Tag: pubmed

J Anim Sci. 2021 Nov 9:skab330. doi: 10.1093/jas/skab330. Online ahead of print.

ABSTRACT

A total of 360 weanling barrows (Line 200 ×400, DNA, Columbus NE; initially 5.6 ± 0.03 kg) were used in a 42-d study to evaluate yeast-based pre- and probiotics (Phileo by Lesaffre, Milwaukee, WI) in diets with or without pharmacological levels of Zn on growth performance and antimicrobial resistance (AMR) patterns of fecal Escherichia coli. Pens were assigned to 1 of 4 dietary treatments with 5 pigs per pen and 18 pens per treatment. Dietary treatments were arranged in a 2 × 2 factorial with main effects of yeast-based pre- and probiotics (none vs. 0.10% ActiSaf Sc 47 HR+, 0.05% SafMannan, and 0.05% NucleoSaf from d 0 to 7, then concentrations were lowered by 50% from d 7 to 21) and pharmacological levels of Zn (110 vs. 3,000 mg/kg from d 0 to 7, and 2,000 mg/kg from d 7 to 21 with added Zn provided by ZnO). All pigs were fed a common diet from d 21 to 42 post-weaning. There were no yeast ×Zn interactions or effects from yeast additives observed on any response criteria. From d 0 to 21, and 0 to 42, pigs fed pharmacological levels of Zn had increased (P < 0.001) ADG and ADFI. Fecal samples were collected on d 4, 21, and 42 from the same three pigs per pen for fecal dry matter (DM) and AMR patterns of E. coli. On d 4, pigs fed pharmacological levels of Zn had greater fecal DM (P = 0.043); however, no differences were observed on d 21 or 42. E. coli was isolated from fecal samples and the microbroth dilution method was used to determine the minimal inhibitory concentrations (MIC) of E. coli isolates to 14 different antimicrobials. Isolates were categorized as either susceptible, intermediate, or resistant based on Clinical and Laboratory Standards Institute (CLSI) guidelines. The addition of pharmacological levels of Zn had a tendency (P = 0.051) to increase the MIC values of ciprofloxacin; however, these MIC values were still well under the CLSI classified resistant breakpoint for Ciprofloxacin. There was no evidence for differences (P > 0.10) for yeast additives or Zn for AMR of fecal E. coli isolates to any of the remaining antibiotics. In conclusion, pharmacological levels of Zn improved ADG, ADFI, and all isolates were classified as susceptible to ciprofloxacin although the MIC of fecal E. coli tended to be increased. Thus, the short-term use of pharmacological levels of Zn did not increase antimicrobial resistance. There was no response observed from live yeast and yeast extracts for any of the growth, fecal DM, or AMR of fecal E. coli criteria.

PMID:34752618 | DOI:10.1093/jas/skab330

J Gerontol B Psychol Sci Soc Sci. 2021 Nov 9:gbab212. doi: 10.1093/geronb/gbab212. Online ahead of print.

ABSTRACT

OBJECTIVES: This study investigates longitudinal within-person associations between urinary incontinence (UI) and depressive symptoms among older women. Drawing on activity theory, this study also adds to limited knowledge about the mediating role of physical activity and social engagement in the association between UI and depressive symptoms.

METHOD: Using six waves of a nationally representative longitudinal study of older adults in Korea between 2008 and 2018, this study examined the relationship between UI and depressive symptoms among women aged 70 and over. Fixed effects models were estimated to account for unobserved time-invariant confounding factors. Sobel mediation tests were conducted to formally test for mediation.

RESULTS: Fixed effects estimates showed that, after adjusting for a wide array of time-varying covariates, having UI is positively associated with depressive symptoms among older women (b = 0.238, p < 0.05). Results revealed that individuals who begin to experience UI tend to have less frequent social interactions and participate in fewer social activities. UI, however, is only marginally associated with a decrease in physical activity. Reductions in physical activity, social connections, and social activities jointly explain about 22% of the association between UI and depressive symptoms, rendering it statistically insignificant.

DISCUSSION: UI poses a threat to psychological well-being among older women. This is partly explained by a decrease in physical activity and disruption in social engagement. This study reaffirms the significance of the programs that promote physical and social activity among older adults.

PMID:34752603 | DOI:10.1093/geronb/gbab212

Biostatistics. 2021 Nov 9:kxab037. doi: 10.1093/biostatistics/kxab037. Online ahead of print.

ABSTRACT

Multimorbidity constitutes a serious challenge on the healthcare systems in the world, due to its association with poorer health-related outcomes, more complex clinical management, increases in health service utilization and costs, but a decrease in productivity. However, to date, most evidence on multimorbidity is derived from cross-sectional studies that have limited capacity to understand the pathway of multimorbid conditions. In this article, we present an innovative perspective on analyzing longitudinal data within a statistical framework of survival analysis of time-to-event recurrent data. The proposed methodology is based on a joint frailty modeling approach with multivariate random effects to account for the heterogeneous risk of failure and the presence of informative censoring due to a terminal event. We develop a generalized linear mixed model method for the efficient estimation of parameters. We demonstrate the capacity of our approach using a real cancer registry data set on the multimorbidity of melanoma patients and document the relative performance of the proposed joint frailty model to the natural competitor of a standard frailty model via extensive simulation studies. Our new approach is timely to advance evidence-based knowledge to address increasingly complex needs related to multimorbidity and develop interventions that are most effective and viable to better help a large number of individuals with multiple conditions.

PMID:34752610 | DOI:10.1093/biostatistics/kxab037

J Pharm Technol. 2021 Aug;37(4):186-192. doi: 10.1177/87551225211021187. Epub 2021 Jun 4.

ABSTRACT

Background: The role of Idaho and Alaska pharmacists in providing health care services has steadily broadened over recent years. With many new pharmacist-provided health care service possibilities, this study assessed the impact of these advancements on community pharmacies. Objective: The objective of this study was to identify current pharmacist-provided health care services and pharmacist-perceived barriers to providing and billing for these services in Idaho and Alaska community pharmacies. Methods: A questionnaire was developed focusing on 2 areas: providing services and billing for services. Pharmacy students on experiential rotations administered the questionnaires to pharmacists at their rotation sites. Pharmacists at community pharmacy practice sites in Idaho and Alaska completed the questionnaire in an interview format conducted by students. Likert-type scale data were analyzed using descriptive statistics. Because the study did not include a comparator group, no power calculation was conducted. All open-response answers were analyzed independently by 2 researchers and discrepancies in coding open-ended questions were resolved by discussion with a group of 4 researchers. Results: Most pharmacists reported that they already provide non-dispensing services, desired to implement new services, and had confidence in their team’s ability to handle new services. Time and resources were the most cited barriers to providing new services; compensation, company support, and education were the most cited barriers to billing for services. Conclusions: Community pharmacists already provide non-dispensing services and many are looking to provide more services, but barriers of time, resources, compensation, company support, and education will need to be overcome to move forward.

PMID:34752574 | PMC:PMC8255977 | DOI:10.1177/87551225211021187

J Pharm Technol. 2021 Apr;37(2):120-126. doi: 10.1177/8755122520978534. Epub 2020 Dec 2.

ABSTRACT

Objective: To review the efficacy and safety of medications used in the management of steroid-induced psychosis. Data Sources: A comprehensive literature search was conducted using PubMed, MEDLINE, ProQuest, and Scopus between May and October 2020 using the following search terminology: “steroid-induced psychosis” OR “corticosteroid-induced psychosis.” Study Selection and Data Extraction: Definitive cases, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, were included in this review. Geriatric patients >65 years of age, those with a confounding neurological condition such as a traumatic brain or spinal cord injury, or those with active malignancy were excluded. Data Synthesis: A total of 13 patient cases were included in this review, representing 8 male patients and 5 female patients. The mean age at symptom presentation was 42.5 years. Six patients presented with delusions, 5 presented with hallucinations, and 2 presented with both manifestations; 12 patients were managed with an antipsychotic, with haloperidol being the most commonly prescribed, followed by risperidone. One patient was managed with lithium and clonazepam alone. All patients returned to their psychological baseline upon the discontinuation or decreased dose of steroids in combination with Pharmacological intervention, though the time to resolution of symptoms varied significantly. No notable adverse drug events associated with treatments were reported. Conclusions: Steroid-induced psychosis is a serious adverse effect of corticosteroid therapy; however, management strategies that combine a dose reduction or elimination of steroids, in combination with an antipsychotic medication, are effective in resolving this syndrome.

PMID:34752563 | PMC:PMC7953074 | DOI:10.1177/8755122520978534

J Pharm Technol. 2021 Feb;37(1):17-22. doi: 10.1177/8755122520960226. Epub 2020 Oct 14.

ABSTRACT

Background: Mental health conditions (MHCs) may affect a patient’s ability to comply with requirements necessary for safe warfarin use. Objective: To describe warfarin control, defined as time in therapeutic range (TTR), for patients with and without MHCs receiving care through a pharmacist-driven anticoagulation service within a rural community health center system. Methods: Retrospective cohort study of patients on warfarin between January 1, 2014, and December 31, 2017. The primary study endpoint was TTR. Secondary endpoints were the number of international normalized ratios (INRs) per 30 days, percentage of INRs within, above, and below target range, and warfarin-related adverse events. Results: A total of 79 patients were included-37 with and 42 without MHCs. Patients were mostly male (n = 47; 59.5%) and prescribed warfarin for atrial fibrillation (n = 45; 57.0%). There were no differences in overall TTR between those with (59.6%; interquartile range = 41.8-73.4) versus without (63.4%; interquartile range = 46.7-73.6) MHCs (P = .542). Secondary outcomes showed no differences in the frequency or percentage of INRs in, above, or below target range (all P > .05). However, there were about twice as many hemorrhagic complications in the group with MHCs (27% vs 11.9%; P = .149). Conclusion: Patients with MHCs experienced no difference in overall TTR as compared to patients without MHCs. However, there was a non-statistically significant reduction in TTR, which would be consistent with limited existing data and demonstrates possible reproducibility to a rural, underserved patient population. Future research is needed to validate these outcomes.

PMID:34752554 | PMC:PMC7809325 | DOI:10.1177/8755122520960226

J Pharm Technol. 2020 Oct;36(5):179-186. doi: 10.1177/8755122520935532. Epub 2020 Jun 26.

ABSTRACT

Background: Omeprazole is a proton pump inhibitor used to manage gastrointestinal disorders. Special populations may require omeprazole to be given as an oral suspension. Objective: The purpose of this project was to compare the stability of omeprazole in the FIRST kit product to a traditionally compounded omeprazole suspension, when stored in refrigerated unit-dosed syringes. NG tube delivery of the 2 products was also investigated. Methods: Five batches of compounded omeprazole oral suspension and 5 kits of FIRST-Omeprazole were prepared to an initial concentration of 2 mg/mL. Suspensions were aliquoted into 5-mL doses in clear plastic oral syringes, and stored at 2-8 °C. Syringes from each batch were analyzed at baseline and after 7, 14, 21, and 30 days for omeprazole potency using HPLC. To assess suitability for NG tube administration, 20 mL of each suspension were administered through NG tubes (8Fr, 10Fr, and 18Fr), and percent omeprazole recovery assessed. Results: The chemical potency remained within 90-110% for 14 days and 30 days for compounded samples and FIRST-Omeprazole samples, respectively. There was a statistically significant difference in initial concentration; 1.89 mg/mL versus 1.98 mg/mL for compounded and FIRST-Omeprazole, respectively. After 30 days, FIRST-Omeprazole demonstrated 97.20% API recovery. Neither suspension experienced statistically significant loss of potency following NG tube passage. Conclusion: FIRST-Omeprazole suspension may be stored in refrigerated clear luer-lock oral syringes for 30 days. Traditionally compounded omeprazole suspension should be used within 14 days. Both suspensions are suitable for NG tube administration.

PMID:34752549 | PMC:PMC7453476 | DOI:10.1177/8755122520935532

J Pharm Technol. 2020 Oct;36(5):211-217. doi: 10.1177/8755122520939640. Epub 2020 Jul 13.

ABSTRACT

Objective: To provide and identify potential roles and strategies for pharmacy technicians to identify and prevent drug abuse within the pharmacy. Data Sources: Related materials were searched via PubMed and Google Scholar from 2000 to present using search terms: “pharmacy,” “technicians,” “prescription,” “drug,” and “abuse.” Articles describing statistics, warning signs, and prevention strategies for pharmacies were identified through databases and organizations’ sites. Portions of the Ohio Administrative Code on OARRS (Ohio Automated Rx Reporting System), and Pennsylvania prescription drug monitoring program information were also identified. Study Selection and Data Extraction: Relevant sections of the Ohio Administrative Code and OARRS were identified through the Ohio Board of Pharmacy website. Information regarding the Pennsylvania Prescription Drug Monitoring was identified via Pennsylvania’s Department of Health website. Sections of the Combat Methamphetamine Act of 2005 were identified through the Drug Enforcement Administration Diversion website. Resources on drug abuse and prevention statistics were obtained from Drug Abuse.gov and American Society of Health System Pharmacists. Information regarding warning signs were identified from the National Association of Boards of Pharmacy. Data Synthesis: The data provided for identification of potential roles for technicians within efforts to prevent prescription drug abuse, including evaluation of warning signs, involvement in the use of prescription monitoring programs, and in efforts to prevent methamphetamine abuse and diversion. Conclusions: After identifying potential roles for pharmacy technician involvement in the prevention of prescription drug abuse, it is evident that there is a need for further education and training on the subject specific to pharmacy technicians.

PMID:34752547 | PMC:PMC7453478 | DOI:10.1177/8755122520939640

J Pharm Technol. 2021 Feb;37(1):23-29. doi: 10.1177/8755122520952436. Epub 2020 Oct 13.

ABSTRACT

Background: Thioguanine (TG) is available only in the form of 40 mg tablets in the United States, and the patient population in which TG is used comprises mostly children. Recognizing its importance as a therapeutic agent and limited stability data for its compounded preparation, the United States Pharmacopoeia has listed TG in its priority list of compounded preparations monographs. Objective: The goal of the present study was to generate stability data and establish a beyond-use date for compounded TG suspension. Methods: Suspensions were compounded using TG tablets and ORA-Plus and ORA-Sweet as vehicles. A robust high-performance liquid chromatography method was developed and validated. TG and guanine (G) in suspensions were quantified immediately after compounding and at regular intervals for 90 days. Physical stability of suspensions was evaluated by observation of organoleptic properties. Results: Results from the study indicate that average TG levels in suspensions remained above 90% of the starting concentration and G formation was less than 2.5% for 90 days. There was no statistically significant difference in the amount of TG degraded over 90 days between suspensions stored at room temperature and in refrigerated conditions. There was also no statistically significant difference in G concentration of suspensions between day 0 and day 90. Conclusion: TG suspensions are stable for 90 days when stored at room temperature or refrigerated conditions and the beyond-use date can be set to 90 days.

PMID:34752544 | PMC:PMC7809332 | DOI:10.1177/8755122520952436

J Pharm Technol. 2020 Oct;36(5):187-195. doi: 10.1177/8755122520942762. Epub 2020 Aug 26.

ABSTRACT

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are estimated to cost $1.5 billion annually in Canada. Previous studies have shown that barely half of all patients receive ideal care in hospitals. Deviations from guideline-defined optimal care lead to longer hospital stays, readmissions, and increased mortality. Objective: To determine the proportion of patients admitted to hospital for AECOPD who received treatment adherent to guidelines. Methods: A retrospective cohort study was conducted with ethics approval from the University of British Columbia Clinical Research Ethics Board. Patients hospitalized for ≥24 hours with an AECOPD at a tertiary care center and a community hospital were assessed. Guideline-adherent treatment was defined as appropriate use of supplemental oxygen, inhaled bronchodilators, systemic corticosteroids, antibiotics, venous thromboembolism prophylaxis, initiation/continuation of nicotine replacement therapy for current smokers, and vaccination optimization, reflecting international standards of care. Outcomes were assessed using descriptive statistics. Results: A random sample of 210 patients were selected of which 99 met inclusion criteria. Only 4% received therapy that met all recommendations. Differences in management were found between sites, specifically the appropriate use of bronchodilators, corticosteroids, antibiotics, and supplemental oxygen. Venous thromboembolism prophylaxis and smoking cessation rates were 97% and 94%, respectively, at the tertiary care center, compared with 73% and 100% at the community hospital. Additionally, less than half of all patients had their immunization history verified. Conclusion: Gaps in the inpatient management of AECOPD continue to exist. Initiatives must be targeted to optimize management and reduce the burden of the disease.

PMID:34752527 | PMC:PMC7453477 | DOI:10.1177/8755122520942762