Optimal management of distal ureteric strictures following renal transplantation: a systematic review.

Our objective was to define optimal management of distal ureteric strictures following renal transplantation. A systematic review on PubMed identified 34 articles (385 patients). Primary endpoints were success rates and complications of specific primary and secondary treatments (following failure of primary treatment). Among primary treatments (n = 303), the open approach had 85.4% success (95% CI 72.5-93.1) and the endourological approach had 64.3% success (95% CI 58.3-69.9). Among secondary treatments (n = 82), the open approach had 93.1% success (95% CI 77.0-99.2) and the endourological approach had 75.5% success (95% CI 62.3-85.2). The most common primary open treatment was ureteric reimplantation (n = 33, 81.8% success, 95% CI 65.2-91.8). The most common primary endourological treatment was dilation (n = 133, 58.6% success, 95% CI 50.1-66.7). Fourteen complications, including death (4 weeks post-op) and graft loss (12 days post-op), followed endourological treatment. One complication followed open treatment. This is the first systematic review to examine the success rates and complications of specific treatments for distal ureteric strictures following renal transplantation. Our review indicates that open management has higher success rates and fewer complications than endourological management as a primary and secondary treatment for post-transplant distal ureteric strictures. We also outline a post-transplant ureteric stricture evaluation and treatment algorithm.

Smoking quit rates among patients receiving pharmacist-provided pharmacotherapy and telephonic smoking cessation counseling.

OBJECTIVES: Tobacco use is the nation's leading cause of preventable illness and death, causing a significant burden on the health care system. Many cessation pharmacotherapy treatment options are available to help smokers quit, including nicotine replacement therapies (NRTs) and prescription medications. Research indicates that pharmacists are able to provide a positive benefit to smokers who want to quit through pharmacologic and nonpharmacologic interventions. The aim of the present work was to examine the quit rates among participants who received smoking cessation pharmacotherapy and pharmacist-provided telephone-based quit counseling services. DESIGN: Retrospective database review of enrolled participants. SETTING: Telephone-based pharmacotherapy and medication counseling services offered from a medication management center. PARTICIPANTS: State employees who voluntarily contacted a medication management center for smoking cessation services after receiving promotional flyers. MAIN OUTCOME MEASURES: Long-term quit rates at 7 and 13 months were determined by means of patient self-report in response to questioning. Smoking cessation was considered to be a success if the patient reported not smoking for the past 30 days. RESULTS: A total of 238 participants were included in the review. Thirty-nine participants completed the program after the first treatment, 12 participants after the second treatment, and 4 participants after the third treatment. Two patients completed the program more than once. Eighty-five participants (36%) reported results at 7-month follow-up; of these, 43 (51%) were smoking free. A total of 44 participants (18%) reported results at 13-month follow-up; of these, 24 participants (55%) reported being smoking free. There were no significant differences in the percentages of smoking-free participants at 7 or 13 months, regardless of their first treatment (P = 0.06 and 0.345, respectively). CONCLUSION: Successful quit rates were higher than previously demonstrated with other telephone-based smoking cessation programs. Therefore, pharmacist-provided telephone-based counseling may be beneficial in helping patients to quit smoking. Future research is warranted to examine the benefits of these types of programs.

Development of a pharmacy capstone course from focus groups to advanced patient care.

OBJECTIVE: To describe the development of a capstone course using qualitative results of focus groups and to determine the impact of the course using a pre- and postcourse surveys. DESIGN: A course titled Advanced Patient Care was developed using themes emerged from 3 stakeholder focus groups and implemented with case-based sessions, interactive exercises, and Objective Structured Clinical Examinations (OSCEs). Pre- and postcourse surveys were conducted to assess the students' confidence and knowledge in managing 8 commonly-encountered conditions. ASSESSMENT: During the 2-year course implementation, a total of 169 students participated in the pre- and postcourse surveys (87.6% response rate). The mean total confidence score increased significantly from 54.3 (±9.2) to 69.0 (±8.6, p < 0.001), and the total mean knowledge score increased significantly from 6.3 to 6.9 (p < 0.001). CONCLUSION: The capstone course, fueled by focus group findings and implemented using interactive sessions and simulations, positively impacted students' confidence and knowledge for clinical practice experiences and professional practice.