Screening Services in a Community Pharmacy in Poznan (Poland) to Increase Early Detection of Hypertension.

BACKGROUND: Community pharmacies in many countries around the world provide healthcare services for patients. Pharmacists trained as medication experts provide a wide range of patient care services related to medication therapy, patient education, disease prevention, and health promotion. Professional training, expertise, and skills qualify pharmacists to engage in health screenings. These screening programs performed by community pharmacists can help to identify risk factors, facilitate early detection of common diseases, and assist physicians with making effective diagnoses. OBJECTIVES: In this study, we created and tested a novel model to provide professional monitoring and counseling on blood pressure by community pharmacists. The aims of the study were to identify the prevalence of elevated blood pressure among patients visiting a community pharmacy and describe the demographic characteristics of patients with hypertension (sex, age, education, body weight, and hypertension risk factors). METHODS: The research project was conducted in an accredited community pharmacy in Poznan, Poland, from January to April 2019. A total of 118 anonymous patients (30.5% men and 69.5% women) participated in this study. To qualify for this study, participants had to be older than 18 years of age and have no previous diagnosis of hypertension or other cardiovascular disease. RESULTS: Based on the blood pressure screenings, 61.9% of patients were qualified for the standard consultation (SC: normal blood pressure), 21.2% for the intensive consultation (IC: normal blood pressure and hypertension risk factor), 16.9% patients with elevated blood pressure for the high-risk consultation (HRC: referred to a physician), and 3.4% received a diagnosis of hypertension. We qualified 35.6% with a high-pressure value (greater than 140/90 mmHg). CONCLUSIONS: The novel model for blood pressure control screening and counseling implemented in a generally accessible community pharmacy may help with early detection of hypertension problems, lead to initiation of effective patient counseling by a community pharmacist, and result in early referral of the patient to a physician.

Prevalence, determinants, and characteristics of extemporaneous compounding in Jordanian pharmacies.

BACKGROUND: Pharmaceutical compounding is an essential component in pharmacy practice allowing pharmacists to provide dosage forms or strengths that are commercially unavailable. Medications compounded for patient-specific needs contribute to personalized medicine. Extemporaneous compounding provided by pharmacies overcomes the market shortage of these therapeutic products. The aim of this study is to investigate and characterize the prevalence, characteristics, and determinants of extemporaneous compounding in Jordanian pharmacies. METHODS: This study was based on a cross-sectional questionnaire and included 431 randomly selected pharmacies in the twelve governorates of the country. Data were collected via face to face interviews of pharmacists who voluntarily and verbally responded to the questions. RESULTS: Results revealed that 223 (51.7%) of the surveyed pharmacies practiced extemporaneous compounding. The main reason for not providing extemporaneous compounding services was lack of prescription orders for compounded preparations (53.8%). The second reason was lack of the equipment and supplies necessary for compounding (24.4%). Extemporaneous compounding prescriptions were mainly issued by dermatologists (98.2%); dermatological indication was the most common of all extemporaneous compounded prescriptions. The main reason for requesting compounded medications was the lack of a commercially available product (87.9%). The vast majority of the compounded dosage forms were creams (99.6) and ointments (91.5), followed by solutions (23.3%). Only 5 (2.2%) of the studied compounding pharmacies prepared sterile products. The major sources for compounding protocols were the physician order (94.2%), and 'in-house' protocols (44.8%). However, the main resource for estimating compounded medications expiration date was information based on pharmacist's experience (57.8%) and the physician's order (53.4%). CONCLUSIONS: Extemporaneous compounding is a common element of pharmaceutical care. Topical preparations are the most commonly compounded products. Finding from this study suggest that there is a need for standardizing the compounded product formularies, product quality testing, and improving the consistency in estimation of an expiration date of compounded products.

Quantitative analysis of single best answer multiple choice questions in pharmaceutics.

INTRODUCTION: The purpose of this study was to: (1) analyze the quality of single best answer multiple choice questions (MCQs) used in pharmaceutics exams, (2) identify the correlation between difficulty index (DIF I), discriminating index (DI), and distractor efficiency (DE), and (3) understand the relationship between DIF I, DI, and DE and the number of MCQ answer options and their cognitive level. METHODS: 429 MCQs used in pharmaceutics exams were analyzed. The quality of the MCQs was evaluated using DIF I, DI, and DE. The number of answer options and the cognitive level tested by each item were evaluated. Relationships between DIF I, DI, and DE were measured using Pearson's correlations and t-tests. RESULTS: DIF I showed a significant negative correlation with DI within questions that measured information recall. A significant negative correlation between DIF I and DI was observed in questions with four and five answer options regardless of the cognitive level measured. The highest DI values were found in moderate difficulty questions, while the worst DE was observed for the easiest questions. Questions that measured analytical and problem-solving abilities were more difficult than those measuring information recall. Questions with four and five answer options had excellent discrimination. CONCLUSIONS: Single best answer MCQs are a valuable assessment tool capable of evaluating higher cognitive skills. Significant correlation between DIF I and DI can indicate the examination quality. Higher quality MCQs are constructed using four and five answer options.

Empathy and the Development of Affective Skills.

Empathy, the most important human attribute that matters in every aspect of life, is essential in health care. Provision of patient-centered care requires empathic health care practitioners. The correlation between empathy of health care providers and improved patient adherence, satisfaction, and treatment outcomes is well-established. Scholarly evidence shows positive correlations between empathy and affective domains and confirms that soft skills are grounded in empathy. Empathic students have stronger affective skills and are capable to acquire, develop, reinforce, and display strong affective behaviors, abilities, and attitudes. As an innate quality, empathy is malleable. The level of empathy can be influenced by educational interventions inculcated into students during the entire curriculum, including both didactic and experiential training. The effectiveness of educational methods may be strengthened by activities that help students enhance empathy and achieve required affective skills. Empathy and the empathy-based affective skills essential in patient-centered care should be routinely and deliberately taught, modelled, and assessed across the continuum of health care curricula.

Overview of Faculty Development Programs for Interprofessional Education.

Objectives. To describe characteristics of faculty development programs designed to facilitate interprofessional education, and to compile recommendations for development, delivery, and assessment of such faculty development programs. Methods. MEDLINE, CINAHL, ERIC, and Web of Science databases were searched using three keywords: faculty development, interprofessional education, and health professions. Articles meeting inclusion criteria were analyzed for emergent themes, including program design, delivery, participants, resources, and assessment. Results. Seventeen articles were identified for inclusion, yielding five characteristics of a successful program: institutional support; objectives and outcomes based on interprofessional competencies; focus on consensus-building and group facilitation skills; flexibility based on institution- and participant-specific characteristics; and incorporation of an assessment strategy. Conclusion. The themes and characteristics identified in this literature overview may support development of faculty development programs for interprofessional education. An advanced evidence base for interprofessional education faculty development programs is needed.

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations.

The objective of this article is to describe the key areas of consideration for global/international advanced pharmacy practice experience (G/I APPE) preceptors, students and learning objectives. At the 2013 Annual Meeting of the American Association of Colleges of Pharmacy (AACP), the GPE SIG prepared and presented an initial report on the G/IAPPE initiatives. Round table discussions were conducted at the 2014 AACP Annual Meeting to document GPE SIG member input on key areas in the report. Literature search of PubMed, Google Scholar and EMBASE with keywords was conducted to expand this report. In this paper, considerations related to preceptors and students and learning outcomes are described. Preceptors for G/I APPEs may vary based on the learning outcomes of the experience. Student learning outcomes for G/I APPEs may vary based on the type of experiential site. Recommendations and future directions for development of G/IAPPEs are presented. Development of a successful G/I APPE requires significant planning and consideration of appropriate qualifications for preceptors and students.

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

Validation of a self-administered computerized system to detect cognitive impairment in older adults.

There is increasing interest in the development of economical and accurate approaches to identifying persons in the community who have mild, undetected cognitive impairments. Computerized assessment systems have been suggested as a viable approach to identifying these persons. The validity of a computerized assessment system for identification of memory and executive deficits in older individuals was evaluated in the current study. Volunteers (N = 235) completed a 3-hr battery of neuropsychological tests and a computerized cognitive assessment system. Participants were classified as impaired (n = 78) or unimpaired (n = 157) on the basis of the Mini Mental State Exam, Wechsler Memory Scale-III and the Trail Making Test (TMT), Part B. All six variables (three memory variables and three executive variables) derived from the computerized assessment differed significantly between groups in the expected direction. There was also evidence of temporal stability and concurrent validity. Application of computerized assessment systems for clinical practice and for identification of research participants is discussed in this article.

Telomere shortening and Alzheimer's disease.

Telomeres, at the ends of chromosomes and strands of genetic material, become shorter as cells divide in the process of aging. Telomere length has been considered as a biological marker of age. Telomere length shortening has also been evidenced as the causable role in age-related neurodegenerative diseases, including Alzheimer's disease (AD). It has been demonstrated that telomere shortening has been associated with cognitive impairment, amyloid pathology and hyper-phosphorylation of tau in AD and plays an important role in the pathogenesis of AD via the mechanism of oxidative stress and inflammation. However, it seems that there is no relationship between telomere shortening and AD. Therefore, it is essential for further clarification of telomere-related pathogenesis in AD.

Opioid system and Alzheimer's disease.

The opioid system may be involved in the pathogenesis of AD, including cognitive impairment, hyperphosphorylated tau, Aß production, and neuroinflammation. Opioid receptors influence the regulation of neurotransmitters such as acetylcholine, norepinephrine, GABA, glutamate, and serotonin which have been implicated in the pathogenesis of AD. Opioid system has a close relation with Aß generation since dysfunction of opioid receptors retards the endocytosis and degradation of BACE1 and γ-secretase and upregulates BACE1 and γ-secretase, and subsequently, the production of Aß. Conversely, activation of opioid receptors increases the endocytosis of BACE1 and γ-secretase and downregulates BACE1 and γ-secretase, limiting the production of Aß. The dysfunction of opioid system (opioid receptors and opioid peptides) may contribute to hyperphosphorylation of tau and neuroinflammation, and accounts for the degeneration of cholinergic neurons and cognitive impairment. Thus, the opioid system is potentially related to AD pathology and may be a very attractive drug target for novel pharmacotherapies of AD.

Oxidative stress and ß-amyloid protein in Alzheimer's disease.

Oxidative stress has been proposed to be an important factor in the pathogenesis of Alzheimer's disease (AD) and contributed to ß-amyloid (Aß) generation. Interaction between oxidative stress and neuro-inflammation leads to Aß generation. AD is associated with an increase in blood-brain barrier (BBB) permeability due to tight junction involvement. Oxidative stress decreases the expression of low-density lipoprotein receptor-related protein 1 and up-regulates receptor for advanced glycation end products in BBB and increases the BBB permeability, which could potentially lead to increased deposition of Aß within AD brain. Apoptosis takes place in the pathogenesis of AD, and oxidative stress contributes to apoptosis through both extrinsic pathway and intrinsic pathway. Oxidative stress-induced apoptosis may be a potential factor to Aß generation. Aß generation requires two sequential cleavages of APP, with the two proteolytic enzymes: ß-secretase and γ-secretase. Oxidative damage up-regulates Aß via inducing activity of ß- and γ-secretases. In this review, we will focus on the mechanism and pathway that oxidative stress contributes to Aß generation.

Role of ethnicity in the expression of features of hot flashes.

The overall goal of this study was to determine the role of ethnicity on features of hot flashes (HFs) in a population of menopausal women in North Central Texas. A total of 397 ethnically diverse menopausal women from North Central Texas were administered our Menopausal Vasomotor Symptoms (MVS) survey to ascertain accurate information about number, length, intensity and behaviorally disruptive effects of hot flash episodes for subsequent analysis for the role of ethnicity in the occurrence of hot flashes. The mean (SD) age for participants was 50.2 (5.3) years; 40% were Caucasian, 38% were African-American and 22% were Hispanic. To evaluate and identify potential associations of hot flash (HF) features, ethnicity, and other independent variables, ordinal/multinomial/binary logistic regression models were used to calculate crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs). The analysis demonstrates strong associations with ethnicity and the number of HF's/day, the length of each HF episode, the intensity of HFs, and the interruption of daily activities and sleep. Ethnicity was important in the crude and adjusted model describing the association between the number of HFs per day and ethnicity. African-American women were 2.22 (95% CI, 1.38-3.56) times and Hispanic women were 1.85 (95% CI, 1.08-3.18) times more likely to experience more frequent HFs per day than Caucasian women. In contrast, Hispanic women were less likely than Caucasian women to experience sweating and disruption of both daily activities and sleep. Collectively, our results show more frequent and more bothersome HFs in African-American women and more frequent, but less intense and bothersome HFs in Hispanic women in comparison to Caucasian women.

Association of various dimensions of hot flashes with systemic levels of gonadal steroids.

Hot flashes, the cardinal sign of menopausal vasomotor symptoms, are experienced by millions of women. The experience of hot flashes is characterized by significant inter- and intra-individual variability among women. The goals of this study were to compare concentrations of gonadal hormones between menopausal women with hot flashes (HF) and those with no HF, and to characterize the association between steroid levels and multiple dimensions of hot flashes. Menopausal women, with HF and with no HF, participated in four study sessions, one every 2 months. The Menopausal Vasomotor Symptom (MVS) survey was used to collect subjective data on various dimensions of hot flashes. Concentrations of gonadal hormones were measure at each bi-monthly session. Steroid levels were correlated to duration, frequency, length of each episode, timing, intensity, and bothersomeness of hot flashes. Data from twenty (n = 20) women with HF and fifteen (n = 15) with no HF with similar demographic profiles were analyzed. The results from the present study showed that systemic levels of estrone and progesterone were significantly lower in women experiencing HF than in asymptomatic women. There was a significant association between levels of estradiol, estrone, progesterone, and androstenedione, but not testosterone, with duration, frequency, timing, intensity, and bothersomeness of HF. The findings from this preliminary study suggest that management of symptoms associated with vasomotor HF should be individualized and guided by two factors: (i) thorough assessment of subjectively reported multiple dimensions of hot flashes, and (ii) levels of circulating gonadal steroids representing an average from 2-4 measures. This approach may lead to more targeted, effective, and safe management of vasomotor symptoms in the rapidly growing population of menopausal women.

Oxidative damage and sensitivity to nociceptive stimulus and opioids in aging rats.

Oxidative stress contributes to aging and may cause alterations in pain and analgesia. Knowledge about effects of oxidative stress on the opioid system is very limited. This project was designed to determine the relationship between age-related oxidative damage and opioid antinociception. Three age groups of male Fischer 344 rats were tested for pain sensitivity and responses to morphine and fentanyl using the hot plate method. Oxidative stress markers in various brain regions were measured. With advancing age, nociceptive threshold and antinociceptive effects of opioids decreased significantly. There was a significant negative correlation between morphine antinociception and protein oxidation in cortex, striatum, and midbrain (r(2)=0.73, 0.87, and 0.77, respectively), and lipid peroxidation in cerebral cortex, hippocampus, and striatum (r(2)=0.73, 0.61, and 0.71, respectively). Similar correlation was observed between oxidative stress markers and fentanyl antinociception. These findings demonstrate that the age-related increase in oxidative damage in brain is associated with a significant decrease in the antinociceptive effects of opioids.

Treatment of vasomotor symptoms in the menopausal transition and postmenopausally: psychiatric comorbidity.

This article aims to educate the nonpsychiatric as well as the psychiatric clinician on the impact of vasomotor symptoms in women with comorbid psychiatric problems and the challenges of treating vasomotor symptoms in these women. The pathophysiology, prevalence and common risk factors associated with disturbing hot flashes in the menopausal transition are reviewed. Hormonal, nonhormonal and behavioral treatment options of vasomotor symptoms for these women are discussed. Special pharmacokinetic implications for hormonal treatment of those women on anticonvulsant medications for the treatment of their mood disorders, on tamoxifen and/or with high or low sex hormone-binding globulin are examined. An in-depth discussion of mood and the menopausal transition, theoretical mechanisms for mood problems with the symptomatic menopause and the impact of stress on the symptomatic menopause are found elsewhere in this clinical review series on psychiatric illness, stress and the symptomatic menopause.

Changes in opioid receptor proteins during mitochondrial impairment in differentiated SK-N-SH cells.

Aging and neurodegenerative diseases are associated with oxidative damage that may contribute to changes in neurosensory processing, including pain. The effects of neuronal oxidation on the opioid receptor system are poorly understood. Earlier, we have reported that 3-nitroproprionic acid (3-NPA)-induced oxidative stress and impairment of mitochondrial energy metabolism significantly reduced the function of mu but not delta opioid receptors [A. Raut, M. Iglewski, A. Ratka, Differential effects of impaired mitochondrial energy production on the function of mu and delta opioid receptors in neuronal SK-N-SH cells, Neurosci. Lett. 404 (2006) 242-246]. In the present study, we studied the effects of 3-NPA-induced oxidative stress on protein levels of the mu, delta, and kappa opioid receptors (MOR, DOR, and KOR, respectively). The opioid-responsive differentiated SK-N-SH neuronal cells were used as an in vitro model. Cells were exposed to 0, 5, 10, and 20mM of 3-NPA for 0, 1, 2, 12, and 24h. After the 3-NPA treatments, plasma membrane preparations were made and used for the Western blot assay. There was a significant reduction in the level of the MOR protein while levels of DOR and KOR proteins remained unaffected after exposure to 3-NPA. These findings demonstrate for the first time that there is a selective impairment of the MOR protein under conditions of mitochondrial oxidative damage at the neuronal level. The reduction in the level of the MOR protein may contribute to the impairment of MOR function under oxidative damage conditions shown in our previous study.

Differential effects of impaired mitochondrial energy production on the function of mu and delta opioid receptors in neuronal SK-N-SH cells.

Oxidative stress contributes to changes in neurosensory processing, including pain, that occur during aging and neurodegeneration. The effects of neuronal oxidation on the opioid system are poorly understood. In this in vitro study, oxidative stress was induced by 3-nitroproprionic acid (3-NPA) in opioid-responsive differentiated SK-N-SH cells. Changes in the inhibitory effects of opioid receptor agonists on intracellular cAMP were used as a marker of the function of mu and delta opioid receptors (MOR and DOR, respectively). Cells were treated with morphine and selective MOR and DOR agonists and antagonists to characterize the function of each receptor subtype. Cyclic AMP (cAMP) was measured by enzyme immunoassay. Levels of reactive oxygen species (ROS) were assessed using the 2',7'-dichlorofluorescin diacetate assay. Exposure of cells to 3-NPA resulted in an increase in ROS. After 3-NPA exposure, there was a significant attenuation of the inhibitory effect of morphine and DAMGO but not of DPDPE on cAMP. In cells pretreated with CTOP, 3-NPA did not change the inhibitory effect on cAMP. These findings demonstrate for the first time that under conditions of mitochondrial damage, the function of MOR is significantly decreased, while the function of DOR does not change, suggesting that the effect of 3-NPA on opioid receptors is subtype-specific.

Menopausal Vasomotor Symptoms (MVS) survey for assessment of hot flashes.

OBJECTIVES: During the menopause, 65%-80% of women experience hot flashes. Hot flashes can also occur after hysterectomy and may be experienced during cancer therapy. A very limited assessment of hot flashes is provided by currently available menopausal instruments. This study was performed to evaluate a new Menopausal Vasomotor Symptoms (MVS) survey as an instrument for a comprehensive and subjective assessment of hot flashes. METHODS: The MVS survey was designed to assess multiple dimensions of hot flashes and to be simple and easy to administer. Hot flashes and associated conditions were addressed with 39 closed-ended questions. Sixty-one qualified women, 40-58 years old, from the Dallas, Fort Worth Metroplex area were enrolled. Women experiencing hot flashes took the survey at baseline and then 14 days, 2 months, and 6 months later. Factor analysis was performed. Face and content validity, internal consistency, test-retest reliability, and sensitivity to changes were evaluated. RESULTS: Fifty-two women (85.2%) completed all study sessions. The MVS survey was found to have good face and content validity and good internal consistency (rhoKR = 0.87). Spearman rank-order correlation coefficients at the 14-day retest varied from 0.58 to 1.00. As a result of these analyses, the MVS survey was further refined. CONCLUSIONS: The MVS survey was found to be comprehensive, simple, valid, reliable, sensitive, and a convenient instrument for subjective assessment of various characteristics of hot flashes. The MVS survey may serve as a valuable clinical and research tool for measurement of hot flashes.