Amazon Pharmacy: distraction or disruption?

After years of anticipation about Amazon's rumored entry into pharmacy, Amazon Pharmacy launched in November 2020. What is yet to be understood is whether this new Amazon offering is a true market disruption capable of upending the pharmacy industry. This commentary describes the epic rise of Amazon from bookseller to retail giant, leading to its entry into the retail pharmacy space. Amazon Pharmacy's business model is described and its potential for industry disruption discussed.

Black Lives Do Matter.

Recent Black deaths at the hands of law enforcement officers has heightened awareness of racism within the United States. The consequences of this racism are not only differential policing practices toward Black people, but also inequities related to numerous other sectors, including housing, education, economics, and overt health care disparities between White and non-White Americans. Health care practitioners, including pharmacists, are extremely well positioned to be leaders in addressing long-standing inequities, thereby saving lives and improving access to and quality of care. The views of two senior faculty administrators are outlined: one, a White faculty member of privilege, the other, a Black CEO Dean. Despite having very different life experiences, they partner to foster unity and an antiracist culture within their institution and among their many stakeholders, with the ultimate goal of creating a culture of equity regardless of skin color.

Intravenous to oral conversion of antihypertensives: a toolkit for guideline development.

OBJECTIVE: To provide a toolkit of information for hospitals to use in developing intravenous to oral conversion protocols for antihypertensives. DATA SOURCES: Articles describing intravenous to oral conversion protocols for any therapeutic category were identified in an English-language MEDLINE search (1990-April 2010) using a wide variety of MeSH terms. References from selected articles were reviewed for additional material. STUDY SELECTION AND DATA EXTRACTION: Experimental and observational English-language studies and review articles that focused on oral transition of intravenous drugs were selected. DATA SYNTHESIS: Most of the literature on conversion from intravenous to oral formulations involves antimicrobials. There is considerable evidence documenting reduced costs and improved patient flow through the health-care system following implementing these protocols with drugs like antimicrobials, histamine-2 receptor antagonists, and proton pump inhibitors. Although antihypertensives have not been studied, principles and implementation strategies used for other drug classes can be applied to antihypertensives. Guidance is provided on framing the problem, issues surrounding oral absorption principles, information pertaining to oral conversion in specific disease states, and implementation and documentation strategies. Detailed tables of oral and intravenous antihypertensives are provided. CONCLUSIONS: We recommend that hospitals consider developing protocols on conversion of intravenous to oral antihypertensives in an attempt to reduce unnecessarily prolonged intravenous therapy. Information contained in this article can be used as a toolkit to select information specific to the characteristics of individual health-care systems.

Blood management: a primer for clinicians.

Blood transfusions are common in the hospital setting. Despite the large commitment of resources to the delivery of blood components, many clinicians have only a vague understanding of the complexities associated with blood management and transfusion therapy. The purpose of this primer is to broaden the awareness of health care practitioners in terms of the risks versus benefits of blood transfusions, their economics, and alternative treatments. By developing and implementing comprehensive blood management programs, hospitals can promote safe and clinically effective blood utilization practices. The cornerstones of blood management programs are the implementation of evidence-based transfusion guidelines to reduce variability in transfusion practice, and the employment of multidisciplinary teams to study, implement, and monitor local blood management strategies. Pharmacists can play a key role in blood management programs by providing technical expertise as well as oversight and monitoring of pharmaceutical agents used to reduce the need for allogeneic blood.

A comprehensive approach to faculty development.

The purpose of this report was to describe the development, implementation, and outcomes from 3 complementary programs to facilitate the development of faculty members. The Faculty Development Committee (FDC) at the University of Tennessee developed 3 new complementary programs: the Individual Faculty Development Program to encourage faculty members to assess and identify their own specific developmental needs; the Seed Research Grant Program to fund scholarly activities by faculty; and the Technology Support Program to foster financial support of technology upgrades crucial for meeting the research, education, and service needs of faculty members. Eighteen faculty members participated in the Individual Faculty Development Program during the first 2 academic years and all provided positive feedback about their experiences. The Seed Research Grant Program funded 6 projects during its inaugural year. Limited outcome data from these 2 programs are extremely favorable relative to grant submissions and publications, and enhanced educational offerings and evaluations. The Technology Support Fund was initiated in the 2005-2006 academic year. The 3 faculty development programs initiated are offered as examples whereby faculty members are given a high degree of self-determination relative to identifying programs that will effectively contribute to their growth as academicians. Other colleges of pharmacy are encouraged to consider similar initiatives to foster individual faculty development at this critical period of growth within academic pharmacy.

The futility of the clinical pulmonary infection score in trauma patients.

INTRODUCTION: The Clinical Pulmonary Infection Score (CPIS) has received much attention recently. Advocates have touted its use for the diagnosis and duration of therapy in patients with ventilator-associated pneumonia (VAP). However, little has been written about its utility in trauma patients. The clinical, physiologic, and radiologic components of the CPIS may be difficult to differentiate from the systemic effects of injury. Quantitative cultures of the lower airway have been shown to be efficacious in differentiating VAP from the systemic inflammatory response syndrome (SIRS). In this study, we evaluated the potential use of CPIS as the sole means for diagnosis of VAP in critically injured patients. METHODS: Patients were identified from the VAP database maintained in our Level I trauma center. Only those who had CPIS calculated at the time of bronchoscopy with BAL were included. VAP required >or=10 colonies/mL on quantitative BAL for diagnosis. Antibiotic therapy was based on quantitative BAL results. Patients with <10 colonies/mL were diagnosed with SIRS. Sensitivity and specificity of a CPIS>6 for VAP diagnosis (confirmed by BAL) were calculated. RESULTS: In all, 158 patients underwent 285 BALs. The overall incidence for VAP was 42%. Patients with episodes of VAP and SIRS were well matched for age, Injury Severity Score, APACHE II score, and Glasgow Coma Scale score. The average CPIS was 6.8 in patients with SIRS and 6.9 for those with VAP. Using a CPIS>6 as the threshold for VAP only yielded a sensitivity of 61% and a specificity of 43%. CONCLUSIONS: CPIS cannot differentiate VAP from SIRS in critically injured patients. Using CPIS to initiate antibiotic therapy in trauma patients could be harmful. Whether CPIS is useful to determine duration of antibiotic therapy is unknown.

Fosphenytoin: current place in therapy.

Fosphenytoin is a parenteral phosphate ester prodrug of phenytoin developed to overcome the limitations associated with parenteral administration of phenytoin. Despite potential clinical advantages, pharmacoeconomic concerns have prevented widespread substitution of parenteral phenytoin with fosphenytoin. The purposes of this descriptive review are to (1) highlight recent clinical and pharmacoeconomic data regarding the therapeutic decision to use phenytoin or fosphenytoin for the parenteral management of acute seizures, and (2) discuss the implications of fosphenytoin use in neonatal and pediatric patients. Supporting recent, multidisciplinary, consensus guidelines, it is our opinion that each patient should be evaluated individually to identify those who will benefit most from fosphenytoin. Such patients may include those without intravenous or enteral access, those requiring parenteral therapy with tenuous peripheral intravenous access, and pediatric and neonatal patients. Additionally, institution-specific cost analyses should be done to assure the most appropriate agent is being used, while being sensitive to the potential disparate risk profiles between patient populations. Until the issues of safety relative to cost are objectively ameliorated, individual clinicians will likely use their own experience to dictate the place of fosphenytoin in their respective practices.