Matthew J. Seamon

Clinical decision support tools: analysis of online drug information databases

BackgroundOnline drug information databases are used to assist in enhancing clinical decision support. However, the choice of which online database to consult, purchase or subscribe to is likely made based on subjective elements such as history of use, familiarity, or availability during professional training. The purpose of this study was to evaluate clinical decision support tools for drug information by systematically comparing the most commonly used online drug information databases.MethodsFive commercially available and two freely available online drug information databases were evaluated according to scope (presence or absence of answer), completeness (the comprehensiveness of the answers), and ease of use. Additionally, a composite score integrating all three criteria was utilized. Fifteen weighted categories comprised of 158 questions were used to conduct the analysis. Descriptive statistics and Chi-square were used to summarize the evaluation components and make comparisons between databases. Scheffes multiple comparison procedure was used to determine statistically different scope and completeness scores. The composite score was subjected to sensitivity analysis to investigate the effect of the choice of percentages for scope and completeness.ResultsThe rankings for the databases from highest to lowest, based on composite scores were Clinical Pharmacology, Micromedex, Lexi-Comp Online, Facts & Comparisons 4.0, Epocrates Online Premium, RxList.com, and Epocrates Online Free. Differences in scope produced three statistical groupings with Group 1 (best) performers being: Clinical Pharmacology, Micromedex, Facts & Comparisons 4.0, Lexi-Comp Online, Group 2: Epocrates Premium and RxList.com and Group 3: Epocrates Free (p < 0.05). Completeness scores were similarly stratified. Collapsing the databases into two groups by access (subscription or free), showed the subscription databases performed better than the free databases in the measured criteria (p < 0.001).ConclusionOnline drug information databases, which belong to clinical decision support, vary in their ability to answer questions across a range of categories.

Statin Withdrawal: Clinical Implications and Molecular Mechanisms

Retrospective analyses of data from the Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM), the National Registry of Myocardial Infarction 4, and the Global Registry of Acute Coronary Events (GRACE) trials revealed that the benefits of 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors (statins) on acute coronary outcomes are rapidly lost and outcomes worsened if statins are discontinued during a patients hospitalization for an acute coronary syndrome. Withdrawal of statin therapy in the first 24 hours of hospitalization for non–ST‐elevation myocardial infarction increased the hospital morbidity and mortality rate versus continued therapy (11.9% vs 5.7%, p<0.01). Data from the Treating New Targets (TNT) study, however, suggested that short‐term discontinuation of statin therapy in patients with stable cardiac conditions may not substantially increase the risk of acute coronary syndromes. In patients with acute coronary syndromes who discontinue statins, the rapid increase in risk of an event may result not only from the lost benefits from the therapy, but also from rebound inhibition of vascular protective substances and activation of vascular deleterious substances. Statins inhibit cholesterol synthesis in vascular cells. By reducing levels of isoprenoid intermediates, statins increase the production of nitric oxide and downregulate angiotensin II AT1 receptors, endothelin‐1, vascular inflammatory adhesion molecules, and inflammatory cytokines. These benefits are rapidly lost and often transiently reversed when statins are acutely discontinued. Acute removal of pleiotropic effects and rebound vascular dysfunction may be more important in an acute coronary event, where inflammation promotes rupture of atherosclerotic plaques and inflammatory and prothrombosis markers are present in high concentration, than in stable chronic vascular disease. In the absence of data from randomized controlled trials, current information suggests that statin therapy should be continued, and possibly boosted, during hospitalization for an acute coronary syndrome. Because statins are discontinued during the early hospitalization of many patients, practitioners must ensure that statins are not omitted, unless contraindicated, from the treatment of patients with acute coronary syndromes.

Ephedra: yesterday, DSHEA, and tomorrow--a ten year perspective on the Dietary Supplement Health and Education Act of 1994.

The Dietary Supplement Heath and Education Act of 1994 (DSHEA) established the regulatory framework for dietary supplements in the United States, triggering the growth of a multi-billion dollar industry. Ephedra is a dietary supplement used for weight loss. However, due to its sympathomimetic activity, it has caused stroke, cardiac arrhythmia, and death. Accordingly, the Food and Drug Administration (FDA) has prohibited its sale in the United States since April 12, 2004. Consequently, numerous other dietary supplements are attempting to fill the marketing void. An evaluation of these products demonstrates a general lack of efficacy and safety data. Thus, in the ten years since the passage of DSHEA, the dietary supplement industry remains controversial and a concern for consumer safety.

Pharmacists’ duty to warn in the age of social media

What constitutes a bonafide pharmacist–patient relationship? In the past, such a relationship required a series of face-to-face meetings between a patient and a pharmacist. The first change to this paradigm occurred with the development and acceptance of and eventual reimbursement for telepharmacy

Legal Requirements for Drug Information Resources Maintained by Pharmacies

Drug information (DI) resource requirements differ between states and practice setting or specialty. The objective of this study was to determine each states legal requirements for maintaining DI resources in a pharmacy according to general or specialty practice. All 50 states in the United States, the District of Columbia, and Puerto Rico were targeted to identify their mandated DI resources. General resources were required by 50 boards of pharmacy (or jurisdictions) (96.2%), whereas 43 (82.6%) specified site- or practice-specific resources. Minnesota and South Dakota (3.8%) required print references. Forty (76.9%) required current laws or regulations. Other specifications include allowances for journals (7.7%), requirements for herbal medicine information (7.7%), and a resource in support of immunization administration (5.8%). This study details DI references mandated in the United States. Pharmacists should be aware that their state and area of practice may dictate which DI resources they must maintain to be in compliance with relevant laws.

Role of Residency Interview Preparatory Activities as a Determinant on Pharmacy Residency Match Rates

Purpose: Different strategies have been implemented to assist students in securing residency positions. The purpose of this study was to explore the impact of student participation in residency preparation activities on match rates. Methods: A retrospective observational study was conducted to explore the effect of participation in residency preparation activities and grade point average (GPA) on residency match rate. Match rates for students participating in the Residency Interview Preparation Seminar (RIPS) or mock interviews (ie, intervention group) were compared with students who participated in neither activity (ie, control group). Results: A total of 118 individuals were included in the comparison. Forty-eight students participated in RIPS (n = 29) or mock interviews (n = 19), while 70 students were in the control group. The intervention group had a statistically larger proportion of students securing residency than the control group (81% vs 57%; P = .009). Match rates between students enrolled in RIPS versus those in the mock interview group were not significant. No statistically significant differences were observed based on GPA. Conclusion: Students receiving additional preparation prior to interviews when seeking postdoctoral training were significantly more likely to obtain a residency position. In academic settings with limited resources, mock interviews may be preferred over comprehensive preparatory courses.