Allison R. King

Evaluation and implications of natural product use in preoperative patients: a retrospective review

BackgroundMedication Reconciliation and Medication Safety are two themes emphasized in a variety of healthcare organizations. As a result, health care facilities have established methods for obtaining a patients medication history. However, these methods may vary among institutions or even among the health care professionals in a single institution, and studies have shown that patients are reluctant to disclose their complementary and alternative medicine use to any health care professional. This lack of disclosure is important in surgical patients because of potential herbal interactions with medications and drugs used during the surgical procedure; and the potential for adverse reactions including effects on coagulation, blood pressure, sedation, electrolytes or diuresis. Therefore, the objectives of this study are to identify patterns of natural product use, to identify potential complications among patients scheduled for surgery, to improve existing medication reconciliation efforts, and to develop discontinuation guidelines for the use of these products prior to surgery.MethodsA retrospective review of surgery patients presenting to the Anesthesia Preoperative Evaluation Clinic (APEC) at the University of Kansas Hospital was conducted to identify the prevalence of natural product use. The following data was collected: patient age; gender; allergy information; date of medication history; number of days prior to surgery; source of medication history; credentials of person obtaining the history; number and name of prescription medications, over-the-counter medications and natural products; and natural product dosage. Following the collection of data and analysis of the most common natural products used, possible complications and interactions were identified, and a protocol regarding the pre-operative use of natural products was developed and implemented.ResultsApproximately one-fourth of patients seen in the APEC indicated the use of natural products. Patients taking natural products were significantly older, were more likely to undergo cardiac or chest surgery, and were more likely to be taking more prescription and non-prescription medications (all p < 0.001).ConclusionBased on the results of this study, it is concluded that there is a need for established guidelines regarding discontinuation of selected natural products prior to surgery and further education is needed concerning the perioperative implications of natural products.

Administration of antiretroviral medication via enteral tubes

PURPOSE Case reports and other published or manufacturer-provided data on the administration of antiretroviral agents through enteral feeding tubes are reviewed. SUMMARY There is very limited published evidence to guide clinicians in the delivery of therapies for human immunodeficiency virus (HIV) infection by feeding tubes, especially crushed tablets and capsule contents. A search of the primary literature (through February 2012) identified a total of nine articles describing the delivery of highly active antiretroviral therapy (HAART) agents via gastrostomy (G), jejunostomy, and other feeding tubes; correspondence with pharmaceutical manufacturers yielded additional information. Most of the published evidence (from two prospective studies, one retrospective study, and six case reports) pertains to the treatment of HIV-infected children (33 of 40 cases). Although not a primary endpoint of any of the reviewed studies, viral suppression was documented in 29 of the 40 patients referenced in the reviewed articles. Manufacturer-provided information indicates that crushed darunavir tablets in suspension, as well as oral solutions of ritonavir and lopinavir-ritonavir, can be administered through G-tubes without significant loss of therapeutic efficacy. CONCLUSION Data regarding enteral feeding tube administration are available for 63% of commercially available oral HAART agents and are primarily limited to case reports specific to the pediatric population.

Writing a review article

![Figure][1] Professional writing can be a daunting task for a pharmacy practitioner. Finding the time to write an article for the pharmacy literature can be nearly impossible, but professional writing has many rewards. Not only is it a way to share ideas with colleagues across the nation—

The Pharmacy Practitioner’s Guide to Publishing

Purpose The purpose of this article is to encourage the pharmacy practitioner to submit scholarly work for publication by providing a guide to the process. As practitioners, pharmacists understand the importance of research and the dissemination of information. Although pharmacists are encouraged to do research, many are overwhelmed by the task. This article highlights the steps in the publication process and provides tips to encourage pharmacists to conduct research and publish their findings. Summary The first step in authoring is deciding on a subject matter that is worthy of publication. Many practitioners believe that placebo-controlled trials are the only worthy endeavors; however, other forms such as case reports and editorials are also essential. Inclusion of researchers with different professional backgrounds will provide a diverse team with vast perspectives. Once the project is identified and team assembled, institutional review board approval should be sought if the project includes human subjects. The target audience should be identified prior to the composition of the publication to allow for identification of the appropriate publication form. Manuscript preparation should be complete, concise, and informative. Special attention should be paid to the editing process. After submission to the particular venue, the peer-review process begins. After final publication, authors must decide the timeframe for updating the work. Conclusion Professional writing is a time-consuming and challenging activity, but it is essential to the advancement of science, the profession, and patient care. This guide hopes to encourage pharmacists to conduct research projects and publish the information regardless of whether it is a case report, a review article, a poster, or a placebo-controlled trial.

Editorial - Avoiding Plagiarism

What do Vice President Joe Biden, scientists James Watson and Francis Crick, filmmaker James Cameron, The Beatles guitarist George Harrison, and author H.G. Wells have in common? All have been associated with plagiarism: Biden for a 1988 presidential campaign speech, Watson and Crick for deoxyribonucleic acid (DNA) double helix structure, Cameron for his 1984 film The Terminator, Harrison for the 1970 song melody of My Sweet Lord, and Wells for his 1920 book Outline of History. Each were accused of misrepresenting someone else’s work as their own. According to the Oxford Dictionary, plagiarism is ‘‘the practice of taking someone else’s work or ideas and passing them off as one’s own.’’ Plagiarism can range from ‘‘the unreferenced use of others’ published and unpublished ideas including, research grant applications to submission under ‘new’ authorship of a complete paper, sometimes in a different language’’ delivered in all publication venues and at any stage of the research process, according to the 2000 article by the Committee on Publication Ethics. The American Medical Association (AMA) goes on to state that plagiarism ‘‘violates standards of honesty and collegial trust.’’ Plagiarism offenses equally affect all disciplines. Most, if not all, universities have policies on plagiarism, with consequences ranging from grade deduction to expulsion for students and disciplinary action to termination for faculty/staff. Professionally, most disciplines maintain an oath to uphold the standards and ethics of their respective profession. The oath of a pharmacist explicitly states that pharmacists ‘‘will maintain the highest principles of our professions’ moral, ethical, and legal conduct,’’ which, when extrapolated, should apply to all aspects of professional life, including clinical practice, management, education, and research. A 2009 study among undergraduate and postgraduate pharmacy students in Sydney, Australia, found ‘‘a widespread deficiency in students’ understanding of plagiarism,’’ thus raising concern as more pharmacists become involved in research and publishing. The purpose of this editorial is to describe ways in which plagiarism can occur and methods to avoid such occurrences.

Special Feature - Gluten Content of the Top 200 Medications of 2009: A Follow-Up to the Influence of Gluten on Patient’s Medication Choices

Patients with celiac sprue disease are recommendedtoadhere toagluten-freedietas ingestion of gluten will initiate an immune response, possibly damaging or destroying villi in the small intestine. Loss of small intestine villi will subsequently lead to malnutrition. More than 90% of patients with celiac sprue will respond to complete dietary gluten restriction; however, patient adherence to a gluten-free diet is estimated to range from extremely poor to satisfactory. Patients with celiac sprue disease must also be cognoscente of gluten in sources other than foods, such as medications. Available resources for patients and health care professionals include the Celiac Disease Foundation (www.celiac.org)andCeliacSprueAssociation/USAInc. (www.csaceliacs.org); however, neither provides medication-specific information. Glutenfreedrugs.com, a Web site maintained by a clinical pharmacist, and previous articles published by Hospital Pharmacy contain medication-specific gluten information. The most recent articles published in Hospital Pharmacy include ‘‘The Influence of Gluten on Patient’s Medication Choices’’ (November 2010) and ‘‘Gluten Content of the Top 200 Medications of 2008: A Follow-Up to the Impact of Celiac Sprue on Patient’s Medication Choices’’ (November 2009). As a follow-up to these articles, Table 1 provides an updated list of the gluten content of the top 200 drugs by retail dollars and the top 200 drugs by total prescriptions, as published by Pharmacy Times in May 2009. The list was compiled by contacting manufacturers of the respective agents in September 2010 and asking if the [specific] drug was considered to be gluten-free. Manufacturer phone numbers were obtained from the Red Book. Only answers of ‘‘yes’’ or ‘‘no’’ were accepted, and all ‘‘yes’’ answers required written documentation. Companies that declined to participate were recorded as ‘‘no’’ answers. Table 1 summarizes the information found from the manufacturers and will be a good starting place for practitioners when searching for a gluten-free medication; however, it is essential to double check with the manufacturer regarding specific products as inactive ingredients and manufacturing processes can change. The University of Kansas Drug Information Center is available to answer both patient and health care professional questions regarding the gluten content of medications (druginfo@kumc.edu).