Amy F. Wilson

Readability of Consumer Health Information on the Internet: A Comparison of U.S. Government–Funded and Commercially Funded Websites

The Internet has become an extremely prevalent means of communicating health information to consumers. Guidelines for selecting reliable health information websites give preference to U.S. government sites over commercially funded sites. However, these websites are not useful to consumers unless they are able to read and understand them. The authors’ objective was to compare the readability of Internet health information intended for consumers found on U.S. government–funded websites versus that found on commercially funded websites. Consumer health websites were identified through a systematic Internet search. Webpages for 10 common health topics were extracted from each website. Readability of webpages was determined by 3 validated measures: Flesch Reading Ease, Flesch-Kincaid Reading Level, and SMOG Formula. Mean readability of government-funded and commercially funded websites was compared using the Mann-Whitney U test. Commercially funded websites were significantly more difficult to read as measured by Flesch Reading Ease (49.7 vs. 55.6 for government-funded sites, p = .002) and Flesch-Kincaid Reading Level (10.1 vs. 9.3, p = .012). There was no significant difference according to SMOG Formula (12.8 vs. 13.2, p = .150). The overall readability of Internet health information intended for consumers was poor. Efforts should be made to ensure that health information communicated via the Internet is easy for consumers to read and understand.

Clinical pharmacokinetics of antiplatelet agents used in the secondary prevention of stroke

Stroke is one of the leading causes of death and debilitation. Several million stroke survivors are alive throughout the world today. Prevention of recurrent stroke is of major importance to stroke survivors. Several pharmacological agents are currently available for use in secondary stroke prevention.Clopidogrel, the combination of immediate-release aspirin and extendedrelease dipyridamole and aspirin alone are the most widely recommended agents for use in the secondary prevention of strokes. Clopidogrel has shown superiority over aspirin in the combined endpoints of stroke, death and myocardial infarction. The immediate-release aspirin/extended-release dipyridamole combination has shown superiority to aspirin alone in the secondary prevention of stroke.Dipyridamole has been studied as an antiplatelet agent for several decades. Early trials to prove its efficacy compared with aspirin were not favourable, and patients often experienced many adverse effects. Researchers began developing an extended-release formulation in an effort to maintain therapeutic blood concentrations with less frequent daily administration and better adverse effect profile. Pharmacokinetic analysis of this new product showed it to have a more consistent and reproducible absorption compared with immediate-release dipyridamole. The rate of absorption of extended-release dipyridamole is considerably slower than that of immediate-release dipyridamole, while similar plasma concentrations are maintained to optimise antiplatelet efficacy. This allows extended-release dipyridamole to be administered twice daily rather than four times daily.A large-scale randomised trial was conducted with extended-release dipyridamole 200mg in combination with immediate-release aspirin 25mg given twice daily. The combination product showed a greater efficacy at preventing a recurring stroke then either agent administered alone. Indirect comparisons with clopidogrel show that the combination of immediate-release aspirin/extendedrelease dipyridamole may be more effective than clopidogrel at preventing a recurring stroke.

Personal Digital Assistant (PDA) Clinical Intervention Documentation System: Development, Implementation, and Comparison to a Previous Paper-Based System

Purpose In preparation for the complete decentralization of pharmacists at our institution, we were asked to create a user-friendly intervention program the pharmacists could use on the patient floors. Summary The current system was cumbersome; the paper-based system made it hard to retrieve meaningful data and many interventions were not being captured. We felt that personal digital assistants (PDAs), with a tailored intervention program developed with Pendragon forms, would best meet our needs. A form was developed and modified based on the feedback of specific staff. After staff training, the program was implemented in June 2002. In an attempt to simplify the program, more forms were added and current forms were streamlined also based on staff feedback. The program is bridged with a Microsoft Access database and reports generated from this database provide essential information for administration to justify current positions, as well as, new positions. A literature search was performed and evaluated to determine our cost avoidance data (based on published cost avoidance associated with clinical pharmacy interventions). Institution-specific ingredient costs were used for cost savings data. Based on pre-PDA data, the number of interventions increased from an average of 112/mo to 361/mo (322% increase). An increase in the number of accepted interventions was also noted. The total cost savings and avoidance by pharmacists for the 21-month period assessed was

A Review of Clinical Pharmacy Interventions Prior to Implementation of a Personal Digital Assistant Intervention Program in a Community Hospital

1,827,286: intervention total cost savings and avoidance of

Gastrointestinal Bleeds Associated with Rofecoxib

1,580,593 and drug information cost avoidance of

Survey and Systematic Literature Review of Probiotics Stocked in Academic Medical Centers within the United States

246,693. Conclusion This program has increased the documentation of clinical pharmacy services at our institution, while reaping the additional benefit of transferring our total cost avoidance and savings into additional full-time equivalent positions.

Lovastatin Content of Commercially Available Red Yeast Rice Supplements

Purpose To evaluate pharmacist interventions and identify areas of improvement prior to decentralization and implementation of a personal digital assistant (PDA) program for documenting interventions. Methods Intervention data were collected from April 1999 to June 2001 using standardized intervention and activity forms. Following collection, data were analyzed to determine the most common medications requiring intervention, acceptance rates, total and estimated cost savings, interventions performed per care unit, and pharmacist time. Results A total of 3030 interventions were captured from April 1999 through June 2001. The most common interventions were dosage or frequency changes (80.6%). The total cost savings for the medication ingredients during the period reviewed was

Comparison of Vitamin D Label Dosing Recommendations to North American National Guidelines

43,733. The estimated cost savings/cost avoidance of interventions during the study period was

Quality of Natural Product Clinical Trials: A Comparison of Those Published in Alternative Medicine Versus Conventional Medicine Journals

850,417. The most common care units involved in interventions were areas where clinical pharmacy faculty practiced: hematology/oncology, general medicine, and intensive care. From January 2001 to June 2001 a comparison of faculty to clinical pharmacists showed that faculty in three care areas (68 beds) documented 552 interventions, compared with 392 interventions by the clinical pharmacists responsible for the seven other care areas (200 beds) (P< 0.05). Conclusions This review reinforces the benefit of interventions on cost avoidance and patient care. Because a high percentage of interventions was lost due to follow up, implementation of a simplified, uniform approach to clinical intervention reporting through a PDA program and additional decentralization is expected to decrease lost interventions and increase estimated cost avoidance.

Making Your Pharmacy Practice Department "In-dispense-able"

Data suggest that cyclooxygenase (COX)‐2 inhibitors are safer for the gastrointestinal tract than traditional nonsteroidal antiinflammatory drugs (NSAIDs). Rofecoxib, a COX‐2‐specific NSAID, does not inhibit the COX‐1 enzyme, thereby decreasing the potential for gastrointestinal‐related adverse effects. Patients who are at an increased risk for NSAID‐related gastrointestinal bleeding are therefore appropriate candidates for COX‐2 inhibitors. Although the agents provide benefits for many patients, gastrointestinal‐related side effects may occur, and caution should be practiced when prescribing COX‐2 inhibitors. We report two patients who were admitted to the hospital with diagnoses of gastrointestinal bleeds while they were taking rofecoxib.