Rebecca S. Finley

Meta-Analysis of Interventions for Medication Adherence to Antihypertensives

OBJECTIVE To identify methods targeted at improving adherence to antihypertensives and determine their effect on adherence using meta-analytic techniques. METHODS A literature search from 1970 to December 2000 using MEDLINE, International Pharmaceutical Abstracts, PsychLit, ERIC, and EMBASE was performed using the terms compliance, adherence, and medication. Randomized articles with an intervention directed at a patient/caregiver, a comparator group, and a minimum of 10 subjects in each intervention group were identified by 3 independent reviewers. Articles that did not report sample size data or adequate results of the intervention were excluded. Sixteen citations focusing on antihypertensive adherence were identified. Of the 16 citations, 6 studied either more than one intervention in the same population or different interventions in different patient populations, yielding 24 cohorts with 2446 patients. RESULTS Fifty-eight percent of the methods focused on behavioral interventions (BIs), 29% studied the effect of a combination of behavioral and educational interventions (BEIs), and 13% utilized educational interventions (EIs) alone. Overall, the study groups were nonhomogenous (Q = 183.92; p < 0.001). However, when the groups were separated by the intervention type, the BIs were homogenous (Q = 1.19; p = 1.00) with an overall effect size (ES) of 0.04 (95% CI −0.01 to −0.09), indicating a trend toward improved adherence. Fifty percent of the BIs were performed in the physicians office; however, setting did not influence the interventions impact (p = 0.13). Within the BIs, no single intervention improved adherence over others. CONCLUSIONS Based on the interventions included in this meta-analysis, there is no single intervention that improves adherence to antihypertensives over others; therefore, a patient-specific approach should be modeled.

Cisplatin nephrotoxicity: a summary of preventative interventions

Nephrotoxicity is usually the dose-limiting toxicity associated with cisplatin therapy. Frequently the nephrotoxicity is mild and reversible. However, it is both dose-related and cumulative and may become life-threatening and irreversible at higher dosages. Many interventions such as vigorous hydration, osmotic or loop diuretics, and alterations of infusion times have been evaluated in the hope of ameliorating this serious toxicity, and are summarized. More recently, hypertonic NaCl 0.9% has been reported to decrease the incidence of cisplatin nephrotoxicity. In addition, newer platinum analogs are currently undergoing clinical trials to ascertain if they retain the antitumor properties of cisplatin but produce less toxicity.

Meta-Analysis of Interventions To Improve Drug Adherence in Patients with Hyperlipidemia

Objective. To examine the results of meta‐analyses addressing the net effect of tools and methods to enhance drug adherence in patients with hyperlipidemia.

Consensus recommendations from the strategic planning summit for pain and palliative care pharmacy practice.

Pain and symptoms related to palliative care (pain and palliative care [PPC]) are often undertreated. This is largely owing to the complexity in the provision of care and the potential discrepancy in education among the various health care professionals required to deliver care. Pharmacists are frequently involved in the care of PPC patients, although pharmacy education currently does not offer or require a strong curriculum commitment to this area of practice. The Strategic Planning Summit for the Advancement of Pain and Palliative Care Pharmacy was convened to address opportunities to improve the education of pharmacists and pharmacy students on PPC. Six working groups were charged with objectives to address barriers and opportunities in the areas of student and professional assessment, model curricula, postgraduate training, professional education, and credentialing. Consensus was reached among the working groups and presented to the Summit Advisory Board for adoption. These recommendations will provide guidance on improving the care provided to PPC patients by pharmacists through integrating education at all points along the professional education continuum.

Combination Antiemetic Therapy in the Control of Chemotherapy-Induced Emesis

Severe nausea and vomiting are frequent complications of cancer chemotherapy. Historically, single-agent antiemetic therapy frequently has been less than optimal. Because multiple sites of emetogenic activity may be involved in chemotherapy-induced nausea and vomiting, many investigators are now using combinations of antiemetics in an effort to block multiple receptor sites. Several preliminary studies using combinations of antiemetic agents that have shown encouraging results are summarized.

Fludarabine: A Review

The new fluorinated adenine analog, fludarabine, has been tested for efficacy in many tumor types over the past ten years. Two other similar nucleoside analogs are currently available for commercial use. Cytarabine is used principally as an antileukemic agent, and vidarabine as an antiviral. Unlike vidarabine, fludarabine is resistant to deactivation by adenosine deaminase. Data from Phase I and II trials suggest that fludarabine is potentially effective in a number of leukemias, including acute lymphocytic leukemia, acute nonlymphocytic leukemia, and chronic lymphocytic leukemia (CLL). Unfortunately, the doses required to achieve adequate response in the acute leukemias (>75mg/m2) were above the maximum tolerated dose, resulting in intolerable granulocytopenia, thrombocytopenia, and a life-threatening neurotoxic syndrome. In CLL, however, the dose required to achieve a satisfactory response is well within tolerated limits. Long-term survival statistics are not yet available, but historical perspective strongly correlates response to other agents with increased survival times. Toxicities seen at dose regimens of 15–40 mg/m2/d for five consecutive days include somnolence, metabolic acidosis, confusion, fatigue, nausea, vomiting, increase in serum creatinine and aminotransferase concentrations, and pulmonary and hepatic abnormalities. Mild to severe hematologic toxicity has been observed at all dose levels.

Advances in oncology pharmacy practice.

The role of the pharmacist in cancer care has continued to evolve over the last 50 years, in part due to more consistent integration of the pharmacist into cancer care teams. There has been tremendous growth in the number of practitioners who practice as oncology pharmacists since the inception of

Colony-Stimulating Factors in Acute Leukemia: Will We Ever Have an Answer?

120 ■ The Annals of Pharmacotherapy ■ 2001 January, Volume 35 The positive impact that the recombinant hematopoietic colony–stimulating factors (CSFs) filgrastim (G-CSF) and sargramostim (GM-CSF) have had on the management of patients receiving cytotoxic chemotherapy is undeniable. Early clinical trials 1-3 demonstrated that administration of these agents could increase the neutrophil count and, most importantly, shorten the period of neutropenia. This was significant because, since the 1960s, both the depth and duration of neutropenia have been positively correlated with the risk of infection. In a landmark report, Bodey et al. 4 at the MD Anderson Cancer Center demonstrated that the most serious infections (e.g., gram-negative bacteremias) occur when the granulocyte count is <100 cells/mm3. These investigators and others further reported that most patients with diseases such as acute leukemia, who often endured periods of profound neutropenia that exceeded three weeks, experienced potentially life-threatening infections.

Reflection, resilience, relationships, and gratitude

As a dean of a college of pharmacy, I spend most of my days considering and tending to what I perceive to be the needs or well-being of our profession’s future—that is, our student pharmacists. As academic and practice leaders, we have an obligation to prepare them to be successful in realizing