scholarly journals Pharmacy Practice: Exploring the Relationship between SSRIs and Sodium Levels in an Older Adult Population

2016 ◽  
Vol 7 (4) ◽  
Author(s):  
Sonya L Anderson ◽  
Nita Johnston
Keyword(s):  
Older Patients ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Sodium Level ◽  
Screening Tool ◽  
Conflicts Of Interest ◽  
Adult Population ◽  
Pharmacy Practice ◽  
Hospital Data ◽  
Inappropriate Use ◽  
Financial Interests

I was asked to examine the presence of hyponatremia (<130 mEq/L) in older patients (>65 years) taking Selective Serotonin Reuptake Inhibitors (SSRIs) at Moses Cone Hospital. The presence of hyponatremia in older patients using SSRIs indicates potentially inappropriate use according to the STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria6. This study was done to assess possible risk factors for potentially inappropriate use of SSRIs by older patients at Moses Cone Hospital. Data collected included the patient’s sex, age, sodium level, and the date the sodium level was drawn. Data also included the specific SSRI and the starting date for the SSRI. The study showed no relationship between age, sex, SSRI prescribed and hyponatremia. However, patients that were prescribed an SSRI for less than a year were more at risk for hyponatremia. Therefore, in order to minimize the risk of hyponatremia, additional monitoring may need to be added at SSRI initiation, three months, six months, and one year, especially in patients with other medications that may lower sodium levels. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.   Type: Student Project

scholarly journals Preceptors' Need For Support In Tutoring Pharmacy Students in Finnish Community Pharmacies

2016 ◽  
Vol 7 (4) ◽  
Author(s):  
Ulla Löfhjelm ◽  
Katja Pitkä ◽  
Sanna Passi ◽  
Marja Airaksinen
Keyword(s):  
Conflicts Of Interest ◽  
Qualitative Content Analysis ◽  
Pharmacy Practice ◽  
Original Research ◽  
Reflective Dialogue ◽  
Assessment Of Learning ◽  
Financial Interests ◽  
Care Guidelines ◽  
Need For Support ◽  
Giving Feedback

A pharmacy degree in Finland includes a six-month obligatory internship. The internship is integrated with theoretical studies and adds up to 30 European Credit Transfer and Accumulation System (ECTS) credits of the BSc (Pharm) degree. Learning is supported by reflective assignments from the university. The preceptors have an important role in organizing the internship and tutoring students successfully in community pharmacy settings. Objective: to assess whether the preceptors of University of Helsinki’s teaching pharmacies need pedagogic support in tutoring and if so, in which core pharmaceutical tasks or tutoring skills. Methods: The survey was sent to all preceptors of University of Helsinki´s teaching pharmacies (n=326) in 2011 (response rate 58%, n=190). The data was analyzed statistically using Excel (version 12.3.6). The open-ended questions were analyzed by qualitative content analysis. Results: The majority of preceptors found their skills in tutoring the students mainly good. However, assessment of learning (27% of the respondents), giving feedback (23%) and organizing the learning situations supportive for learning (23%) were the areas in which the preceptors mostly indicated a need for support. Teaching current care guidelines and pharmaceutical care (36%) and multi-professional collaboration (28%) were the areas in which the preceptors expressed that they needed to update their skills. Conclusions: The faculty should focus the support on the pedagogic skills of preceptors, particularly in improving their skills in assessment of learning and in reflective dialogue. In addition, their skills in teaching clinical and patient care aspects of pharmacy practice should be enhanced. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties   Type: Original Research  

scholarly journals The Drug Court Pharmacist: Expanding Pharmacy Practice and Addressing Substance Abuse

2016 ◽  
Vol 7 (3) ◽  
Author(s):  
Laura C Palombi ◽  
Cynthia P Koh-Knox
Keyword(s):  
Substance Abuse ◽  
Problem Solving ◽  
Prescription Drugs ◽  
Drug Court ◽  
Conflicts Of Interest ◽  
Health Care Systems ◽  
Pharmacy Practice ◽  
The United States ◽  
Problem Solving Courts ◽  
Financial Interests

Problem solving courts, including Drug Court, were established to address substance abuse while providing an alternative to prison sentences and traditional corrections supervision. Drug Courts have been shown to reduce crime in participants and graduates, save the criminal justice and health care systems money, reduce victimization, and restore families. Pharmacists in Tippecanoe County, Indiana, and Carlton County, Minnesota, have established innovative practices as members of Drug Court teams; these practices include the provision of a variety of pharmaceutical and health-related services that other Drug Court team members are not able to provide. The role of the pharmacist on the Drug Court team deserves exploration in light of the increasing needs of problem-solving courts across the United States and the current substance abuse epidemic that unfortunately includes prescription drugs. Conflict of Interest "We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties."   Type: Idea Paper

scholarly journals Impact of Independent Pharmacist Prescribing on the Future of Pharmacy

2016 ◽  
Vol 7 (4) ◽  
Author(s):  
Jimmy Shangala Mwawaka
Keyword(s):  
Community Pharmacy ◽  
Pharmaceutical Care ◽  
Conflict Of Interest ◽  
Expert Testimony ◽  
Conflicts Of Interest ◽  
Pharmacy Practice ◽  
Pharmacy Education ◽  
Pharmacist Prescribing ◽  
Financial Interests ◽  
Made In

Pharmaceutical care as a philosophy is neither universal nor sustainable. Pharmacist prescribing will be the most unifying and transformative innovation in pharmacy practice, globally. Scope expansion supported by prescribing rights for pharmacists will impact pharmacy and other professions: community pharmacy will evolve into an independent profession; and pharmacy and medicine will merge. Important decisions in pharmacy education and practice policy must be made in view of these future changes. Conflict of Interest "We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties".   Type: Commentary

scholarly journals Multiple Bosses: Challenges and suggestions to improve organizational environments in academic settings.

2016 ◽  
Vol 7 (2) ◽  
Author(s):  
Agnes Ann Feemster ◽  
T. Joseph Mattingly
Keyword(s):  
Conflicts Of Interest ◽  
Pharmacy Practice ◽  
Job Dissatisfaction ◽  
Additional Stress ◽  
Original Research ◽  
Organizational Environments ◽  
Academic Settings ◽  
Financial Interests ◽  
Reporting Structure ◽  
Teaching Responsibilities

Practice faculty members are often supervised by more than one individual, creating a reporting structure that mirrors a matrix organization. They are tasked with balancing administrative and teaching responsibilities established by the school with expectations of maintaining a pharmacy practice site. A matrix reporting structure offers opportunities for enhanced development, but risks of additional stress from the organizational complexity must be mitigated to reduce job dissatisfaction. Frequent and consistent communication, mutual agreement and alignment of expectations and priorities, and the ability to manage conflict and adapt to change will aid pharmacy practice faculty in managing the relationship between their primary employer (the school) and the contracted entity. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.   Type: Original Research

Death, taxes and uncertainty: Economic motivations in end-of-life decision making

2021 ◽  
pp. 147775092110114
Author(s):  
George Slade Mellgard ◽  
Jacob M Appel
Keyword(s):  
End Of Life ◽  
Ethical Issues ◽  
Conflicts Of Interest ◽  
Clinical Care ◽  
Third Party ◽  
Ethical Conflicts ◽  
Financial Interests ◽  
End Of Life Decision ◽  
Death Taxes

Economic motivations are key drivers of human behavior. Unfortunately, they are largely overlooked in literature related to medical decisionmaking, particularly with regard to end-of-life care. It is widely understood that the directions of a proxy acting in bad faith can be overridden. But what of cases in which the proxy or surrogate appears to be acting in good faith to effectuate the patient’s values, yet doing so directly serves the decision-maker’s financial interests? Such situations are not uncommon. Many patients care as deeply about economic wellbeing of their families as they do for their own lives and health. This brief work examines three scenarios that raise ethical issues regarding the role of pecuniary motives in making critical medical decisions. Each scenario presents a potential financial conflict of interest between an incapacitated patient and a third-party decision-maker and offers a framework for integrating ethical and legal concerns into clinical care. It is our hope that this work prepares physicians for unexpected ethical conflicts of interest and enables them to further the interests of his or her patients.

scholarly journals First validation of the G-8 geriatric screening tool in older patients with glioblastoma

2019 ◽  
Vol 10 (1) ◽  
pp. 159-163 ◽  
Author(s):  
Elise Deluche ◽  
Sophie Leobon ◽  
Francois Lamarche ◽  
Nicole Tubiana-Mathieu
Keyword(s):  
Older Patients ◽  
Screening Tool ◽  
Geriatric Screening

scholarly journals Community Pharmacist Attitudes on Medication Synchronization Programs

2017 ◽  
Vol 8 (2) ◽  
Author(s):  
Matthew Witry ◽  
Thao Hoang
Keyword(s):  
Community Pharmacist ◽  
Conflicts Of Interest ◽  
Positive Impact ◽  
Patient Adherence ◽  
Original Research ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medication Therapy ◽  
Financial Interests ◽  
Significant Change

Background: Medication synchronization is a service offered by an increasing number of community pharmacies that aligns refilling of a patient’s multiple medications. Purported benefits include increased adherence and improved dispensing efficiency. Objective: To assess community pharmacist agreement with a set of declarative statements about medication synchronization programs and to identify variation related to pharmacist characteristics. Methods: In 2015, a cross-sectional survey was mailed to 1,000 pharmacists from 5 Midwestern U.S. states using 4-contacts and an online option. Respondents used a 7-point Likert scale to agree or disagree with 5 statements about medication synchronization. Demographic and workplace characteristics were collected. Data were analyzed using descriptive statistics and factor analysis. Multiple linear regression tested the relationship between pharmacist characteristics and a 4-item attitude composite. Results: There were 258 usable responses for a response rate of 28.8%. About half (45.0%) reported their pharmacy offered medication synchronization. Most pharmacists (82.6%) agreed this service has a positive impact on patient adherence but 57% agreed that a “significant change to workflow” was or would be required. Pharmacist agreement that the program provides financial benefits to the pharmacy was higher than agreement that the service provides more opportunities for patient interactions (p<0.001). In the multiple regression analysis, having a PharmD and working at a pharmacy offering Medication Therapy Management were associated with more positive scores on the medication synchronization benefits composite whereas working in a staff role (rather than a manager/owner) was lower. No demographic predictors were significantly associated with agreeing that a significant change to workflow would be required for implementation. Conclusions: Pharmacists generally were positive about medication synchronization programs, although some negative views were present, especially regarding the need for workflow change. Research is needed to understand barriers and facilitators to how medication synchronization programs are implemented and maintained and their effects on outcomes. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.   Type: Original Research

scholarly journals A new experimental community pharmacy internship module for undergraduate pharmacy students in western Nepal: overview and reflections

2017 ◽  
Vol 14 ◽  
pp. 18 ◽  
Author(s):  
Sangita Timsina ◽  
Bhuvan K.C. ◽  
Dristi Adhikari ◽  
Alian A. Alrasheedy ◽  
Mohamed Izham Mohamed Ibrahim ◽  
...  
Keyword(s):  
Community Pharmacy ◽  
Adverse Drug Reaction Reporting ◽  
Pharmacy Practice ◽  
Pharmacy Students ◽  
Community Pharmacies ◽  
Case Presentation ◽  
Business Plans ◽  
Inappropriate Use ◽  
Hands On

Community pharmacies in Nepal and other South Asian countries are in a mediocre state due to poor regulation and the fact that many pharmacies are run by people with insufficient training in dispensing. This has led to the inappropriate use of medicines. The problems due to poor regulation and the mediocre state of community pharmacies in South Asia encompass both academia and clinical practice. In this paper, a 2-week community pharmacy internship programme completed by 2 graduating pharmacy students of Pokhara University (a Nepalese public university) at Sankalpa Pharmacy, Pokhara, Nepal is illustrated. During the internship, they were systematically trained on store management, pharmaceutical care, counselling skills, the use of medical devices, pharmaceutical business plans, medicine information sources, and adverse drug reaction reporting. An orientation, observations and hands-on training, case presentation, discussion, and feedback from 2 senior pharmacists were used as the training method. A proper community pharmacy internship format, good pharmacy practice standards, and a better work environment for pharmacists may improve the quality of community pharmacies.

Appropriateness of peripherally inserted central catheter use among general medical inpatients: an observational study using routinely collected data

2020 ◽  
Vol 29 (11) ◽  
pp. 905-911 ◽  
Author(s):  
Amol A Verma ◽  
Alexander Kumachev ◽  
Sonam Shah ◽  
Yishan Guo ◽  
Hae Young Jung ◽  
...  
Keyword(s):  
General Medicine ◽  
Cross Sectional Study ◽  
Charlson Comorbidity Index Score ◽  
Severe Illness ◽  
Hospital Data ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
General Internal ◽  
Medical Inpatients ◽  
Hospital Administrative

BackgroundPeripherally inserted central catheters (PICC) are among the most commonly used medical devices in hospital. This study sought to determine the appropriateness of inpatient PICC use in general medicine at five academic hospitals in Toronto, Ontario, Canada, based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).MethodsThis was a retrospective, cross-sectional study of general internal medicine patients discharged between 1 April 2010 and 31 March 2015 who received a PICC during hospitalisation. The primary outcomes were the proportions of appropriate and inappropriate inpatient PICC use based on MAGIC recommendations. Hospital administrative data and electronic clinical data were used to determine appropriateness of each PICC placement. Multivariable regression models were fit to explore patient predictors of inappropriate use.ResultsAmong 3479 PICC placements, 1848 (53%, 95% CI 51% to 55%) were appropriate, 573 (16%, 95% CI 15% to 18%) were inappropriate and 1058 (30%, 95% CI 29% to 32%) were of uncertain appropriateness. The proportion of appropriate and inappropriate PICCs ranged from 44% to 61% (p<0.001) and 13% to 21% (p<0.001) across hospitals, respectively. The most common reasons for inappropriate PICC use were placement in patients with advanced chronic kidney disease (n=500, 14%) and use for fewer than 15 days in patients who are critically ill (n=53), which represented 14% of all PICC placements in the intensive care unit. Patients who were older, female, had a Charlson Comorbidity Index score greater than 0 and more severe illness based on the Laboratory-based Acute Physiology Score were more likely to receive an inappropriate PICC.ConclusionsClinical practice recommendations can be operationalised into measurable domains to estimate the appropriateness of PICC insertions using routinely collected hospital data. Inappropriate PICC use was common and varied substantially across hospitals in this study, suggesting that there are important opportunities to improve care.

What you need to know about malnutrition in older adults

2020 ◽  
Vol 81 (9) ◽  
pp. 1-8
Author(s):  
Kerry Cheah ◽  
Amy Illsley
Keyword(s):  
Older Patients ◽  
Nutritional Assessment ◽  
Adult Population ◽  
Management Strategies ◽  
Community Dwelling ◽  
Nursing Home Care ◽  
Assessment Tools ◽  
Ageing Population ◽  
Age Related ◽  
Older Adult Population

Malnutrition is the disturbance of normal form or function, arising from the deficiency of one or more nutrients, and is a significant issue in the older adult population. Despite their reduced energy requirements, older patients need the same protein intake and micronutrients as younger patients, but age-related changes may impact the ability to meet these requirements. The cause of malnutrition in individuals is likely to be multifactorial and can therefore be complex to manage. Adequate nutrition is important for both community dwelling patients and inpatients, as malnutrition increases the risk of complications and the likelihood of needing residential or nursing home care on discharge. This article discusses the risk factors for the development of malnutrition in older patients and the different nutritional assessment tools available. Management strategies for optimising nutrition can be divided into systems and supplementation. With an ageing population, most doctors will inevitably become increasingly involved with treating older patients and this article highlights the need to consider a patient's nutritional status. Nutrition should be considered during every ward round and the multidisciplinary team as a whole should maintain an awareness and responsibility for managing malnutrition.

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