Michael S. Monaghan

Educational Technology Use Among US Colleges and Schools of Pharmacy

Objective. To develop a searchable database of educational technologies used at schools and colleges of pharmacy. Methods. A cross-sectional survey design was used to determine what educational technologies were being used and to identify an individual at each institution who could serve as an information resource for peer-to-peer questions. Results. Eighty-nine survey instruments were returned for a response rate of 75.4%. The resulting data illustrated the almost ubiquitous presence of educational technology. The most frequently used technology was course management systems and the least frequently used technology was microblogging. Conclusions. Educational technology use is trending toward fee-based products for enterprise-level applications and free, open-source products for collaboration and presentation. Educational technology is allowing educators to restructure classroom time for something other than simple transmission of factual information and to adopt an evidence-based approach to instructional innovation and reform.

An evidence-based review of fat modifying supplemental weight loss products.

Objective. To review the literature on fat modifying dietary supplements commonly used for weight loss. Methods. Recently published randomized, placebo-controlled trials were identified in PubMed, MEDLINE, International Pharmaceutical Abstracts, Cochrane Database, and Google Scholar using the search terms dietary supplement, herbal, weight loss, obesity, and individual supplement names. Discussion. Data for conjugated linoleic acid (CLA), Garcinia cambogia, chitosan, pyruvate, Irvingia gabonensis, and chia seed for weight loss were identified. CLA, chitosan, pyruvate, and Irvingia gabonensis appeared to be effective in weight loss via fat modifying mechanisms. However, the data on the use of these products is limited. Conclusion. Many obese people use dietary supplements for weight loss. To date, there is little clinical evidence to support their use. More data is necessary to determine the efficacy and safety of these supplements. Healthcare providers should assist patients in weighing the risks and benefits of dietary supplement use for weight loss.

Physician-prompting statin therapy intervention improves outcomes in patients with coronary heart disease

Study Objective. To evaluate the effectiveness of a posthospital discharge intervention that prompted physicians to increase the use and effectiveness of statins (3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors) in patients with coronary heart disease (CHD).

Rhabdomyolysis associated with simvastatin-nefazodone therapy

Simvastatin is a hydroxymethyl glutaryl coenzyme A reductase inhibitor commonly used to treat patients with hyperlipidemia. It is a safe and effective medication in most patients when used appropriately. A serious side effect known as rhabdomyolysis may rarely occur in patients who take simvastatin, especially at higher doses and with agents that interact and increase the level of simvastatin in the blood. We describe the case of a patient with rhabdomyolysis that occurred after the patients simvastatin was titrated to 80 mg at approximately the same time that his antidepressant medication was switched to nefazodone. We found only two other similar cases in the literature, both of which were presented as letters to the editor in two different journals. We present this case to add to the literature and to assist practitioners by raising their awareness of this interaction so that it can be monitored.

Lifestyle modifications for patients with hypertension

OBJECTIVES To review the lifestyle modification components listed in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) from the National Heart, Lung, and Blood Institute (NHLBI) and discuss how the guidelines can be used by pharmacists in the treatment of patients with hypertension. DATA SOURCES Published guidelines and abstracts identified through PubMed (May 1987 to April 2007) and Medline (January 1966 to April 2007) using the search terms hypertension, prehypertension, lifestyle modification, nutrition, physical activity, weight loss, weight control, behavior modification, smoking cessation, guidelines, and prevention, as well as the JNC 7 guidelines, NHLBI Obesity Guidelines, and Dietary Guidelines for Americans 2005. DATA SYNTHESIS Lifestyle modification strategies are recommended in the JNC 7 guidelines for the treatment and prevention of hypertension and cardiovascular disease. The primary strategies discussed are proper nutrition through the Dietary Approaches to Stop Hypertension (DASH) eating plan and sodium restriction, weight reduction, increased physical activity, and moderation of alcohol consumption. Patients with hypertension have been shown to decrease their resting blood pressure considerably by adopting one of more of these strategies. CONCLUSION Pharmacists are in an ideal setting to care for patients with hypertension by managing their medications and lifestyle behaviors. Doing so provides patients a higher level of clinical care from their pharmacist.

Correlation and prediction of phenytoin protein binding using standard laboratory parameters in patients after Renal transplantation

Renal transplant recipients provide a unique model for protein-binding studies in that patients experience hypoalbuminemia and renal dysfunction, both of which alter protein binding. The purposes of this investigation were to model the relationship between serum creatinine, blood urea nitrogen (BUN), albumin, and the unbound fraction of phenytoin (FU, as a percentage) in patients who had undergone renal transplant, and to determine the value of these measurements in predicting FU. Blood from 29 patients was collected at various time points after establishment of graft function. Sera were spiked with phenytoin to a concentration of 15 mg/L, and total/unbound phenytoin concentrations were determined. Correlations between FU and the biochemical indices of serum creatinine, BUN, and albumin were determined using multiple regression. The algorithm with the highest correlation at all times after the transplant became the method to predict future FU. This algorithm was applied prospectively in 23 samples from 14 other patients with variable renal function after transplant. Samples were analyzed as above and the corresponding biochemical indices of serum creatinine, BUN, and albumin were used to calculate FU values. Accuracy of the predictions was evaluated using prediction-error analysis. The best relationship between FU and the measured biochemical indices incorporated serum creatinine and albumin [y = 24.3 + 0.6(serum creatinine) − 3.9(albumin)] and served as the method for FU prediction. Prediction-error analysis resulted in a bias of −5.1% and a precision of 5.7%. This method failed to estimate FU with sufficient accuracy to permit clinical utility. The predicted value underestimated the measured value, and some other variable(s) must be affecting the binding even though serum creatinine and albumin are within or approaching the reference range. Consequently, estimating FU in patients with a history of uremia and hypoalbuminemia, based on measures of serum creatinine and albumin alone, should not be used.

Cost of a Pharmacist-Directed Intervention to Increase Treatment of Hypercholesterolemia

Study Objective. To evaluate the cost of a pharmacist‐directed intervention that prompts physicians to treat hypercholesterolemia more aggressively in patients with coronary heart disease (CHD).

Repeated Testing to Improve Skills in a Pharmacy Practice Laboratory Course

Objective. To evaluate the impact of repeated simulations and testing on the pharmacy practice skills development of third-year doctor of pharmacy (PharmD) students. Design. A pharmacy practice skills laboratory was redesigned to reinforce skills development and enhance retention. Timed, repeated learning experiences that increased in complexity throughout the semester were used to test student knowledge, skills, and abilities. Assessment. Over a 5-year period, scores from skills-based activities deemed essential to professional practice and repeated 4 or more times in the course were analyzed. There was a significant improvement in scores on drug utilization reviews and patient counseling simulations despite the increasing difficulty and complexity of the medication problems presented (p <0.001). Students’ scores on prescription verification and sterile product verification also improved significantly over 3 assessments (p <0.001), but then plateaued, with less improvement seen in performance on subsequent assessments. Conclusion. Providing multiple opportunities for students to conduct or simulate pharmacy practice activities and then test their knowledge and skills improves students’ learning and performance.

Pay-for-performance model of medication therapy management in pharmacy practice

OBJECTIVE To use an existing pharmacist-run medication therapy management (MTM)/lifestyle medicine program to propose a new model of reimbursement for pharmacists that is based on pay for performance (P4P) rather than product-based dispensing or fee for service. DATA SOURCES Specific patient outcomes were collected during a 1-year period from an existing pharmacist-run MTM/lifestyle medicine program as the basis to propose this new model of reimbursement. DATA SYNTHESIS The proposed model outlines a P4P model of reimbursement for pharmacists that includes both traditional MTM services and patient-centered lifestyle medicine programming. The model uses an all-or-none bundled approach for reimbursement in which the pharmacist is reimbursed at a higher rate if patients achieve all six proposed outcome criteria at 1 year. Pharmacists could earn as much a 43% more income with this model compared with traditional MTM services. This model is an incentive for payers because it is based on patient outcomes and preestablished return on investment models. CONCLUSION Pharmacist should begin to explore ways they can participate in a high-performance health care system by moving to a P4P model of reimbursement rather than fee-for-service or product-based dispensing reimbursement models. P4P models of reimbursement could be beneficial to the patient, the payer, and the pharmacist.

Development of a Composite Lifestyle Index and Its Relationship to Quality of Life Improvement: The CLI Pilot Study.

An important component to optimal health is quality of life (QOL). Several healthy lifestyle behaviors have independently shown to improve QOL. The simultaneous implementation of multiple lifestyle behaviors is thought to be difficult, and the current literature lacks the assessment of multiple lifestyle behaviors simultaneously with respect to the effect on QOL. This current pilot study sought to develop a method to quantify multiple lifestyle behaviors into a single index value. This value was then measured with QOL for a possible correlation. The results showed that it is possible to convert multiple raw healthy lifestyle data points into a composite value and that an improvement in this value correlates to an improved QOL. After 12 months of participation in a cardiovascular risk reduction program, study participants (N = 35) demonstrated a 37.4% (P < 0.001) improvement in the composite lifestyle index (CLI). The improved CLI demonstrated a correlation with a statistically significant improvement in how participants rated their overall health in 12 months (r = 0.701, P < 0.001) as well as the number of self-reported unhealthy days per month in 12 months (r = −0.480, P = 0.004).