Sandra Benavides

Pharmacist Involvement in Improving Asthma Outcomes in Various Healthcare Settings: 1997 to Present

OBJECTIVE To evaluate pharmacists’ impact on asthma management outcomes in various healthcare settings on the basis of updated guidelines set by the National Heart, Lung, and Blood Institute (NHLBI). DATA SOURCES A search of MEDLINE (1997–April 2008) and International Pharmaceutical Abstracts (1997–April 2008) was conducted using the MeSH terms asthma, community pharmacy services, pharmacists, pharmacies, clinic, hospital, disease state management, medication therapy management, emergency department, and community. STUDY SELECTION AND DATA EXTRACTION Articles were included if pharmacists participated in the intervention and the report measured outcomes of asthma as defined by symptoms, pulmonary function, asthma severity, quality of life (QOL), or healthcare utilization. DATA SYNTHESIS Since January 1997, a substantial number of studies have been published examining pharmacists’ impact on asthma clinical outcomes. Twenty-five studies were included in this review: 15 were conducted in community pharmacies, 5 in ambulatory clinics, 2 in an in-patient hospital setting, and 3 as various community initiatives. The studies varied in the type of intervention provided and outcomes measured. The most common outcome in community pharmacies was pulmonary function measures, in which all but one trial found improvements. Half of the community pharmacy trials found improvements in asthma severity, 75% found improvements in healthcare utilization, and although some trials found improvements in QOL, 2 trials found decreases in QOL. Ambulatory clinics reported improvements in asthma symptoms and pulmonary function and decreased healthcare utilization. Most trials in the ambulatory care setting reported decreases in QOL postintervention. Trials in the hospital setting most often reported decreases in healthcare utilization. Limitations of the studies, however, included varying definitions of asthma control, methodologies used in the studies, and the lack of long-term follow-up. CONCLUSIONS Future study designs may require larger sample size and measure outcomes that better assess disease severity in asthma, such as impairment and risk domains. This review supports the National Heart, Lung, and Blood Institutes of the National Institutes of Health Expert Panel Report 3 guidelines in recognizing pharmacists as accessible healthcare practitioners who, via patient education and medication management, may help patients with asthma attain better control of their disease state.

Treatment Options in Insulin Resistance Obesity–Related Acanthosis Nigricans

Objective: To evaluate the literature to determine which oral and topical medications are most effective In the treatment of insulin resistance obesity–related acanthosis nigricans (IRORAN). Data Sources: A MEDLINE literature search was conducted (1950–January 2008) using the search terms acanthosis nigricans (AN), metformin, rosiglita-zone, octreotide, retinoic acid, acitretin, etretinate, and isotretinoin. The search was limited to articles on treatment of IRORAN in humans written in the English language. Articles were retrieved and all references were reviewed. Study Selection and Data Extraction: Articles selected for inclusion were limited to AN related to obesity with no other underlying etiology. Clinical trials and case repons using monotherapy were included. Data Synthesis: Metformin, rosiglitazone, octreotide, vitamin D analogs, and retinoic acid have been used in the treatment of IRORAN. In one randomized trial, metformin 500 mg 3 times daily was compared with rosiglitazone 4 mg once daily. Neither treatment demonstrated significant Improvements in AN; however, rosiglitazone did significantly decrease serum insulin levels. In a second clinical trial and in several case reports, AN and hyperinsulinemia did show improvement with metformin treatment. After a 6-month period, octreotide improved IRORAN, body weight, and glucose/insulin response to a meal. The improvements persisted for 6 additional months after discontinuation of octreotide. Vitamin D analogs and retinoids produced inconsistent results in 5 separate case reports. Conclusions: IRORAN is a growing problem, particularly in children and adolescents, secondary to the Increase in the prevalence of obesity. Treatment of IRONAN should focus on reversal of the underlying hyperinsulinemia. Patients with IRORAN may benefit from a trial of metformin for Improvement of lesions and underlying hyperinsulinemia.

Human Papillomavirus Vaccine Safety in Pediatric Patients: An Evaluation of the Vaccine Adverse Event Reporting System

Recent news reports have linked the human papillomavirus (HPV) vaccine to serious adverse events (AEs) in children and adolescents. We used the Vaccine Adverse Event Reporting System (VAERS) database to extract postmarketing AEs reported in patients who received the vaccine. Since approval of the HPV vaccine in the US, 3174 AEs occurring in children and adolescents (aged 6-17 y) have been reported to the VAERS. Of these, 191 (6%) were deemed to be serious. Although these AEs are of significant concern, more research is required before they can be directly correlated with the vaccine.

The Impact of Student-Faculty Ratio on Pharmacy Faculty Scholarship

Objective. To determine the relationship and impact of student-faculty ratio on scholarship of pharmacy faculty members. Methods. The number and rank of faculty members, pharmacy program characteristics, and faculty productivity data were collected to determine the impact of student-faculty ratio on faculty scholarship. Results. Faculty scholarship was not predicted by student-faculty ratio. Factors impacting positively on faculty productivity included National Institutes of Health funding; presence of clinical associate professors, instructors, and lecturers; and programs located in public universities. Conclusions. Faculty productivity is not related to the student-faculty ratio, wherein more faculty members and fewer students equates to increased scholarship. However, public universities may have different infrastructures which are associated with greater academic productivity compared to private institutions. Additionally, utilizing instructors and clinical or nontenure-track faculty members can significantly increase scholarship among faculty members.

A Clinical Pharmacist's Role in Screening for Metabolic Syndrome in a Rural Pediatric Ambulatory Clinic.

PURPOSE The prevalence of metabolic syndrome in the pediatric population is increasing. Barriers, including the lack of consensus of a definition for metabolic syndrome and time constraints for the pediatrician, may limit the identification and diagnosis of metabolic syndrome in children. The objective of this pilot study was to evaluate the role of a clinical pharmacist (CP) in screening children and adolescents for metabolic syndrome. METHODS A 3-month, prospective, cross-sectional study aimed at utilizing a CP to identify metabolic syndrome in high-risk children, ages 10-18 years, in a pediatric ambulatory clinic located in a rural community health center was conducted. Upon enrollment a personal and family medical history was obtained, physical examination was reviewed, and a fasting laboratory analysis was performed. The CP evaluated each component of metabolic syndrome to determine if the participant met criteria for diagnosis. The CP provided a summary of the risk factors and treatment recommendations to the pediatrician. FINDINGS Twenty-five Mexican American participants (ages 13.7 ± 2.3 years) enrolled and completed the study. One child (4%) met 3 or more criteria required for diagnosis of metabolic syndrome. Of the remaining participants, 7 (28%) met 2 criteria, 9 (36%) met 1 criterion, and 8 (32%) met no criteria for metabolic syndrome. The CP provided treatment recommendations for 68% of the participants. CONCLUSION CPs can have an active role in early identification of specific components of metabolic syndrome in a rural community health center.

Difficulty and discrimination indices of multiple-choice examination items in a college of pharmacy therapeutics and pathophysiology course sequence

The purpose of this study was to identify differences in difficulty and discrimination among multiple‐choice examination items with regard to format and content in pharmacy therapeutics and pathophysiology (TP) courses.

Implementation and faculty assessment of an oral examination in a therapeutics course in a distance synchronous education pharmacy programme

Objectives  To describe the process and implementation of an oral exam in a large class with distance synchronous education technology and to evaluate the facultys perspective of the development, administration, and assessment of the oral exam.

Non‐modifiable determinants of pharmacy residency match rates

The purpose of this study was to examine non‐modifiable pharmacy program characteristics on residency match rates.

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.

The Patient Protection and Affordable Care Act: Implications for Pediatric Pharmacy Practice

The impact of the Patient Protection and Affordable Care Act on the pediatric health care landscape includes expanded health insurance coverage and health care delivery improvements by increasing implementation of patient-centered medical homes and accountable care organizations. These offer opportunities for pharmacists to assume responsibility for the medication-related needs of pediatric patients through pharmacotherapy selection, medication therapy management performance, and medication reconciliation at each transition of care. Medically complex children with at least 2 chronic disease states may be the target population. Studies demonstrating the positive outcomes and cost-effectiveness of pharmacists in pediatric ambulatory care settings are needed.