CONSULTANT PHARMACIST最新文献

{"title":"Balanitis: A Unique Presentation of Diabetes in an Elderly Male.","authors":"Diana Fischer,&nbsp;Patricia L Orlando,&nbsp;Laura Shane-McWhorter","doi":"10.4140/TCP.n.2017.740","DOIUrl":"https://doi.org/10.4140/TCP.n.2017.740","url":null,"abstract":"<p><p>While diabetes is a common medical condition, the initial presentation of patients with diabetes may vary. In some cases, different types of infections or inflammatory conditions may prompt a patient to seek medical attention. Males may present to their primary care provider with a bothersome inflammation of the penis that may be the first recognition of previously undiagnosed diabetes. Balanitis is an inflammation of the glans of the penis that may prompt a patient to seek medical care. While there are several different causes of balanitis, underlying medical conditions such as uncontrolled diabetes have been associated with balanitis. The genital irritation prompts patients to seek medical evaluation, and at that point diabetes is diagnosed. It is important for pharmacists to recognize that balanitis is a potential though uncommon type of diabetes presentation. It is also important for pharmacists to review other aspects of diabetes care once a patient is diagnosed with diabetes.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2017.740","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35850500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Two Versions of the Beers Criteria and Adverse Outcomes in Older Hospitalized Patients.","authors":"Stephanie M Ozalas,&nbsp;Victoria Huang,&nbsp;Luigi Brunetti,&nbsp;Timothy Reilly","doi":"10.4140/TCP.n.2017.752","DOIUrl":"https://doi.org/10.4140/TCP.n.2017.752","url":null,"abstract":"<p><strong>Objective: </strong>To compare the performance of the 2003 and 2012 Beers criteria (BC) to predict negative clinical outcomes associated with potentially inappropriate medications in hospitalized older adults.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Acute Care of Elders (ACE) unit in a community-based teaching hospital.</p><p><strong>Participants: </strong>All patients admitted to an ACE unit who were older than 65 years of age and prescribed at least one medication upon hospital admission.</p><p><strong>Main outcome measure(s): </strong>The primary outcome was hospital length of stay (LOS). Secondary outcomes included likelihood of experiencing adverse drug events (ADEs) and in-hospital mortality.</p><p><strong>Results: </strong>A total of 340 patients were included in this study. Inpatients prescribed a BC drug at any time had a longer hospital LOS than those not prescribed a BC drug (2003 BC: adjusted geometric mean, 5.93 vs. 5.50 days, P = 0.003; 2012 BC: adjusted geometric mean, 5.87 vs. 4.21 days, P < 0.001). Patients prescribed a 2003 BC drug had an increased risk of experiencing an ADE compared with those not prescribed a BC drug (odds ratio [OR] = 1.86, 95% confidence interval [CI] 1.11-3.11); however, this outcome was not statistically significant after adjusting for confounders (OR = 1.51, 95% CI 0.870-2.63). There was no statistically significant difference in ADEs when using the 2012 BC (adjusted OR = 1.27, 95% CI 0.689-2.33). There was no difference in hospital mortality regardless of the BC version used.</p><p><strong>Conclusion: </strong>Prescription of BC drugs in an acute care setting is associated with an increased hospital LOS; however, there is no difference in the risk of ADEs or in-hospital mortality.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2017.752","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35850502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congress Quiet on Long-Term Care, but Agencies Continue to Work.","authors":"Paul Baldwin","doi":"10.4140/TCP.n.2017.772","DOIUrl":"https://doi.org/10.4140/TCP.n.2017.772","url":null,"abstract":"","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2017.772","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35850504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Brief Review of Caprylidene (Axona) and Coconut Oil as Alternative Fuels in the Fight Against Alzheimer's Disease.","authors":"Monica Chintapenta,&nbsp;Justin Spence,&nbsp;Hyanggi Irene Kwon,&nbsp;Amie Taggart Blaszczyk","doi":"10.4140/TCP.n.2017.748","DOIUrl":"https://doi.org/10.4140/TCP.n.2017.748","url":null,"abstract":"<p><p>Type 3 diabetes mellitus has been coined to describe an alternative pathologic pathway of Alzheimer's disease (AD). The insulin resistance and impaired insulin signaling seen on positron-emission tomography scans in the brain of those affected by AD support this disease hypothesis. Two products-the medical food caprylidene (Axona) and coconut oil-seek to target the underlying pathology of type 3 diabetes mellitus by providing an alternative fuel source in the brain. Rather than improving glucose utilization, these two products seek to supply ketone bodies in sufficient quantities to pass through the blood-brain barrier and provide an alternative energy source to glucose. This review will provide an overview of the research behind these two modalities, as well as information necessary to ensure the safe use of these supplements.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2017.748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35850501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to Reset and Recharge.","authors":"H Edward Davidson","doi":"10.4140/TCP.n.2017.714","DOIUrl":"https://doi.org/10.4140/TCP.n.2017.714","url":null,"abstract":"","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2017.714","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35850497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Refusal: Resident Rights, Administration Dilemma.","authors":"Danielle R Haskins,&nbsp;Jeannette Y Wick","doi":"10.4140/TCP.n.2017.728","DOIUrl":"https://doi.org/10.4140/TCP.n.2017.728","url":null,"abstract":"<p><p>Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2017.728","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35850499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determination of Anticholinergic Medication Use in Patients Prescribed Medications for the Treatment of Dementia.","authors":"Brooke Ellard,&nbsp;John A Galdo","doi":"10.4140/TCP.n.2017.764","DOIUrl":"https://doi.org/10.4140/TCP.n.2017.764","url":null,"abstract":"<p><strong>Objective: </strong>The primary endpoint of the study is to determine the variations in the use of medications to treat dementia in patients concomitantly or not prescribed anticholinergics.</p><p><strong>Design: </strong>The study is a case series of patients at a single community pharmacy over one year based on prescription claims data.</p><p><strong>Setting: </strong>The setting is an independent community pharmacy in the South.</p><p><strong>Main outcome measure(s): </strong>The main outcome is the variations associated in treatment plans for patients either receiving anticholinergics or not receiving medications with anticholinergic properties.</p><p><strong>Results: </strong>The community pharmacy had 33 patients on medications to treat dementia, and 17 patients (51.5%) were prescribed anticholinergic medications. Only patients on anticholinergic medications were prescribed memantine immediate-release. Fifteen patients (93%) not prescribed anticholinergic medications were on a single medication to treat dementia, whereas 9 patients (52%) prescribed anticholinergic medications were on a single medication to treat dementia.</p><p><strong>Conclusion: </strong>Further research should be conducted in this area to better ascertain the impact anticholinergic medications have on patients. This study noted differences from previous data regarding the prevalence of concomitant prescribing of medications for the treatment of dementia and anticholinergics.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2017.764","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35850503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacy Diabetes Management of a Veteran Population in a Long-Term Care Setting: A Program Evaluation.","authors":"Forest Hansen,&nbsp;Hilary Teeples,&nbsp;Jordan Csati,&nbsp;Suzanne M Gillespie","doi":"10.4140/TCP.n.2017.676","DOIUrl":"https://doi.org/10.4140/TCP.n.2017.676","url":null,"abstract":"<p><strong>Background: </strong>The benefits of an outpatient pharmacy diabetes clinic has been established, with improved patient outcomes and reduced total costs of care. We describe the benefits of an inpatient clinical pharmacy diabetes service within a Department of Veterans Affairs long-term care facility.</p><p><strong>Methods: </strong>Patients were referred to the pharmacy diabetes monitoring program between February 2016 and August 2016. During this time, clinical pharmacy specialists managed all pharmacotherapy relating to diabetes care as well as all fingerstick monitoring frequencies and laboratory monitoring to achieve a prespecified, patient-specific A1C goal. The primary endpoints were optimization of blood glucose fingerstick monitoring frequency and cessation of sliding-scale insulin. Secondary end points were achievement of A1C goal, reduction of hypoglycemic/hyperglycemic events, and reduction of total insulin injections per day.</p><p><strong>Results: </strong>At the time of discharge or end of the observation period, fingerstick frequency had been reduced by a mean of 7.7 fingersticks/patient/week (35.6% total reduction, median 17.5; interquartile range [IQR] 5.5-21; P = 0.002). All eight patients initially prescribed sliding-scale insulin upon referral had their sliding scale stopped by the end of observation. Total injections per day had been reduced from baseline with a mean reduction of 0.55 injections/patient/day (16.5% total reduction; P < 0.05). A1C also showed improvement from baseline, though this was not statistically significant (median 7.75%, IQR 6.8-8.3; P = 0.1). Total hyperglycemic events were reduced from 36 prior to enrollment to 23 post-observation period, while hypoglycemic events decreased from 8 before enrollment to 4 post-observation period.</p><p><strong>Conclusion: </strong>Type 2 diabetes mellitus patients managed by clinical pharmacy specialists at a Veterans Affairs long-term care facility significantly decreased weekly fingerstick blood monitoring frequency, number of insulin injections per day, and ceased sliding-scale insulin use. A1C and hypoglycemic and hyperglycemic events remained stable. Our results are limited because of a small sample size.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2017.676","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35531787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton-Pump Inhibitors and Risk of Dementia.","authors":"Rebekah Lynn Ford,&nbsp;Keith A Swanson","doi":"10.4140/TCP.n.2017.682","DOIUrl":"https://doi.org/10.4140/TCP.n.2017.682","url":null,"abstract":"<p><p>Chronic use of a proton-pump inhibitor (PPI) has been associated with a number of unexpected negative outcomes. The most recent revision of the American Geriatrics Society Beers criteria recommends avoiding using longer than eight weeks unless the patient is at high risk. However, this recommendation is often overlooked in the long-term care setting. Recent literature suggests a link between chronic PPI use and increased risk of dementia. A hypothesized mechanism for the relationship between PPI use and dementia has been supported by cellular and animal models. Because of lack of disease-modifying medications for dementia, prevention strategies are essential. The purpose of this article is to compile and summarize information from published research and clinical trials, allowing readers to draw individual conclusions that could potentially lead to a change in recommendations for acid-lowering therapies in an older population.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2017.682","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35531788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technology Moves Senior Care Pharmacy into the Future.","authors":"Joanne Kaldy","doi":"10.4140/TCP.n.2017.662","DOIUrl":"https://doi.org/10.4140/TCP.n.2017.662","url":null,"abstract":"<p><p>Technology continues to evolve, and pharmacists need to be part of this evolution where goals are reducing readmissions and related costs, improving outcomes, and enabling elders to stay in their homes longer. Increasingly, it's not enough to know about computerized prescription order-entry and electronic medical records. It's important to understand technologies that connect organizations and individuals, as well as those that patients and families are using to enhance safety and quality of life. This requires using effective technology for capturing and sharing information with clinicians and others as well as understanding what consumer-oriented technology can help improve medication adherence and keep people out of the hospital and in their homes.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2017.662","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35531785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}