New Models of Care: How Pharmacists Can Provide Better Care at Lower Costs.

Pharmacists, highly trained and accessible health care professionals, continue to be underused in American communities. Helping pharmacists to make the best use of their extensive clinical education and skills is a primary focus for the discipline's leaders. The University of Connecticut School of Pharmacy's PRISM initiative ( PeRformance I mprovement for Safe Medication Management) creates opportunities to partner with other health professionals or programs to advance the pharmacist's role in the community. All stakeholders must understand the evolving health care climate as society moves toward "health care without walls" (i. e., health care that is innovative, convenient, and likely to be entirely different than previous models). This article discusses progress made in Connecticut to advance pharmacy practice and describes programs that, if replicated in other areas of the country, could significantly improve care for vulnerable populations, especially the elderly. Programs that have been especially useful have emphasized the difference between needing medical versus pharmacy services, and approached provision of care in entirely new ways.

Oral health in the long-term care facility.

For a variety of reasons, residents of long-term care facilities often lack basic dental care, leading to poor nutrition, needless pain, medical complications, and unnecessary tooth loss. The "Healthy People 2010" initiative included a goal to reduce the number of older adults who have had all their natural teeth extracted, and increase the proportion of long-term care residents who use the oral health care system each year. Medication is a primary or contributing cause of oral problems. Although the overall incidence of dental disease is decreasing, around 50% of adults have some signs of periodontal disease; 35% have some root damage. Poor oral health in long-term care facilities has numerous causes and tragic results. Several steps, including calcium and vitamin D supplementation and careful medication monitoring can help prevent tooth loss, combat caries, and decrease periodontal disease.

An overview of small-molecule inhibitors of VEGFR signaling.

VEGFR inhibitors are in broad use for the treatment of metastatic renal-cell carcinoma, gastrointestinal stromal tumors and hepatocellular carcinoma and in development in a number of other oncology indications, including colorectal cancer, non-small-cell lung cancer, pancreatic cancer, thyroid malignancies, ovarian cancer, breast cancer and sarcomas. This Review outlines the structure-activity relationships of the 44 VEGFR inhibitors currently in development. An overview of the pharmacokinetic profile of each molecule and its stage in development is provided. Phase III clinical trials being conducted for licensing of these agents for specific indications and phase III developmental efficacy trials are described in detailed tables that include the disease studied, trial design including combination therapy, study end points, and projected or final accrual. The relative frequency of on-target and off-target adverse events observed in 3,060 patients is described for a subset of agents in development in clinical trials sponsored by the National Cancer Institute. No interagent comparisons were undertaken and no data from pharmaceutical pharmacovigilance databases were used. The on-target effects seem to be mechanistically based and predicted by VEGFR inhibition. Small-molecule inhibitors of angiogenesis are active in a wide variety of malignancies and fill a unique niche for cancer therapeutics.

From chronobiology to chronotherapeutics.

Chronobiology focuses on variations in biological rhythms across time. This article describes biologic cycles, particularly circadian cycles and their underlying neuroanatomy. Metabolic rhythms are reviewed and their impact on disease and symptom variation discussed. Clinical and chronopharmacological implications and diagnostic applications are presented, highlighting chronotherapy's perspective.