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1.
Curr Pharm Teach Learn ; 10(11): 1501-1506, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30514541

RESUMEN

BACKGROUND AND PURPOSE: The Society of Teachers of Family Medicine Group on Pharmacotherapy recommends a formal curriculum during family medicine residency training and describes benefits of utilizing pharmacists. Limited literature exists on how programs have incorporated questions from family medicine board preparation sources into pharmacotherapy academic education. The primary objective was to assess the impact on family medicine residents' perceived knowledge after incorporation of board review items into pharmacotherapy sessions. EDUCATIONAL ACTIVITY AND SETTING: Pharmacists affiliated with the University of Alabama Family Medicine Residency program incorporated questions from board preparation sources into monthly interactive pharmacotherapy sessions as part of a didactic curriculum between 2014 and 2016. An anonymous survey was administered for two consecutive years in 2015 and 2016 to assess residents' perceptions of the sessions and utilization of board-type questions as an active learning component. The change in residents' perception of knowledge was quantitatively analyzed and written comments were evaluated for recurring themes. FINDINGS: The cumulative survey response was 78% (68/87). Over 80% of residents reported that pharmacotherapy sessions and the use of board-type questions was quite or very helpful. The percent of residents that rated their knowledge as good or excellent significantly increased after every session compared to baseline. Residents noted the sessions' information, applicability, interactive nature, and relevance as strengths. SUMMARY: Incorporation of board preparation questions into interactive pharmacotherapy sessions was well received and improved residents' perception of pharmacotherapy knowledge. Utilizing this model in a formal pharmacotherapy curriculum taught by pharmacists is beneficial for family medicine resident learners.

2.
Hosp Pharm ; 50(8): 700-9, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26823619

RESUMEN

BACKGROUND: Pharmacist interventions have been shown to have an impact on reducing readmission rates, however further research is necessary to target resources to high-risk populations and determine the most effective bundle of interventions. OBJECTIVE: To evaluate the effect of a pharmacist-bundled intervention on 30-day readmission rates for high-risk patients with pneumonia. METHODS: A pilot study with a historical control conducted at a community, teaching-affiliated medical center. Up to 65 selected subjects were included if they had pneumonia and any of the following high-risk criteria: admission within 6 months, at least 5 scheduled home medications, chronic obstructive pulmonary disease (COPD), or heart failure. A retrospective chart review was conducted to compile the historical control group that received usual care between June and November 2013. Patients admitted from December 2013 through March 2014 were reviewed to receive a bundled intervention. The primary outcome was 30-day readmission rates. Risk factors and reasons for readmission, pharmacist clinical interventions, and the time interval between discharge and readmission were also evaluated. RESULTS: A trend toward a reduced 30-day readmission rate was observed in the intervention group (n = 43) compared to those who received usual care (n = 65) (27.9% vs 40.0%; relative risk [RR], 0.6977; 95% CI, 0.3965-1.2278; P = .2119). The most commonly identified high-risk inclusion criteria were having at least 5 scheduled home medications and COPD. The time interval between discharge and readmission did not considerably differ between groups (10.8 vs 10.6 days). CONCLUSIONS: The pharmacist-bundled intervention was associated with a reduced 30-day readmission rate for high-risk patients with pneumonia.

3.
Artículo en Inglés | MEDLINE | ID: mdl-24833897

RESUMEN

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic and progressive disease that affects an estimated 10% of the world's population over the age of 40 years. Worldwide, COPD ranks in the top ten for causes of disability and death. Given the significant impact of this disease, it is important to note that acute exacerbations of COPD (AECOPD) are by far the most costly and devastating aspect of disease management. Systemic steroids have long been a standard for the treatment of AECOPD; however, the optimal strategy for dosing and administration of these medications continues to be debated. OBJECTIVE: To review the use of corticosteroids in the treatment of acute exacerbations of COPD. MATERIALS AND METHODS: Literature was identified through PubMed Medline (1950-February 2014) and Embase (1950-February 2014) utilizing the search terms corticosteroids, COPD, chronic bronchitis, emphysema, and exacerbation. All reference citations from identified publications were reviewed for possible inclusion. All identified randomized, placebo-controlled trials, meta-analyses, and systematic reviews evaluating the efficacy of systemic corticosteroids in the treatment of AECOPD were reviewed and summarized. RESULTS: The administration of corticosteroids in the treatment of AECOPD was assessed. In comparison to placebo, systemic corticosteroids improve airflow, decrease the rate of treatment failure and risk of relapse, and may improve symptoms and decrease the length of hospital stay. Therefore, corticosteroids are recommended by all major guidelines in the treatment of AECOPD. Existing literature suggests that low-dose oral corticosteroids are as efficacious as high-dose, intravenous corticosteroid regimens, while minimizing adverse effects. Recent data suggest that shorter durations of corticosteroid therapy are as efficacious as the traditional treatment durations currently recommended by guidelines. CONCLUSION: Systemic corticosteroids are efficacious in the treatment of AECOPD and considered a standard of care for patients experiencing an AECOPD. Therefore, systemic corticosteroids should be administered to all patients experiencing AECOPD severe enough to seek emergent medical care. The lowest effective dose and shortest duration of therapy should be considered.


Asunto(s)
Corticoesteroides/administración & dosificación , Pulmón/efectos de los fármacos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Corticoesteroides/efectos adversos , Progresión de la Enfermedad , Vías de Administración de Medicamentos , Esquema de Medicación , Humanos , Pulmón/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Recuperación de la Función , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
4.
Ann Pharmacother ; 48(2): 258-67, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24259640

RESUMEN

BACKGROUND: Health care professionals, trainees, and patients use the Internet extensively. Editable Web sites may contain inaccurate, incomplete, and/or outdated information that may mislead the public's perception of the topic. OBJECTIVE: To evaluate the editable, online descriptions of clinical pharmacy and pharmacist and attempt to improve their accuracy. METHODS: The authors identified key areas within clinical pharmacy to evaluate for accuracy and appropriateness on the Internet. Current descriptions that were reviewed on public domain Web sites included: (1) clinical pharmacy and the clinical pharmacist, (2) pharmacy education, (3) clinical pharmacy and development and provision for reimbursement, (4) clinical pharmacists and advanced specialty certifications/training opportunities, (5) pharmacists and advocacy, and (6) clinical pharmacists and interdisciplinary/interprofessional content. The authors assessed each content area to determine accuracy and prioritized the need for updating, when applicable, to achieve consistency in descriptions and relevancy. The authors found that Wikipedia, a public domain that allows users to update, was consistently the most common Web site produced in search results. RESULTS: The authors' evaluation resulted in the creation or revision of 14 Wikipedia Web pages. However, rejection of 3 proposed newly created Web pages affected the authors' ability to address identified content areas with deficiencies and/or inaccuracies. CONCLUSIONS: Through assessing and updating editable Web sites, the authors strengthened the online representation of clinical pharmacy in a clear, cohesive, and accurate manner. However, ongoing assessments of the Internet are continually needed to ensure accuracy and appropriateness.


Asunto(s)
Internet , Farmacia , Edición , Educación en Farmacia , Comunicación en Salud , Humanos , Farmacias , Farmacéuticos
5.
Ren Fail ; 34(6): 703-7, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22463708

RESUMEN

Advances in hemodialysis (HD) techniques have increased the potential for drug removal. Quantifying drug clearance in clinical studies for all possible dialysis conditions is impractical, given the variability in dialysis conditions. The purpose of this study was to determine the dialysis clearance (CL(D)) of vancomycin and gentamicin using in vitro and in vivo methods and evaluate the applicability of in vitro data. In vitro dialysis was used to determine the CL(D) of vancomycin and gentamicin under conditions of intermittent HD (IHD) and sustained low-efficiency dialysis (SLED). Two Fresenius polysulfone dialyzers were studied: F180NR for IHD and F50 for SLED. Data were compared with in vivo CL(D) determined in patients with end-stage renal disease receiving IHD and from the literature for SLED. Under IHD conditions, in vitro CL(D) of vancomycin and gentamicin was 131 ± 3 and 154 ± 3 mL/min, respectively, and under SLED condition it was 72 ± 9 and 84 ± 11 mL/min, respectively. These values were 11-27% higher than in vivo CL(D) for IHD (103 ± 15 mL/min for vancomycin and 132 ± 25 mL/min for gentamicin) and SLED (63 mL/min for vancomycin and 76 ± 38 mL/min for gentamicin). There was a statistically significant difference in vancomycin clearance by IHD for the in vitro study compared with in vivo data (p = 0.012), but not for gentamicin (p = 0.18). In vitro methods overestimated in vivo CL(D), but are reasonable to assist with drug regimen design if one considers the limitations.


Asunto(s)
Antibacterianos/farmacocinética , Gentamicinas/farmacocinética , Fallo Renal Crónico/terapia , Diálisis Renal/métodos , Vancomicina/farmacocinética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Soluciones para Diálisis , Femenino , Humanos , Técnicas In Vitro , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos
6.
Clin Ther ; 34(1): 56-66, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22284994

RESUMEN

BACKGROUND: Roflumilast is a newly approved phosphodiesterase-4 inhibitor for the treatment of severe chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis and a history of exacerbations. OBJECTIVE: The objective of this article is to review the pharmacology, clinical efficacy, and tolerability of roflumilast in the treatment of COPD. METHODS: Articles were identified using MEDLINE (1966-August 1, 2011) and EMBASE (1947-August 1, 2011). Searches were conducted using the terms roflumilast and COPD. Included in the search were all English-language clinical trials that were randomized, had durations of >6 weeks, and studied the effects of roflumilast on the forced expiratory volume in 1 second (FEV(1)) or rates of exacerbations in patients with COPD. Abstracts from the annual meetings of the American Thoracic Society, American College of Chest Physicians, and European Respiratory Society were also searched to identify relevant publications. In addition, all pertinent studies evaluating the pharmacokinetics and pharmacodynamics of roflumilast were included. RESULTS: A total of 6 clinical trials (4 publications) evaluating the efficacy of roflumilast were identified and included. For the treatment of COPD, roflumilast was associated with a significant improvement in lung function (increase in FEV(1) of 36-88 mL) when compared with placebo. Roflumilast also reduced the rate of exacerbations in subsets of patients with chronic cough and a history of exacerbations. Overall, health-related quality of life was not significantly affected. Adverse effects were common in clinical trials, with 9% to 16% of patients discontinuing therapy as a result. The most frequently reported adverse effects were gastrointestinal issues, headache, and weight loss. Suicide-related adverse effects have occurred in 5 patients receiving roflumilast and 1 patient receiving placebo. CONCLUSION: Roflumilast significantly improved FEV(1) in clinical trials but had inconsistent reductions in the rates of exacerbations. Comparative studies with recommended therapies for COPD, particularly inhaled corticosteroids, are needed to better assess the role of roflumilast in the management of COPD.


Asunto(s)
Aminopiridinas/uso terapéutico , Benzamidas/uso terapéutico , Pulmón/efectos de los fármacos , Inhibidores de Fosfodiesterasa 4/uso terapéutico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Aminopiridinas/efectos adversos , Aminopiridinas/farmacocinética , Animales , Benzamidas/efectos adversos , Benzamidas/farmacocinética , Ciclopropanos/efectos adversos , Ciclopropanos/farmacocinética , Ciclopropanos/uso terapéutico , Volumen Espiratorio Forzado , Humanos , Pulmón/enzimología , Pulmón/fisiopatología , Inhibidores de Fosfodiesterasa 4/efectos adversos , Inhibidores de Fosfodiesterasa 4/farmacocinética , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/enzimología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
7.
Am J Health Syst Pharm ; 67(12): 1011-5, 2010 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-20516472

RESUMEN

PURPOSE: The successful use of conivaptan for the treatment of symptomatic hypervolemic hyponatremia in a patient with acute decompensated heart failure is reported. SUMMARY: A 67-year-old woman with severe ischemic dilated cardiomyopathy was admitted to the hospital due to a heart failure exacerbation. She was initially managed with furosemide and milrinone, but her condition continued to worsen. By hospital day 10, her serum sodium concentration had decreased to 114 meq/L. A 96-hour trial of conivaptan was initiated, and the patient's serum sodium concentration increased to 125 meq/L, blood urea nitrogen level decreased from 34 to 15 g/dL, serum creatinine concentration decreased from 1.1 to 0.9 g/dL, and fluid balance was -9800 mL. After completion of the 96-hour trial of conivaptan, the patient quickly decompensated. Conivaptan was restarted three days later; again, the patient's sodium level quickly increased, and aquaresis occurred. By hospital day 24, the patient was stable enough to undergo a cardiac catheterization, and a stent was placed. On day 26, the patient died while being prepared for an upgrade to a biventricular implantable cardioverter defibrillator. Multiple trials have evaluated conivaptan for the treatment of heart failure. Conivaptan improves hyponatremia and hemodynamic parameters acutely and increases urine output but has failed to show improvement in heart failure symptoms in the published literature. No adverse cardiac effects resulted from the use of conivaptan in this patient. CONCLUSION: Treatment with i.v. conivaptan in a patient with symptomatic hyponatremia and acute decompensated heart failure resulted in marked diuresis and improvement of hyponatremia.


Asunto(s)
Benzazepinas/uso terapéutico , Insuficiencia Cardíaca/complicaciones , Hiponatremia/complicaciones , Hiponatremia/tratamiento farmacológico , Anciano , Benzazepinas/administración & dosificación , Nitrógeno de la Urea Sanguínea , Cateterismo Cardíaco , Creatinina/sangre , Desfibriladores Implantables , Femenino , Insuficiencia Cardíaca/terapia , Humanos , Inyecciones Intravenosas , Receptores de Vasopresinas/efectos de los fármacos
8.
World Neurosurg ; 74(6): 631-5, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21492631

RESUMEN

OBJECTIVE: Warfarin-related intracranial hemorrhage (ICH) is a devastating complication of warfarin therapy. Several studies have demonstrated successful correction of the international normalized ratio (INR) using prothrombin complex concentrate (PCC) or recombinant activated factor VII (rFVIIa). To our knowledge, no study has directly compared these agents for treatment of warfarin-related ICH. METHODS: We retrospectively reviewed the charts of 15 patients who received rFVIIa and 9 who received PCC for treatment of warfarin-related ICH over a 2-year period. The primary objective was to compare the efficacy of rFVIIa and PCC in correcting the INR to 1.3 or less. Baseline INR was compared to INR obtained within 1, 3, 6, 12, and 24 hours after rFVIIa or PCC administration. RESULTS: Six patients in the rFVIIa group and five in the PCC group had a follow-up INR within 1 hour of agent administration. In the rFVIIa group, the mean INR decreased from 6.1 to 1.1 and from 2.3 to 1.48 in the PCC group. At 6 hours, all rFVIIa patients and six (67%) PCC patients had at least one subsequent INR, with 93% and 50% correcting to an INR of 1.3 or less. Mean dose for all patients included was 53.4 ± 17.5 µg/kg and 27.8 ± 15.4 units/kg for rFVIIa and PCC, respectively. CONCLUSION: Correction of the INR is more reliably obtained with rFVIIa when compared to PCC. Larger, prospective studies comparing these therapies for warfarin-related ICH are needed.


Asunto(s)
Anticoagulantes/efectos adversos , Factores de Coagulación Sanguínea/administración & dosificación , Factor VIIa/administración & dosificación , Hemorragias Intracraneales/tratamiento farmacológico , Warfarina/efectos adversos , Anciano , Coagulación Sanguínea/efectos de los fármacos , Estudios de Seguimiento , Humanos , Relación Normalizada Internacional , Hemorragias Intracraneales/inducido químicamente , Proteínas Recombinantes/administración & dosificación , Estudios Retrospectivos , Resultado del Tratamiento
9.
Expert Rev Clin Pharmacol ; 3(5): 601-12, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22111741

RESUMEN

Tolvaptan is a new vasopressin antagonist developed for the treatment of hypervolemic or euvolemic hyponatremia. It has greater affinity for the V(2) receptor than native vasopressin or any other vasopressin antagonist. Blockade of the V(2) receptor induces solute-free water excretion without affecting normal electrolyte excretion. The pharmacokinetics and pharmacodynamics of tolvaptan are suitable for once-daily dosing. Throughout all phases of clinical studies, it was shown to be safe for short- and long-term use. Tolvaptan effectively increases serum sodium levels in patients with heart failure, cirrhosis and syndrome of inappropriate secretion of antidiuretic hormone. In patients hospitalized owing to heart failure, tolvaptan decreased bodyweight, increased urine output and improved dyspnea compared with placebo. However, tolvaptan has not proven to be beneficial for the long-term management of heart failure. Currently, tolvaptan is the only oral agent in its class available in the USA and Europe.

10.
Am J Pharm Educ ; 73(3): 50, 2009 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-19564993

RESUMEN

OBJECTIVES: To describe the integration of a first- and second-year introductory pharmacy practice experience (IPPE) involving direct patient contact in hospitals and clinics as a means of more efficiently using academic and preceptor resources. DESIGN: Two IPPE courses were integrated in fall 2004 to accommodate increasing enrollment in classes and limited clinical practice sites and preceptors, as well as to meet the increased need for students and clinicians to practice principles of self-education. P1 and P2 students interviewed patients and presented patient cases; preceptor expectations were structured by instructional objectives. Student and preceptor course evaluations were assessed from survey data. ASSESSMENT: During the assessment period, all students passed the courses. Following integration of the IPPEs, both courses received positive evaluations from students and preceptors. Initial advanced pharmacy practice experience (APPE) grades for students completing the courses further suggests that the integrated IPPEs were beneficial to students. CONCLUSION: The successful integration of first- and second- year IPPE courses resulted in more efficient use of academic and preceptor resources and created a model for other colleges of pharmacy to consider.


Asunto(s)
Educación en Farmacia , Farmacia , Preceptoría , Práctica Profesional , Curriculum , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Humanos , Servicios Farmacéuticos , Estudiantes de Farmacia
11.
J Asthma ; 46(3): 212-6, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19373625

RESUMEN

Correct use of inhalation devices is one essential component of optimal management of asthma. Several longstanding controversies regarding specific steps to correct use of metered dose inhalers (MDI) include the lung volume when the MDI should be actuated. As a primary objective, literature was reviewed examining this one step in MDI use. Results from six of nine investigations support the need to gently exhale either to functional residual capacity (FRC) or residual volume (RV) before MDI actuation. Literature is also summarized regarding the need to exhale to FRC or RV before inhaling from MDI plus valved holding chambers or other extension devices and from dry powder inhalers. Numerous studies indicate that many patients as well as health care professionals either do not know or forget to exhale to RV or FRC before inhaling asthma medications. Both patients and health care professionals need education to help ensure correct use of MDI and other asthma inhalation devices, including instruction to first exhale gently to RV or FRC before inhaling the medication.


Asunto(s)
Asma/tratamiento farmacológico , Espiración , Nebulizadores y Vaporizadores/estadística & datos numéricos , Asma/fisiopatología , Ensayos Clínicos como Asunto , Humanos , Mediciones del Volumen Pulmonar
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