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Purpose. The results of a national survey to evaluate on-call practices and responsibilities of pharmacy residents nationwide, as well as opinions related to duty-hour changes, are reported. Methods. A 39-question survey was distributed to 1292 residency program directors (RPDs) listed in the American Society of Health-System Pharmacists (ASHP) online residency directory, which includes programs in all stages of the accreditation process. The survey opened on November 7, 2011, and closed on November 28, 2011. The survey collected demographic information and answers to questions about the residency's on-call component (if applicable) and barriers to the creation of an on-call component. Respondents were also asked to indicate their support of or opposition to the adoption of the 2011 Accreditation Council for Graduate Medical Education (ACGME) duty-hour rules and identify the areas of greatest concern. Results. Of the 1292 RPDs listed in the ASHP online residency directory to whom the survey was sent, 521 surveys were completed, yielding a response rate of 40%. Of these, 471 identified their residency program as including or excluding an on-call component. Of the 138 programs with on-call services, 102 programs (74%) indicated the inclusion of an overnight experience. Programs that did not utilize an on-call component indicated barriers such as a perceived lack of demand (39%) and duty-hour limitations (21%). Common on-call activities included drug information consults and therapeutic drug monitoring. There was not a clear consensus from RPDs regarding the adoption of the 2011 ACGME duty-hour standards. Conclusion. Among usable responses to a survey of pharmacy residency programs, 29% indicated that their program included an on-call component. On-call programs varied greatly in activities, location, hours, and requirements. [ABSTRACT FROM AUTHOR]

Purpose. The results of a survey assessing the views of pharmacy directors, medical center executives, and pharmacists on the value of residency programs to their institutions are reported. Methods. In a two-phase survey entailing face-to-face interviews and the use of an electronic questionnaire, representatives of the pharmacy departments and executive staffs of eight academic medical centers were asked to rate the impact of pharmacy residency programs in areas such as educational and research innovation, quality-of-care and cost outcomes, and opportunities for revenue generation. Results. Seven hospital administrators, eight directors of pharmacy, 122 pharmacists serving as residency preceptors, and 91 nonpreceptor pharmacists participated in the survey. The survey responses indicated that hospital administrators view pharmacy residency programs as important contributors to their institutions' prestige, academic success, and capacity for delivering educational programs. All directors of pharmacy surveyed were in agreement that the costs associated with conducting a pharmacy residency program are outweighed by the cost savings achieved through resident contributions to patient care and medication error prevention. A large majority (90%) of preceptor pharmacists agreed or strongly agreed that residents help reduce medication errors by educating prescribers and other activities that promote rational medication use; only about half of nonpreceptor pharmacists shared that view, although 65% of nonpreceptors acknowledged the contributions of residents to overall pharmacy department success. Conclusion. All groups of survey respondents viewed residency programs as important assets to their institutions, especially in the areas of institutional prestige, staff recruitment, and professional development and education. [ABSTRACT FROM AUTHOR]

Objective To compare the long-term effectiveness of hospital versus telephone-monitored home-based exercise training during cardiac rehabilitation (CR) on exercise capacity and habitual physical activity. Design Six-year follow-up of patients who participated in a randomised controlled trial of hospital versus monitored home-based exercise training during CR after coronary artery bypass graft surgery. Setting Outpatient CR centre in Central-South Ontario, Canada. Participants 196 Patients who participated in the original randomised controlled trial and who attended an evaluation 1 year after CR. Interventions 6 months of home or hospital-based exercise training during CR. Main outcome measures Peak oxygen uptake (peak VO2), Physical Activity Scale in the Elderly (PASE) to assess habitual activity, semi-structured interviews to assess vital status, demographic and descriptive information. Results Of the 196 eligible patients, 144 (75.5%; 74 Hospital, 70 Home) were available for participation. Patients were predominantly male (n=120; 83.3%) aged 70±9.5 years. Clinical and sociodemographic outcomes were similar in both groups. While exercise performance declined over time, there were significant between-group differences in peak VO2 (1506±418 ml/min vs 1393±341 ml/min; p=0.017) and PASE scores (166.7±90.2 vs 139.7±66.5; p=0.001) at 6-year follow-up in favour of the home group. Conclusions Home and hospital-based exercise training maintained exercise capacity above pre-CR levels 6 years after CR. Exercise training initiated in the home environment in low-risk patients undergoing coronary artery bypass graft surgery conferred greater long-term benefit on VO2 and persistent physical activity compared with traditional hospital-based CR. [ABSTRACT FROM AUTHOR]

Several religions, including Hinduism, Judaism, and Islam, prohibit the consumption of swine and bovine products. More than 1000 medications contain inactive ingredients derived from these sources. [ABSTRACT FROM AUTHOR]

The article presents several case studies about the challenges associated with disclosing errors to patient and current practice. These cases involve a pancreas transplant failure, fatal diagnostic error, and an intraoperative cardiac arrest. The second case shows how institutions can overlook the needs of patients and families following errors. It is appropriate for institutions to consider whether involving neutral third parties can make disclosures more patient centered.

Drug information is a specialty area within the realm of clinical pharmacy that has evolved as technology and clinical practice have changed. Drug information specialists are trained individuals who have clinical knowledge and skills that allow them to provide clear, concise, and accurate recommendations regarding drug use. The constant changing culture of drug information and health care in general has prompted the need for continual growth and refinement of the standards that govern drug information practice. This article outlines specific standards to help ensure that the education and practice of drug information will continue to meet the needs of the health care community. This opinion paper is divided into two sections: Education and Training, and Practice Areas. The Education and Training section is organized to describe the role of drug information and that of the drug information specialist in the training of all pharmacy students and advanced trainees, as well as to describe the role of focused training for those individuals wishing to specialize in drug information. This article also affirms the recommendations for the standards-based approach to drug information education and specialty training. The Practice Areas section is organized to describe the role of the drug information specialist within various practice settings, to identify some of the challenges faced by the drug information specialist within those settings, and to provide recommendations for the different practice areas. The areas found within this section include academia, institutional health systems, managed care, industry, medical writing, and informatics. [ABSTRACT FROM AUTHOR]

Implementing energy efficiency measures is widely regarded as a high priority in the search for carbon dioxide emission reductions and can create competitive advantage for industry. Yet, approximately 50% of industry's cost effective energy efficiency measures are never implemented. The lack of implementation of energy efficiency measures results in the energy efficiency gap, which is generally attributed to barriers. Attempts to close the gap are directed at overcoming barriers and leveraging drivers. However, the current view of barriers and drivers may be incomplete due to the under representation of frontline workers' perspectives in research. Frontline workers strongly influence energy use because they make decisions about how and when industrial equipment is operated and maintained. This study compares survey responses from frontline workers and managers to investigate the barriers and drivers to industrial energy efficiency. Analysis of free text responses found perceived barriers and drivers for energy efficiency are different for frontline workers and managers. Differences between frontline workers' and managers' views are less prominent when only responses to Likert-type questions are considered. In response to this, new taxonomies for barriers and drivers were created. It is proposed these new taxonomies will be useful for empirical research as they can incorporate more complete views of frontline workers and managers. Common methods used to overcome barriers may have limited impact on the barriers found in this study. This more complete understanding of barriers and drivers could be useful for industry to characterise their challenges, contribute meaningfully to policy creation and generate new ways to close the energy efficiency gap. The novelty of this research stems from its investigation and presentation of the frontline workers' perspective. Further research into drivers, barriers and data gathering for frontline workers is needed to validate this exploratory study. • Frontline worker perspectives on barrier and drivers are presented. • Barriers and drivers for frontline workers and managers show some differences. • Common methods to overcome barriers may have limited impact on some of the barriers identified. [ABSTRACT FROM AUTHOR]

Objectives: To examine the effects of computerized requests for pharmacist-to-dose (PTD), an advanced clinical decision support tool for dosing guidance, on antimicrobial therapy with vancomycin and aminoglycosides, describe PTD request utilization, and identify factors that may prolong this process. Design: A retrospective review was conducted of patients hospitalized from Jan 2004 to Jun 2006 with suspected pneumonia who received vancomycin, tobramycin, or gentamicin via PTD (study) or routine provider order entry (control). Measurements: The primary endpoint was time to pharmacist completion of PTD request. Secondary data points included medication turn-around times for first doses of vancomycin or aminoglycosides and for first doses of any antibiotic, dose adjustment for renal dysfunction, medication errors, and time of order entry. Multivariate analysis was conducted to identify predictors of total time to pharmacist verification and time to administration of first doses of vancomycin or aminoglycosides. Results: Median time for pharmacist completion of PTD requests was 29 minutes. Delays were noted in the study group (n = 49) by comparison with the control group (n = 48) for median time to first dose of vancomycin or amunoglycoside (185 vs. 138 min, p = 0.45) and for any antibiotic (134 vs. 118 min, p = 0.42), respectively. Fewer medication errors were reported in the study group (5 vs. 18 errors, p = 0.002). In a multivariate model, PTD was not significantly predictive of time to pharmacy verification or medication turn-around time. Conclusions: Pharmacists completed pharmacist-to-dose consultations for dosing guidance of vancomycin and aminoglycosides within a median of 30 minutes. Implementation of a computerized request for clinical pharmacists to provide medication-related clinical decision support increased medication turn-around time of vancomycin and aminoglycosides and reduced medication errors. Consultation of clinical pharmacists by computerized request for initial antibiotic dosing of medications with narrow therapeutic windows is an option for medication-related clinical decision support but providers should be aware that consultation may delay medication turn-around time. [ABSTRACT FROM AUTHOR]

The article examines the significance of biomedical literature in the future of medical researches and patient care. It notes that past researches may give an overview and resources in developing a study design, thus, perfecting a study. It states that reviewing the research literature could help in the research methodology such as the proper determination of variables, sample size, and length of the study. It suggests that researchers should review past biomedical literature.

The article examines the association between colleges of pharmacy and academic medical centers which focuses on clinical service, experiential education in ambulatory care, research, and sharing of expenses. It states that a 22-question survey was deviced to arrive at the relationship of pharmacy colleges and academic medical centers, experiential education, and pharmacist and resident roles in education. Further discussions of the findings and conclusions are also provided.

Purpose. A case of angioedema caused by bupropion used for smoking cessation is discussed. Summary. A 33-year-old man with a 12-pack-year of smoking history developed a rash on his extremities 18 days after the initiation of bupropion, followed by pruritus and swelling of the arms, feet, lower lip, and tongue by day 20. Progression subsided after treatment with intravenous histamine antagonists and corticosteroids and required two emergency department visits. On day 22, the patient took his morning dose of bupropion as scheduled, which resulted in his symptoms returning. He discontinued bupropion on his own. The recommendation to discontinue the drug was not made or documented by the treating clinician. By day 23, the diarrhea had subsided, the next day his swelling disappeared, and by day 25, the pruritus had ceased. Cases of angioedema, a rare adverse effect of bupropion, have not been extensively described in previous literature. The reaction is linked to medications in 90% of all cases. Nonpitting edema typically affects the head and neck and may progress to respiratory failure. Failure to remove the causative agent may increase patient risk and result in increased health care costs, both of which occurred in this case. According to the Naranjo et al. probability scale, bupropion was deemed a definitive causative agent for this adverse reaction. Conclusion. A 33-year-old man developed angioedema during treatment with bupropion for smoking cessation. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 46-year-old- man who was taken to the hospital because of blue-gray discoloration of his skin. He has neurogenic bladder, multiple sequences of urinary tract infection, and long-term use of existing urinary catherer. His discoloration was assigned to argyria in connection to his normal oxygen level, history of silver ingestion, and denial of exposure to other metals that can discolor skin. Thus, skin biopsy or serum silver assay is required.

Purpose. The pharmacokinetics, benefits, risks, and future of transdermal drug products are reviewed. Summary. Transdermal drug delivery capitalizes on an attractive route of drug delivery, as it avoids the need for painful i.v. drug administration, i.v. site access, and syringe disposal and is an option for drug delivery to patients who are unable to swallow oral medications. Specific transdermal drug designs have advantages and disadvantages, including the ability to alter the patch size or readily manipulate the products. Transdermal drug delivery systems currently available include drug reservoir and microreservoir membranemodulated systems, drug-in-adhesive layer designs, and matrix patches. Maximizing patient response to transdermal drug formulations may also rely on a number of other practical concerns, including patient dexterity, dose reproducibility, storage and stability of the remaining portion, and decreased adhesive efficacy. Adhesives in transdermal precuts may be locally irritating, and prolonged use and high dosages have resulted in dermatological reactions to some patches. Patients may also develop contact sensitization or systemic sensitization to the transdermal formulation itself. When a transdermal product regimen is initiated, caregivers should be mindful of the product's primary features and educate patients accordingly, specifically addressing where and how to apply the patch, duration of patch use, and procedures for properly changing and storing patches. Conclusion. The increasing complexity of transdermal drug products, the growing number of medications available in such dosage forms, and reports of potential safety concerns contribute to the need for clinicians to understand the principles of transdermal drug delivery, safe usage techniques, and proper patient counseling points. [ABSTRACT FROM AUTHOR]

Constipation is one of the most common gastrointestinal symptoms that orthopedic patients may experience during the recovery phase. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) discomfort is a common complaint among patients infected with HIV. GI symptoms can be caused by a myriad of factors including but not limited to coinfections, antiretroviral therapy, medications for opportunistic infections, and nutritional status. Some researchers have hypothesized that Helicobacter pylori infection may be more common among HIV-infected patients as a result of immune suppression. An increased incidence of H. pylori infection would contribute to the prevalence of GI complaints in this population. Several epidemiologic studies have examined the relationship between H. pylori infection and HIV. While studies have generally reported conflicting results that may be related to the use of varied study designs, some identifiable patterns can be discerned. It does appear that the incidence of H. pylori infection is lower among patients with AIDS compared to matched HIV-infected and -uninfected controls. This review discusses the various epidemiologic trials that have been conducted in this area and describes the potential physiologic mechanisms to explain these findings. The clinical applicability of these studies as well as limitations are also discussed. A greater number of well-designed and controlled trials are needed before any definitive conclusions regarding these diseases can be made, until such time clinicians should be aware of the potential issues regarding H. pylori screening and management in the context of HIV. Research in this area might also provide information relating to HIV-associated GI changes and the role of these changes in HIV pathogenesis. [ABSTRACT FROM AUTHOR]

Drug allergies are specific to characteristics of the medication's chemical structure. [ABSTRACT FROM AUTHOR]

The article discusses the career path and the opportunities available to the public health pharmacist in the U.S. In 2006, pharmacists are in demand locally and abroad to provide services to individuals, small groups and institutional systems. In 2003, President George W. Bush has created the Emergency Plan for Relief initiative which focuses on the development of health care programs in 15 countries such as Haiti, Kenya, Ethiopia which gave job opportunities for at least 2 years.

This article details several common pharmacological entities, as well as new procedural sedation and analgesia agents and methods currently in use. [ABSTRACT FROM AUTHOR]

Hospitalized orthopedic patients commonly require management of chronic disease states, one of which is alcohol withdrawal syndrome. This article is the second in a two-part series reviewing alcohol withdrawal in the hospitalized patient. Part one appeared in the May 2007 issue of Orthopedics. [ABSTRACT FROM AUTHOR]

The article reports on the epidemiology and clinical management of methamphetamine abuse (MA)treatments. It provides a review of the historical precursor of the chemical substance and evidences of the widespread abuse of the it among children and adults in the U.S. and the world. The social implications of MA abuse and its significance in the long-term intervention treatment are discussed.

Supplemental glucocorticoid therapy is a topic widely debated in the medical field. Patients present with various signs, symptoms and etiologies making diagnosis of the condition elusive. There is wide inter-patient variability in cortisol response during stress so defining normal response concentrations of cortisol is difficult. Deficiency of cortisol in acutely ill patients increases the potential of morbidity and mortality. Despite the conflicting evidence, if cortisol deficiency is identified, supplemental treatment with glucocorticoids is advocated. One aspect agreed on by all is the need for continued investigations in the requirement of supplemental glucocorticoids. [ABSTRACT FROM AUTHOR]

Information stored on the Internet is not organized, monitored, or structured. Imparting the skills necessary to retrieve information from the Internet to trainees and novice health care professionals can therefore be challenging. A drug information webography and push notification process of featured Web site content were created by a drug information center to identify Web sites of interest to pharmacy practitioners, maintain a current listing of Web sites with medication-related information, and develop pharmacy students' abilities to formally assess Web site quality. Students evaluate Web site content for potential applications to pharmacy practice, as well as navigability and quality, utilizing a structured approach. Narrative commentaries are then prepared, and features of each site are formally demonstrated. A single Web site is then featured on the center's Web site each week, with subsequent integration into a drug information webography. An announcement of each week's posting is made via push notification service. The webography is utilized by students and practitioners alike to locate drug information efficiently on the Internet. [ABSTRACT FROM AUTHOR]

Purpose. Medication and nutrient administration considerations after bariatric surgery are discussed. Summary. Bariatric surgery is categorized by surgical technique (i.e., restrictive procedure or a combination of restrictive and malabsorptive procedures). Roux-en-Y gastric bypass is the most frequently performed bariatric surgery in the United States. Patients who have undergone this surgery are at risk for nutrient deficiencies. Several factors, such as pH and absorption sites, should be considered when providing these patients with appropriate supplementation. Drug solubility and surface area for absorption are also affected by gastric bypass procedures. By bypassing major portions of the small intestine, Roux-en-Y procedures drastically reduce the surface area for absorption. These changes may warrant manipulation in drug route or dose to ensure adequate delivery. Drugs with long absorptive phases that remain in the intestine for extended periods are likely to exhibit decreased bioavailability in these patients. The reduced size of the stomach after surgery can place patients at risk for adverse events associated with some medications. Medications implicated in such adverse events include nonsteroidal antiinflammatory drugs, salicylates, and oral bisphosphonates. Drugs that are rapidly and primarily absorbed in the stomach or duodenum are likely to exhibit decreased absorption in patients who have had combination restrictive-malabsorptive procedures. Because reduced drug absorption may result in decreased efficacy rather than toxicity, increased patient monitoring for therapeutic effects can help detect potential absorption problems. Conclusion. Selection of appropriate nutrient salts can improve nutrient replacement in patients who have undergone bariatric surgery. Changes in dosage forms based on drug characteristics can improve bioavailability. [ABSTRACT FROM AUTHOR]

Methamphetamine is a highly potent and addictive drug that is abused in the United States and around the world. The drug is inexpensive and easily manufactured from simple chemicals such as pseudoephedrine. These features, coupled with its long half-life and highly addictive nature, contribute to the increasing problem of illicit methamphetamine use. Abuse of this agent has both acute and chronic serious health consequences. Policy makers and public health officials must continue to develop programs that educate the public and limit the abuse associated with methamphetamine. [ABSTRACT FROM AUTHOR]

Several options to reduce perioperative blood loss have been studied, with varying degrees of efficacy ascertained. This article is part one in a two-part series reviewing prophylaxis options to minimize perioperative blood loss. [ABSTRACT FROM AUTHOR]

Describes the use of polymethylmethacrylate (PMMA) antibiotic beads in the treatment of osteomyelitis. Key functions of PMMA antibiotic beads in the treatment of osteomyelitis; Advantages; Commercial formulations of PMMA beads; Result of clinical trials with PMMA antibiotic beads; Adverse effects of using polylactic acid following orthopedic procedures.

Discusses pharmacokinetic characteristics, animal models, clinical studies and observations for various antimicrobial agents. Types of formulations available for vancomycin; Efficacy of clindamycin in the treatment of methicillin-resistant Staphylococcus aureus osteomyelitis in a rabbit model; Results of a clinical trial involving linezolid treated patients with osteomyelitis.

The article focuses on the U.S. Food and Drug Administration's (FDA) reliance on voluntarily submitted adverse drug reaction (ADR) reports to assist in identifying postmarketing drug safety issues. MedWatch, the safety information and adverse-event reporting program of the FDA, receives 200,000 to 300,000 reports of suspected ADR annually.

Online reporting systems for adverse drug reaction (ADR) and medication error (ME) reporting were developed at the University of Kentucky Chandler Medical Center. Collaboration between Pharmacy Services, Information Services, and the Drug Information Center resulted in the creation of two stand-alone systems that input data directly into centrally-stored databases. Web forms were designed using Web-authoring tools, as well as javascript and server-side scripting. Medication error reporting incorporated an E-mail notification process for hospital personnel based upon patient location, medical service, and severity of the error. Adverse drug reaction reporting increased initially following implementation, but leveled out soon thereafter. Conversely, ME reporting greatly increased, and also captured a greater number of type AMEs (eg, situations with a capacity for error). A number of system changes and patient safety initiatives have been implemented in response to data obtained from the reporting systems. Internally developed systems have supported customized forms that meet the institution's reporting needs and support a safer patient care environment. [ABSTRACT FROM AUTHOR]

Presents several dietary supplements and selected foods reported to interact with anticoagulant warfarin. Chinese wolfberry; Ginseng; Soy milk.

1alpha,25-dihydroxycholecalciferol [1alpha,25(OH)2D3], the active form of cholecalciferol, is a negative growth regulator of breast cancer cells. CYP27B1 is a cytochrome P450-containing hydroxylase expressed in kidney and other tissues that generates 1alpha,25(OH)2D3 from an inactive vitamin D precursor 25-hydroxycholecalciferol [25(OH)D3]. In these studies, we tested the hypothesis that mammary cells express CYP27B1 and locally produce 1alpha,25(OH)2D3, which acts in an autocrine manner to regulate cell turnover. Using Western blot and quantitative real-time PCR, CYP27B1 mRNA and protein were detected in immortalized, nontumorigenic human mammary epithelial cell (HMEC) cultures. Furthermore, HMEC cultures were dose dependently growth inhibited by physiological concentrations of 25(OH)D3, suggesting that CYP27B1 converts this precursor cholecalciferol metabolite to 1alpha,25(OH)2D3, the ligand for the vitamin D receptor (VDR). In support of this suggestion, both 1alpha,25(OH)2D3 and 25(OH)D3 transactivated VDR in HMEC cultures, as measured by induction of a vitamin D responsive reporter gene and upregulation of CYP24, an endogenous VDR target gene. No induction of CYP24 by 25(OH)D3 was observed in mammary cells derived from CYP27B1 null mice. Similar results were observed in 2 independently derived immortalized HMEC lines as well as in primary cultures derived from human breast epithelium. These are the first studies to demonstrate that nontransformed human mammary cells express CYP27B1, that they are growth inhibited by physiologically relevant concentrations of 25(OH)D3, and that they provide a biological mechanism linking vitamin D status to breast cancer risk. [ABSTRACT FROM AUTHOR]

While patient-controlled analgesia and intermittent intravenous opioids are primarily used for pain control, transdermal drug delivery is a possible adjuvant treatment. [ABSTRACT FROM AUTHOR]

To determine financial and professional benefits to examinees for Board of Pharmaceutical Specialties (BPS) certification, a web-based survey was developed and sent to all 84 US colleges of pharmacy. Numbers of pharmacy practice faculty and board certified faculty were obtained independently from the American Association of Colleges of Pharmacy Roster and the BPS website. Twenty-six surveys were returned. The proportion of BPS-certified faculty was not statistically significantly related to reimbursement of certification-related expenses. The proportion of BPS-certified faculty was statistically significantly related to increases in salary, but not other recognition factors. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: [ABSTRACT FROM PUBLISHER]

This article is part one in a two-part series addressing risk factors for and management of drug-induced torsade de pointes, a potentially fatal arrhythmia that can result from severe QT-interval prolongation. [ABSTRACT FROM AUTHOR]

Reports that the American Society of Health-System Pharmacists standard for accreditation of pharmacy residencies has required each residency program director to establish an evaluation process to monitor program effectiveness in the U.S. Assessment of the effectiveness of the residency programs; Collection of data that would describe recent pharmacy resident graduates' career paths and experiences with residency training programs; Number of individuals who have completed their residency training.

Focuses on the abuse of methyenedioxymethamphetamine, flunitrazepam, ketamine hydrochloride and gama hydroxybutyrate. Definition of club drugs; Side effects of club drugs.

The article highlights how the curriculum vitae (CV) transforms while the new practitioner's career starts. Topics discussed include observations on the addition of CV builder activities which are weighed against other activities listed on the student CV, education and training as the initial part of a CV for many new practitioners and those into their careers and the licensure and certification section requiring minor revision for most new practitioners depending on original contents.