicians may possess susceptibility data and they are typically aware of the potential toxicity of these agents. However, the myriad of potential drugs that antifungal agents can interact with is daunting and can be confusing. This article reviews the pharmacokinetic properties of antifungal agents and their clinically relevant drug interactions. The antifungal agents differ markedly in their pharmacokinetic properties and in how they interact with other medicines. The amphotericin B formulations interact with other medicines primarily by reducing their renal elimination or producing additive toxicities. The azoles interact with other medicines primarily by inhibiting biotransformation or by affecting drug distribution and elimination. The echinocandins have the lowest propensity to interact with other medicines. The clinical relevance of antifungal-drug interactions varies substantially. While certain interactions are benign and result in little or no untoward clinical outcomes, others can produce significant toxicity or compromise efficacy if not properly managed through monitoring and dosage adjustment. However, certain interactions produce significant toxicity or compromise efficacy to such an extent that they cannot be managed and the particular combination of antifungal and interacting medicine should be avoided.
Drug absorption from the gastrointestinal (GI) tract and the impact of GI surgery and disease on ... more Drug absorption from the gastrointestinal (GI) tract and the impact of GI surgery and disease on drug absorption are discussed. Recommendations are made to manage problems of drug malabsorption. Absorption from the GI tract is a first-order process described by its rate and extent. GI surgery changes the anatomy of the GI tract and alters important variables in the absorption process. In the wake of procedures which diminish small bowel surface area, the extent of absorption of phenytoin, digoxin, cyclosporin, aciclovir, hydrochlorothiazide and certain oral contraceptives is reported to be reduced. The underlying cause of the reduction is unknown. When gastric emptying time or pH are altered by surgery, the rate of drug absorption appears to be reduced. However, it is not clear which variable is more important in determining therapeutic effects. The effects of coeliac and inflammatory bowel diseases on the distribution and clearance of drugs must be considered before attributing abnormal serum concentrations of drugs to malabsorption. GI disease may slow gastric emptying and delay the complete absorption of drugs when their rate of absorption depends on gastric emptying time. Other inflammatory GI diseases such as graft-versus-host disease (GVHD) of the gut, Behçet's syndrome and scleroderma involving the GI tract may directly reduce absorption of drugs such as cyclosporin, amitriptyline, benzodiazepines, anticonvulsants, paracetamol (acetaminophen) and penicillamine. GI diseases which alter gut pH affect the absorption only of drugs with limited water solubility and pH-dependent dissolution such as ketoconazole. Clinicians should be aware of the variable absorption seen after GI disease and surgery and monitor their patients accordingly.
Pharmacotherapy the Journal of Human Pharmacology and Drug Therapy, 1994
To determine the influence of treatment on the microbiologic outcome of funguria. Retrospective c... more To determine the influence of treatment on the microbiologic outcome of funguria. Retrospective case series. A 300-bed tertiary care teaching hospital in a large metropolitan area. 141 hospitalized patients, 18 years of age or older, with at least one urine culture positive (> or = 10(2) cfu/ml) for fungi. Retrospective review of medical records to determine the microbiologic outcome of funguria. Funguria developed rapidly in individuals with known predisposing factors. Urinalysis did not routinely detect the presence of fungi or pyuria. Symptoms such as fever, dysuria, and frequency were generally absent. Funguria persisted whether it was due to Candida albicans or nonalbicans species. There were no statistical differences in the microbiologic outcomes of treated and untreated funguria. Funguria is a rapidly developing, often benign and persistent process. Minimizing predisposing risks, such as removing indwelling urinary catheters, is beneficial in its management. Pharmacologic treatment of funguria due to C. albicans or non-albicans species does not influence the microbiologic outcome.
American journal of pharmaceutical education, Jan 25, 2016
Objective. To identify admissions variable prognostics for academic difficulty in the PharmD curr... more Objective. To identify admissions variable prognostics for academic difficulty in the PharmD curriculum to use for admissions determinations and early identification of at-risk students. Methods. Retrospective multivariate analysis of 2008-2012 admission data were linked with academic records to identify students with academic difficulty (ie, those with Ds, Fs, delayed progression). The influence of prepharmacy grade point average (GPA), composite Pharmacy College Admission Test (PCAT) score, multiple-mini interview (MMI) score, age, credit hours, state residence, and prior degree on academic difficulty was estimated using multivariate logistic regression. Results. Students' (n=587) prepharmacy GPA, composite PCAT score, mean MMI score, and age were 3.6, 72.0, 5.5, 22.8 (SD=4.14 years), respectively. Students having a GPA <3.25, PCAT score <60th percentile, or MMI score <4.5, were approximately 12-, 7-, and 3-times more likely, respectively, to experience academic diffi...
International Journal for the Scholarship of Teaching and Learning, 2014
Expansion in academic pharmacy and other health professions has increased the demand for clinical... more Expansion in academic pharmacy and other health professions has increased the demand for clinical faculty members. The requirement to provide clinical service is unique to clinical faculty and creates a competing demand with the expectation to excel in the tripartite missions of their institution. The efforts of clinical faculty are heavily focused towards the institution's educational mission. However, often they lack formal training in educational methodology and require ongoing professional development to hone their teaching skills. Therefore, as clinical faculty develop as scholarly teachers, the scholarship of teaching and learning (SoTL) represents an ideal form of scholarship for them to pursue. This essay provides guidance on how clinical faculty members in academic pharmacy and other health professions can transform the act of teaching into scholarly teaching to develop a program of scholarship in SoTL.
Factors associated with family commitment among pharmacists in the south central U.S. are explore... more Factors associated with family commitment among pharmacists in the south central U.S. are explored. In 2010, a cross-sectional mailed self-administered 70 item survey of 363 active licensed pharmacists was conducted. This analysis includes only 269 (74%) participants who reported being married. Outcome measures were family commitment (need for family commitment, spouse's family commitment), work-related characteristics (work challenge, stress, workload, flexibility of work schedule), and job and career satisfaction. Married participants' mean age was 48 (SD = 18) years; the male to female ratio was 1:1; 73% worked in retail settings and 199 (74%) completed the family commitment questions. Females reported a higher need for family commitment than males (p = 0.02) but there was no significant difference in satisfaction with the commitment. Work challenge and work load
Elderly are at high risk for hospitalization for community-acquired pneumonia (CAP), especially d... more Elderly are at high risk for hospitalization for community-acquired pneumonia (CAP), especially due to Streptococcus pneumoniae, and seasonal influenza viruses. Data suggest PPV23's influence on various CAP-related outcomes among the elderly may depend upon how many years have elapsed since they received this vaccine. PPV23's protection against invasive pneumococcal disease and CAP hospitalizations are often limited to moderately ill elderly, who are less than 75 years old, or female. PCV13 demonstrates broad protection against a variety of CAPs, but ultimately, its influence on their outcomes among the elderly may be limited by herd immunity from PCV7 use. Influenza vaccine's indirect protective effect against all-cause and non-invasive pneumococcal CAP in the elderly is difficult to ascertain. The use of both PPV23 and influenza vaccine shortens length of stay in hospitalized elderly with CAP, but whether that benefit would be realized in the presence of herd immunity ...
Abstract Point-of-care tests (POCTs) can be performed in a health-care setting outside of the cli... more Abstract Point-of-care tests (POCTs) can be performed in a health-care setting outside of the clinical laboratory. These tests are increasingly used to facilitate screening, diagnosis, monitoring, treatment, and referral decisions for a variety of acute and chronic conditions. Growing evidence demonstrates that community and ambulatory care pharmacists can use POCTs to expand pharmacy services in chronic disease management and infectious disease surveillance. Once regulatory requirements are met and logistical barriers overcome, such services can improve patient outcomes, access to care, and augment preventative public health efforts in the community. This chapter reviews how community and ambulatory care pharmacists apply POCTs to their practice to manage and screen for chronic diseases and infectious diseases and improve patient health and wellness. The chapter also highlights how performing POCT services improves health-care access and promotes public health efforts. Future opportunities for pharmacist to apply POCTs to their practice are also addressed.
Over 1000 new molecular entities (NMEs) have been introduced into the marketplace since the end o... more Over 1000 new molecular entities (NMEs) have been introduced into the marketplace since the end of World War II. These therapeutic innovations have contributed to an increase in life expectancy but have also increased the prevalence of polypharmacy and the risk for adverse drug-drug interactions. The economic burden associated with adverse drug events is estimated to exceed $100 billion in the United States alone. These adverse events are most often associated with chronic medications used to manage hypercholesterolemia, diabetes, asthma, and depression that are widely prescribed in more economically developed countries. Acute infections most often lead to the short-term prescription of antimicrobials that can increase the risk for adverse events and or therapeutic failure when co-prescribed with these agents. Likewise combination antimicrobial therapies used to manage chronic or deep-seated infections carry a high potential for drug-drug interactions. The large number of NMEs and c...
Current CMS State Operations Manual (SOM) requirements for skilled nursing facilities require a m... more Current CMS State Operations Manual (SOM) requirements for skilled nursing facilities require a minimum monthly pharmacist Drug Regimen Review, or Medication Regimen Review (MRR), as indicated by the resident's condition (F756). This includes reporting of any medication
American Journal of Pharmaceutical Education, 2018
Doctor of Pharmacy (PharmD) curriculum and establish whether performance on the multiple mini int... more Doctor of Pharmacy (PharmD) curriculum and establish whether performance on the multiple mini interview (MMI) independently predicts APPE evaluation scores. Methods. A multi-case MMI has been used in the admissions process since 2008. Students are scored anywhere from 1 to 7 (unsatisfactory to outstanding) on each interview. Traditional factors (GPA, PCAT, etc.) are also used in the admissions determination. Pearson product-moment correlation and ordinary least squares regression were used to explore the relationships between admissions data, pharmacy GPA, and APPE evaluation scores for the graduating classes of 2011-2014. These analyses identified which factors (pharmacy GPA, PCAT, MMI score, age, gender, rurality, resident status, degree, and underrepresented minority status) related to APPE performance. Results. Students (n5432) had a mean APPE score of 4.6; a mean MMI score of 5.5; mean pharmacy GPA, PCAT and age of 3.14, 73.2, 22.6 years, respectively. Pre-pharmacy GPA and pharmacy GPA positively correlated with mean APPE scores. MMI score demonstrated positive correlations with overall APPE score; including subcategories patient care, documentation, drug information/EBM, public health, and communication. MMI scores were positively related to overall APPE scores in the multivariable regression. Variables showing negative associations with APPE scores included a pre-pharmacy GPA of ,3.0 (ref5 GPA .3.5) and pharmacy school GPA of .3.0-3.5 and GPA 2.6-3.0 when compared to GPAs .3.5. Conclusion. GPA (pre-pharmacy and pharmacy) and MMI positively correlate with preceptor-rated performances in the APPE year.
Background: Experiential education designed around transitions of care (TOC) offers student pharm... more Background: Experiential education designed around transitions of care (TOC) offers student pharmacists a variety of educational activities to build their skills and confidence related to direct patient care, communication, and practice management. The purpose of this paper is to describe the development, implementation, and student perceptions of introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs) that emphasize TOC. Educational activity: Sixty students (22 IPPE and 38 APPE) completed the learning experience with the oversight of two faculty members in two, separate, large community hospitals providing pharmacy led TOC services. Each educational activity was mapped to the Pharmacists' Patient Care Process, which includes guided electronic medical record review, patient case discussions, and direct patient care (i.e. medication history collection, patient education). Other aspects of the learning experience include the use of layered learning, intention/reflection dialogues, and topic discussions. Evaluation of the learning experience occurred through review of student performance data and feedback. Critical analysis of the educational activity: Student performance data demonstrated an increase in the mean score between midpoint and final evaluation of all TOC specific competencies. Students expressed a positive learning experience as demonstrated by an approximately 3.8 overall rating of the learning experience on a 4-point scale for both IPPEs and APPEs. Analysis of open comments from students demonstrated the most beneficial aspects of the learning experience as interprofessional communication, patient communication, and a variety of patient care opportunities. Background The Centers for Medicare and Medicaid (CMS) define transitions of care (TOC) as "the movement of a patient from one care setting to another." 1 The importance of TOC grew following CMS implementation of the Hospital Readmissions Reduction Program that aimed to decrease costs associated with 30-day readmission rates. 2 As a result, institutions and clinics focus on TOC as a quality standard for cost and patient safety purposes. During TOC, patients are more vulnerable to preventable adverse drug events, and the majority of medication errors occur during this time. The Joint Commission National Patient Safety Goal 03.06.01 focuses on medication safety during TOC within hospitals, 3 and many national organizations support this goal. Studies suggest an estimated 60% of medication errors take place during
Nonadherence produces considerable health consequences and economic burden to patients and payers... more Nonadherence produces considerable health consequences and economic burden to patients and payers. One approach to improve medication nonadherence that has gained interest in recent years is the use of smartphone adherence apps. The development of smartphone adherence apps has increased rapidly since 2012; however, literature evaluating the clinical app and effectiveness of smartphone adherence apps to improve medication adherence is generally lacking. The aims of this study were to (1) provide an updated evaluation and comparison of medication adherence apps in the marketplace by assessing the features, functionality, and health literacy (HL) of the highest-ranking adherence apps and (2) indirectly measure the validity of our rating methodology by determining the relationship between our app evaluations and Web-based consumer ratings. Two independent reviewers assessed the features and functionality using a 4-domain rating tool of all adherence apps identified based on developer cl...
Journal of public health management and practice : JPHMP, Jan 16, 2016
Health care professionals must continually identify collaborative ways to combat antibiotic resis... more Health care professionals must continually identify collaborative ways to combat antibiotic resistance while improving community health and health care delivery. Clinical Laboratory Improvement Amendments of 1988 (CLIA)-waived point-of-care (POC) testing (POCT) services for infectious disease conducted in community pharmacies provide a means for pharmacists to collaborate with prescribers and/or public health officials combating antibiotic resistance while improving community health and health care delivery. To provide a comprehensive literature review that explores the potential for pharmacists to collaborate with public health professionals and prescribers using pharmacy-based CLIA-waived POCT services for infectious diseases. Comprehensive literature review. PubMed and Google Scholar were searched for manuscripts and meeting abstracts for the following key words: infectious disease, community pharmacy, rapid diagnostic tests, rapid assay, and POC tests. All relevant manuscripts a...
American journal of pharmaceutical education, Jan 25, 2016
Objective. To explore methods used by pharmacy programs to attract and sustain relationships with... more Objective. To explore methods used by pharmacy programs to attract and sustain relationships with preceptors and experiential practice sites. Methods. Interviews with eight focus groups of pharmacy experiential education experts (n=35) were conducted at two national pharmacy meetings. A semi-structured interview guide was used. Focus group interviews were recorded, transcribed verbatim, and categorically coded independently by two researchers. Codes were compared, consensus was reached through discussion, and two experiential education experts assisted with interpretation of the coded data. Results. Six themes emerged consistently across focus groups: a perceived increase in preceptor compensation, intended vs actual use of payments by sites, concern over renegotiation of established compensation, costs and benefits of experiential students, territorialism, and motives. Conclusion. Fostering a culture of collaboration may counteract potentially competitive strategies to gain sites. ...
Antifungal agents are often prescribed in critically ill patients who are receiving many other me... more Antifungal agents are often prescribed in critically ill patients who are receiving many other medications. When using systemic antifungals, clinicians may possess susceptibility data and they are typically aware of the potential toxicity of these agents. However, the myriad of potential drugs that antifungal agents can interact with is daunting and can be confusing. This article reviews the pharmacokinetic properties of antifungal agents and their clinically relevant drug interactions. The antifungal agents differ markedly in their pharmacokinetic properties and in how they interact with other medicines. The amphotericin B formulations interact with other medicines primarily by reducing their renal elimination or producing additive toxicities. The azoles interact with other medicines primarily by inhibiting biotransformation or by affecting drug distribution and elimination. The echinocandins have the lowest propensity to interact with other medicines. The clinical relevance of antifungal-drug interactions varies substantially. While certain interactions are benign and result in little or no untoward clinical outcomes, others can produce significant toxicity or compromise efficacy if not properly managed through monitoring and dosage adjustment. However, certain interactions produce significant toxicity or compromise efficacy to such an extent that they cannot be managed and the particular combination of antifungal and interacting medicine should be avoided.
Drug absorption from the gastrointestinal (GI) tract and the impact of GI surgery and disease on ... more Drug absorption from the gastrointestinal (GI) tract and the impact of GI surgery and disease on drug absorption are discussed. Recommendations are made to manage problems of drug malabsorption. Absorption from the GI tract is a first-order process described by its rate and extent. GI surgery changes the anatomy of the GI tract and alters important variables in the absorption process. In the wake of procedures which diminish small bowel surface area, the extent of absorption of phenytoin, digoxin, cyclosporin, aciclovir, hydrochlorothiazide and certain oral contraceptives is reported to be reduced. The underlying cause of the reduction is unknown. When gastric emptying time or pH are altered by surgery, the rate of drug absorption appears to be reduced. However, it is not clear which variable is more important in determining therapeutic effects. The effects of coeliac and inflammatory bowel diseases on the distribution and clearance of drugs must be considered before attributing abnormal serum concentrations of drugs to malabsorption. GI disease may slow gastric emptying and delay the complete absorption of drugs when their rate of absorption depends on gastric emptying time. Other inflammatory GI diseases such as graft-versus-host disease (GVHD) of the gut, Behçet&#39;s syndrome and scleroderma involving the GI tract may directly reduce absorption of drugs such as cyclosporin, amitriptyline, benzodiazepines, anticonvulsants, paracetamol (acetaminophen) and penicillamine. GI diseases which alter gut pH affect the absorption only of drugs with limited water solubility and pH-dependent dissolution such as ketoconazole. Clinicians should be aware of the variable absorption seen after GI disease and surgery and monitor their patients accordingly.
Pharmacotherapy the Journal of Human Pharmacology and Drug Therapy, 1994
To determine the influence of treatment on the microbiologic outcome of funguria. Retrospective c... more To determine the influence of treatment on the microbiologic outcome of funguria. Retrospective case series. A 300-bed tertiary care teaching hospital in a large metropolitan area. 141 hospitalized patients, 18 years of age or older, with at least one urine culture positive (&gt; or = 10(2) cfu/ml) for fungi. Retrospective review of medical records to determine the microbiologic outcome of funguria. Funguria developed rapidly in individuals with known predisposing factors. Urinalysis did not routinely detect the presence of fungi or pyuria. Symptoms such as fever, dysuria, and frequency were generally absent. Funguria persisted whether it was due to Candida albicans or nonalbicans species. There were no statistical differences in the microbiologic outcomes of treated and untreated funguria. Funguria is a rapidly developing, often benign and persistent process. Minimizing predisposing risks, such as removing indwelling urinary catheters, is beneficial in its management. Pharmacologic treatment of funguria due to C. albicans or non-albicans species does not influence the microbiologic outcome.
American journal of pharmaceutical education, Jan 25, 2016
Objective. To identify admissions variable prognostics for academic difficulty in the PharmD curr... more Objective. To identify admissions variable prognostics for academic difficulty in the PharmD curriculum to use for admissions determinations and early identification of at-risk students. Methods. Retrospective multivariate analysis of 2008-2012 admission data were linked with academic records to identify students with academic difficulty (ie, those with Ds, Fs, delayed progression). The influence of prepharmacy grade point average (GPA), composite Pharmacy College Admission Test (PCAT) score, multiple-mini interview (MMI) score, age, credit hours, state residence, and prior degree on academic difficulty was estimated using multivariate logistic regression. Results. Students' (n=587) prepharmacy GPA, composite PCAT score, mean MMI score, and age were 3.6, 72.0, 5.5, 22.8 (SD=4.14 years), respectively. Students having a GPA <3.25, PCAT score <60th percentile, or MMI score <4.5, were approximately 12-, 7-, and 3-times more likely, respectively, to experience academic diffi...
International Journal for the Scholarship of Teaching and Learning, 2014
Expansion in academic pharmacy and other health professions has increased the demand for clinical... more Expansion in academic pharmacy and other health professions has increased the demand for clinical faculty members. The requirement to provide clinical service is unique to clinical faculty and creates a competing demand with the expectation to excel in the tripartite missions of their institution. The efforts of clinical faculty are heavily focused towards the institution's educational mission. However, often they lack formal training in educational methodology and require ongoing professional development to hone their teaching skills. Therefore, as clinical faculty develop as scholarly teachers, the scholarship of teaching and learning (SoTL) represents an ideal form of scholarship for them to pursue. This essay provides guidance on how clinical faculty members in academic pharmacy and other health professions can transform the act of teaching into scholarly teaching to develop a program of scholarship in SoTL.
Factors associated with family commitment among pharmacists in the south central U.S. are explore... more Factors associated with family commitment among pharmacists in the south central U.S. are explored. In 2010, a cross-sectional mailed self-administered 70 item survey of 363 active licensed pharmacists was conducted. This analysis includes only 269 (74%) participants who reported being married. Outcome measures were family commitment (need for family commitment, spouse's family commitment), work-related characteristics (work challenge, stress, workload, flexibility of work schedule), and job and career satisfaction. Married participants' mean age was 48 (SD = 18) years; the male to female ratio was 1:1; 73% worked in retail settings and 199 (74%) completed the family commitment questions. Females reported a higher need for family commitment than males (p = 0.02) but there was no significant difference in satisfaction with the commitment. Work challenge and work load
Elderly are at high risk for hospitalization for community-acquired pneumonia (CAP), especially d... more Elderly are at high risk for hospitalization for community-acquired pneumonia (CAP), especially due to Streptococcus pneumoniae, and seasonal influenza viruses. Data suggest PPV23's influence on various CAP-related outcomes among the elderly may depend upon how many years have elapsed since they received this vaccine. PPV23's protection against invasive pneumococcal disease and CAP hospitalizations are often limited to moderately ill elderly, who are less than 75 years old, or female. PCV13 demonstrates broad protection against a variety of CAPs, but ultimately, its influence on their outcomes among the elderly may be limited by herd immunity from PCV7 use. Influenza vaccine's indirect protective effect against all-cause and non-invasive pneumococcal CAP in the elderly is difficult to ascertain. The use of both PPV23 and influenza vaccine shortens length of stay in hospitalized elderly with CAP, but whether that benefit would be realized in the presence of herd immunity ...
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Papers by Paul Gubbins