Patient-guided counseling in the community pharmacy setting.

OBJECTIVE: To test a new prescription counseling method termed "patient-guided counseling" (PGC) in community pharmacies. DESIGN: Post-test experimental design in which subjects were randomized to three groups. SETTING: Six community pharmacies (three chain and three independent). PATIENTS: Patients presenting new prescriptions. INTERVENTIONS: Patients were randomly assigned to one of three comparison groups. The PGC group was given a written prompt instructing them to write any questions they wished to ask about their prescription or their medical condition. The pharmacist then incorporated these questions into the subsequent verbal counseling. A second group was given a written prompt encouraging them to ask the pharmacist questions. This was followed by customary verbal counseling. A third group served as the control. No prompts were provided, but the pharmacist did provide customary verbal counseling. MAIN OUTCOME MEASURES: Patients' demographics, recall of medication information, and satisfaction with counseling. Patients were contacted by telephone 5 days after the start of drug therapy to measure compliance. Pharmacists rated their satisfaction with the information communicated and with their interactions with patients. RESULTS: Compared with customary verbal counseling, the PGC method was associated with more supplemental questions asked by the patient. Compared with the other two methods, PGC was associated with greater pharmacist satisfaction with the information communicated and slightly longer counseling sessions. No significant differences were found for patients' overall satisfaction with counseling, recall of information, and compliance. CONCLUSION: In the community pharmacy setting, PGC fosters patient participation in medication counseling, a necessary element for the provision of pharmaceutical care.

Affinity constants and beta-adrenoceptor reserves for isoprenaline on cardiac tissue from normotensive and hypertensive rats.

To determine whether there are differences in cardiac beta-adrenoceptor responsiveness, isoprenaline affinity constants and fractional beta-adrenoceptor occupancy-response relationships for isoprenaline in the early stages of established hypertension, we studied the effects of bromoacetylalprenololmenthane (BAAM) and ([3,5-diamino-6-chloro-N-(1[N-beta-(2-hydroxyl-3-alpha-naphthoxypropy lamino)ethylcarbamoyl]-1-methylethyl)-pyrazine-2-carboxamide (ICI 147 798), slowly reversible beta-adrenoceptor antagonists, on the isoprenaline responses of the left ventricular papillary muscle and the left and right atria of 6-month-old Wistar Kyoto rats (WKY) and spontaneously hypertensive rats (SHR). The papillary muscles, but not the right and left atria, of the SHR were less responsive to isoprenaline than those of the WKY. The isoprenaline pD2 values (the negative logarithms of the molar concentrations of agonist producing 50% of the maximum response) were 7.72 and 8.00 on the SHR and WKY papillary muscles, respectively. On the WKY papillary muscle the isoprenaline KA values were 2-3 x 10(-6) M, which is as expected for isoprenaline at beta1 or beta2-adrenoceptors. Isoprenaline had 100-fold greater affinity on the WKY and SHR left atria than on the papillary muscles; the isoprenaline KA values were 2-4 x 10(-8) M. On the WKY papillary muscle and left atrium, isoprenaline had to occupy 3-4% of the beta-adrenoceptors to produce a 50% maximum response; on the WKY papillary muscle and left atrium isoprenaline had to occupy 25-35% and 55%, respectively, of the beta-adrenoceptors to produce a 90% maximum response. The SHR papillary muscles and left atrium had smaller beta-adrenoceptor reserves for isoprenaline than did the WKY tissues. We were unable to obtain isoprenaline KA values on the WKY right atrium. The isoprenaline KA value on the SHR right atrium was 1-4 x 10(-8) M. Because the isoprenaline KA values for the left and right atria are markedly different from those previously reported for isoprenaline at beta1 or beta2-adrenoceptors, we suggest that atypical beta-adrenoceptors might be present on the atria of WKY and SHR. We have also demonstrated a lower beta-adrenoceptor reserve on SHR papillary muscle and atria in the early stages of established hypertension.

Effects of veratridine on the action potentials and contractility of right and left ventricles from normo- and hypertensive rats.

1. We have studied the effects of prolonging the opening of sodium channels with veratridine on the action potentials (AP) and contractility of isolated right and left ventricles of Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR). It was examined whether the effects of veratridine were altered in the SHR right ventricle in the absence of hypertrophy. The main aim of the present study was to test the hypothesis that the effects of veratridine were altered in the SHR left ventricle in the presence of hypertrophy. 2. The tail-cuff pressures of 14- and 22-week-old, but not 5-week-old, SHR were greater than those of the WKY rat. At 14 weeks of age of SHR left, but not right, ventricle had developed hypertension-associated hypertrophy. 3. The AP and contractions and the ability of veratridine to prolong the AP and act as a positive inotrope were similar in the right ventricles from 22-week-old WKY rats and SHR. The effects of veratridine and the AP and contractions of left ventricles of 5-, 14- and 22-week-old WKY rats and of 5- and 14-week-old SHR were also similar. 4. The AP of the left ventricles of 22-week-old SHR were prolonged by 3 ms at the action potential duration (APD)50 and APD90 levels. The contractions to cardiac stimulation and the maximum combined force responses to cardiac stimulation and isoprenaline were reduced in the left ventricles of 22-week-old SHR compared with WKY rats and younger SHR. 5. The effectiveness of veratridine in prolonging the AP and augmenting the contractions to cardiac stimulation was reduced in the hypertrophied left ventricle of 22-week-old, but not 14-week-old, SHR. 6. In summary, the response to prolonging the opening of sodium channels with veratridine is not altered in the SHR right ventricle. However, in left ventricles of the hypertrophied 22-week-old, but not 14-week-old, SHR the effects of veratridine are reduced and this demonstrates that the response to prolonging the opening of sodium channels is changed in persistent hypertension-associated hypertrophy.

Cost of medication therapy in ambulatory HIV-infected patients.

OBJECTIVE: To examine the use and cost associated with prescribed medications as well as the use of over-the-counter medications and nontraditional therapies among ambulatory HIV-infected patients at Ryan White Title IIIb grantee centers. METHODS: Study participants (n = 223) were enrolled from eight centers across the US and Puerto Rico. Data were collected by a nurse, pharmacist, or physician through review of medical records and medication profiles. Information on the use of over-the-counter drugs and alternative therapies was obtained from the patients. RESULTS: Two hundred eleven (94.6%) patients received a mean +/- SD of 5.3 +/- 3.8 prescription medications during a consecutive 90-day period. The cost of medication was $1237.62 +/- $1751.49 per patient. Patients with a diagnosis of AIDS received a greater number of prescription drugs: an average of 6.6 compared with 3.4 among HIV-positive patients and 3.5 among asymptomatic patients. Antiretroviral agents were used by 143 (68.7%) patients. Zidovudine and stavudine had the highest cost ($611.81 +/- $254.10 and $596.96 +/- $352.80, respectively). Eighty-one (40.9%) patients reported the use of at least one over-the-counter product (range 0-11) and 11.8% reported use of alternative therapies. CONCLUSIONS: This study shows the cost of drug treatment for HIV-infected patients has remained stable since the early 1990s. However, it is anticipated this will change due to the introduction of new anti-HIV agents, greater use of combination therapies, greater use of prophylactic therapies, and increased survival times.

The effects of racemic, (+)- and (-)-pinacidil on the membrane potential of the rat aorta.

The endothelium-intact and -denuded rat aorta is hyperpolarized by racemic and (-)-pinacidil, probably by opening ATP-dependent potassium channels. (+)-Pinacidil caused depolarization of the endothelium-intact and -denuded rat aorta. The depolarization induced by 20 mAM KCl in the endothelium-intact rat aorta was reversed by racemic and (-)-, but not by (+)-pinacidil. On the endothelium-intact rat aorta, isoprenaline produced hyperpolarization and ICI 118551 (erythro-(+/-)-1-(7-methylindan-4-yloxy)-3-isopropylamino butan-2-ol) had no effect alone but prevented isoprenaline from causing hyperpolarization. The hyperpolarization induced by isoprenaline was reversed by racemic and (+)-, but not by (-)-pinacidil. Glibenclamide depolarized the endothelium-intact rat aorta and prevented the hyperpolarizing action of racemic pinacidil and (-)-pinacidil. (+)-Pinacidil prevented the hyperpolarizing action of (-)-pinacidil. Glibenclamide is probably preventing the hyperpolarization associated with opening of the ATP-dependent potassium channel by blocking this channel. Several mechanisms may underlie the depolarizing action of (+)-pinacidil, including blocking of ATP-dependent potassium channels.

Advance directives: implementing a program that works.

Development of policy and procedures for best complying with the Patient Self-Determination Act of 1990 involved the efforts of a large multidisciplinary committee. In-service sessions for all personnel, along with availability of awareness-raising sessions for incoming patients, their families and the general public, are showing positive results.

Changes in plasma levels of gonadal steroids and gonad morphology during the spawning cycle of male and female demoiselles Chromis dispilus (Pisces: Pomacentridae).

This study examined the relationship between gonad morphology and endocrine function of male and female demoiselles Chromis dispilus. Gonad samples were collected over two successive seasons and staged macroscopically and histologically. Blood samples were assayed for the gonadal steroids 17 beta-estradiol (E2), testosterone (T), 11-ketotestosterone (11KT), and 17 alpha,20 beta-dihydroxy-4-pregen-3-one (17,20 beta P) by radioimmunoassay. Histological examination indicated that demoiselles are multiple spawners with group synchronous gamete development, and gonad changes are synchronised within local populations. Gonad morphology does not differ between nonterritorial and territorial males. Plasma levels of E2 and T increased with vitellogenesis in female demoiselles. Plasma levels of 17,20 beta P did not change in association with final oocyte maturation, but 17,20 beta P was not excluded as the possible maturation inducing steroid. However, 17,20 beta P was elevated in females in association with spawning activity. Plasma levels of T and 11KT were not consistently associated with spermiation in male demoiselles but were elevated in association with spawning behaviour. Androgen levels were significantly higher during spawning in territorial males than in nonterritorial males. There was no association between 17,20 beta P and spermiation. Plasma levels of 17,20 beta P were elevated during the display and spawning period in territorial males only. The results of this study provide further evidence for the association of plasma levels of gonadal steroids and behavioural status in demoiselles.

Relationship of population density, territorial interaction and plasma levels of gonadal steroids in spawning male demoiselles Chromis dispilus (Pisces: Pomacentridae).

Territorial male demoiselles Chromis dispilus were captured and bloodsampled underwater by scuba divers, from reef areas of low, medium, and high population density, over five spawning seasons. Measurements of densities of territory-holding males and the water-column population (females and nonterritory-holding males) were made from the same sites. Behavior of territory-holding males was assessed in relation to phase of the reproductive cycle and population density, using a remote underwater video system. Plasma levels of testosterone, 11-ketotestosterone (11KT), and 17 alpha,20 beta-dihydroxy-4-pregnen-3-one (17,20 beta P) were measured by RIA. Territory density was found to be proportional to population size. Males from high density sites spent more time chasing conspecifics and spawning during the phase of courtship display and spawning (spawning phase), but there were no differences in behavior between males from different density sites during periods of egg-brooding and defence (nesting phase). Plasma levels of all three steroids were elevated during the spawning phase, and low during the nesting phase. Absolute levels of gonadal steroids were higher in fish from areas of high population density during the spawning phase, than in fish from lower population densities. In one case, plasma 11KT and 17,20 beta P were also elevated at high density during the nesting phase. The results of the study indicate that steroid hormone levels are labile in response to changes in population density, and frequency of territorial interaction. Changes in levels of plasma androgens are consistent with the "challenge" hypothesis of social regulation of territorial aggression.(ABSTRACT TRUNCATED AT 250 WORDS)

Burnout experienced by recent pharmacy graduates of Mercer University.

The degree of burnout experienced by graduates of the Mercer University Southern School of Pharmacy from 1973 to 1983 was studied. Questionnaires were mailed to 1000 alumni, representing 850 Bachelor of Science (B.S.) and 150 Doctor of Pharmacy (Pharm.D.) graduates. Three components of burnout--emotional exhaustion, depersonalization, and personal achievement--were measured using the Maslach Burnout Inventory to determine relationships between burnout and primary work setting, primary work activity, and type of degree (Pharm.D. or B.S.). The response rate was 41%. The respondents experienced a moderate degree of burnout. Those pharmacists working primarily in community chain store settings reported greater levels of burnout than those working in hospital or institutional pharmacies, independent community pharmacies, academia, and home health care. Respondents who performed primarily nondistributive duties (direct patient care, drug information, teaching or research, and management or administration) experienced lower levels of burnout than those involved primarily in drug distribution. Pharmacists holding the Pharm.D. degree were involved to a greater extent in nondistributive positions and experienced a lower degree of burnout than the pharmacists holding a B.S. degree only. Pharmacists in nondistributive roles appear to be less affected by burnout than pharmacists performing traditional distributive activities.

Development and validation of an instrument to measure pharmacists' satisfaction with their jobs and careers.

The development and validation of a survey questionnaire measuring pharmacists' satisfaction with their jobs and careers is outlined. The instrument was part of a 1983 study which surveyed pharmacists licensed and residing in Florida. The use of the pilot survey to arrive at a final survey instrument is outlined. Reliability of the instrument is assessed with tests of internal consistency reliability. Validity is judged through a test of concurrent validity utilizing the Job Descriptive Index, a standardized measure of job satisfaction. The delineation of this process is intended to aid other researchers in the development and validation of their surveys of job satisfaction and similar attitudinal measures.