The latest medical research on Clinical Pharmacology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about clinical pharmacology gathered by our medical AI research bot.
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Generosity, collegiality, and scientific accuracy when writing and reviewing original research.Research in Social
In spite of concerns about the lack of recognition for its conduct, peer review remains the backbone of scientific evaluation and advancement of sc...
Unifying a profession and a health care system: Building the case for a "one pharmacy" global community.Research in Social
The rational use of medicines to achieve better patient outcomes is a global concern. This need has pressured the practice of pharmacy to move away...
Community pharmacist led medication reviews in the UK: A scoping review of the medicines use review and the new medicine service literatures.Research in Social
Medicines Use Reviews (MURs) and the New Medicine Service (NMS) are services delivered by UK community pharmacists to improve adherence, improve patient understanding of their medicines and reduce medicines wastage.
In this scoping review we aim to identify, map and critically examine the nature of existing empirical evidence in peer reviewed journals relating to MUR and NMS consultations.
Systematic searches identified the available MUR and NMS empirical literature. We sought data on barriers and facilitators to conducting MUR or NMS consultations, the perceptions of pharmacists and patients, the conduct of consultations, and outcomes of consultations. Searches from 2005 (when MURs were introduced) to May 2018 were conducted in MEDLINE, PsycINFO, Embase and Scopus databases. Data were extracted into Excel for examination of study characteristics, participant characteristics, type of intervention/services delivered and key study quantitative and/or qualitative findings.
Forty-one papers from 37 studies met the inclusion criteria: 28 papers were of MURs, 10 of NMS and 3 for both services. Studies focused on the introduction and implementation of these services, with little attention to outcomes for patients; effectiveness was not evaluated beyond in a single NMS RCT. Observational data indicated that pharmacists and patients view MURs and the NMS positively, despite challenges implementing these services and apparent lack of communication between pharmacists and GPs. Consultations were reported to be short, typically 10-12 min, characterised by limited engagement with patients and their health problems. The extent and nature of advice on health behaviours during consultations or other content was rarely examined.
The research literature on MURs and the NMS has developed slowly. There is much scope for further research attention to developing more patient-centred care.
The uses and expenses of antihypertensive medications among hypertensive adults.Research in Social
The literature lacks information about the use and cost of prescribed antihypertensive medications, especially by the type and class of medication prescribed.
This study investigated the uses and expenses of antihypertensive medications among hypertensive adults in the United States.
Using the 2014-2015 Medical Expenditure Panel Survey data, adult men and nonpregnant women aged 18 or older who had a diagnosis code of hypertension and used any prescribed antihypertensive medication were included in the study (n = 10,971). Adults with hypertension who were using a single antihypertensive medication were defined as single medication users, and those using two or more medications were defined as multiple medication users. Medications were classified into angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), thiazide-type diuretics (TDs), β-blockers (BBs), and others. The average annual total antihypertensive medication expenses and the expenditures of each medication class were estimated by using generalized linear models with a log link and gamma distribution and were adjusted to 2015 US dollars.
Among 10,971 hypertensive adults, 4759 (44.1%) were single medication users, and 6212 (55.9%) were multiple medication users. The average annual total cost for antihypertensive medications was $336 per person (95% confidence interval [CI] = $319-$353); $199 (95% CI = $177-$221) for single medication users and $436 (95% CI = $413-$459) for multiple medication users. The average annual costs for each medication class were estimated at $438 (95% CI = $384-$492) for ARBs and $49 for TDs (95% CI = $44-$55).
Users of multiple medications incurred more than twice the expense than single medication users. When comparing classes of medications, the cost for ARBs was the highest, whereas the cost for TDs was the lowest. This information can be used in evaluating the cost-effectiveness of antihypertension therapies.
Implementing screening interventions in community pharmacy to promote interprofessional coordination of primary care - A mixed methods evaluation.Research in Social
Screening is a critical component of efforts to reduce the population burden of cardiovascular disease (CVD), by facilitating early use of cost-effective prevention and treatment strategies. While international evidence suggests that screening in community pharmacies improves screening access and identifies at-risk individuals, concerns from medical organisations about the absence of interdisciplinary coordination and related lack of continuity of care with general practice have significantly contributed to reluctance from some stakeholders to endorse, and engage with, pharmacy-based screening initiatives. The Cardiovascular Absolute Risk Screening (CARS) study was designed to address these challenges and promote an interprofessional approach to screening for cardiovascular disease risk by pharmacists. This study describes the impact of the CARS implementation model on interdisciplinary coordination and continuity of care.
In addition to clinical training, pharmacists at eleven participating pharmacies were provided with implementation training, resources and support to promote interprofessional coordination. Completion of training and pharmacy implementation plans, both of which highlighted GP engagement strategies, were pre-requisites for screening commencement. Using mixed methods approaches, data were analyzed from screening records (n = 388), researcher interviews with patients at 6-10 weeks post-screening (n = 248, 64%), and pharmacist interviews (n = 10).
Screening records suggested that 94% of screened individuals were advised to seek formal GP assessment, and 98% consented to sharing of results. Among interviewed participants, 81% recalled direct pharmacist action to facilitate GP engagement. Among interviewees who had seen their GP already (n = 70), 79% reported that their GP was aware of the results (another 16% were uncertain). Pharmacists reported positive GP feedback stemming from efforts at early engagement, but an absence of ongoing collaboration.
Use of implementation planning by pharmacists, alongside clinical training, can effectively promote an interdisciplinary coordination focus by pharmacists.
Medication rebates and health disparities: Mind the gap.Research in Social
Compared to white patients in the United States, people of racial and ethnic minority groups face higher rates of chronic disease including diabete...
Discharge report for the community pharmacist: Development and validation of a prototype.Research in Social
The potential benefit of community pharmacist's involvement in continuity of care is well-known. However, it is not standard practice to exchange information with the community pharmacist (CP) after hospitalization.
To construct and validate an evidence-based prototype of a discharge report for the community pharmacist.
First, a review of literature, guidelines and established initiatives was performed to construct a preliminary discharge report. Secondly, the content of the discharge report was reviewed and optimized using semi-structured individual interviews with CPs and general practitioners (GPs).
The review identified six guidelines for information exchange with the CP originating from three countries, 17 research papers and three local initiatives. Overall, 49 different elements for a discharge document were identified. Based on recurring elements, a preliminary discharge report was created. Interviews with ten CPs and nine GPs provided insights into which information is considered crucial for patient safety and why. This allowed an optimization of the document. The final discharge report consists of three categories: administrative, medication and medical data. The medication data includes medication registered at hospital admission as well as at hospital discharge, drug indications, reasons for initiating, adjusting or discontinuing therapies and start/stop dates. The medical data contains reasons for hospitalization, comorbidities and allergies.
The literature review and semi-structured interviews resulted in an evidence-based prototype of a discharge report for the community pharmacist. This document contains both administrative, medical and medication data.
Physician-pharmacist collaboration on chronic non-cancer pain management during the opioid crisis: A qualitative interview study.Research in Social
Management of chronic non-cancer pain is complex, requiring clinicians to balance pain management with the risk of opioid abuse. The role of ambulatory care pharmacists in chronic pain management is well-established, but little research has explored the feasibility of building collaboration on chronic pain and opioid management between physicians and community pharmacists.
To explore physician and pharmacist perspectives on the opioid crisis and the possibility of physician and community pharmacist collaborations to manage chronic non-cancer pain in the context of the opioid crisis.
Semi-structured interviews were performed with a snowball convenience sample 15 physicians and 25 pharmacists in North Carolina between November 2016 and April 2017. Transcribed data were analyzed using applied thematic analysis, and resulting codes were organized into themes and domains which emerged from analysis.
Both physicians and pharmacists described current care deficiencies and steps needed to mitigate opioid abuse and diversion. Physicians discussed the need for additional supports and resources for chronic pain management and regarded positively the role of the community pharmacist in chronic pain management and mitigating opioid abuse. Pharmacists identified cost as the major barrier to implementing new services, and expressed willingness to participate in new chronic pain and opioid interventions.
Within the study sample, strong interest exists for collaboration between physicians and community pharmacists. This highlights a potential opportunity to expand care for patients with chronic non-cancer pain.
Developing a grass-roots method for monitoring medicines shortages in southern Africa: Report of a pilot in Namibia.Research in Social
Shortages of medicines is a global problem that can have significant impact on health outcomes of patients and reduce the effectiveness of public h...
Erratum: The hot patient: acute drug-induced hyperthermia [Correction].Australian Prescriber
[This corrects the article DOI: 10.18773/austprescr.2019.006.].
Lean mass declines consistently over 10 years in people living with HIV on antiretroviral therapy, with patterns differing by sex.Antiviral Therapy
The long-term trajectory of and factors affecting lean mass in people living with HIV (PLWH) are incompletely described.
PLWH in the Modena HIV Metabolic Cohort underwent dual-energy X-ray absorptiometry (DXA) scans every 6-12 months for up to 10 years (median 4.6 scans). Mixed effect regression modeling in combined and sex-stratified models determined annual rates of and clinical factors significantly associated with appendicular lean mass (ALM).
839 women and 1759 men contributing ≥2 DXA scans had baseline median age 44 years and 14 years since HIV diagnosis; 76% were virologically suppressed on antiretroviral therapy (ART). Baseline median ALM was 16.9 kg for women and 24.8 kg for men. ALM decreased during the study period, with mean yearly ALM loss of -231 g in women and -322 g in men. Less ALM was associated with female sex, age >50 years, detectable HIV-1 RNA, and tenofovir and integrase inhibitor use. Greater ALM was associated with longer ART duration. In sex-stratified models, relationships between ALM and total ART duration and integrase inhibitor use were not significant for women, but the relationship with tenofovir use persisted. For men, AIDS wasting and CD4+ T lymphocyte nadir <200 cells/μL were independently associated with lower ALM.
ALM steadily declined over time in this cohort of PLWH on ART that included a large number of women. HIV- and ART-specific risk factors emerged that varied by sex. The observed associations between tenofovir or integrase inhibitor use and lower ALM particularly warrant further study.
Shared decision making in chronic medication use: Scenarios depicting exemplary care.Research in Social
Patient-centred care includes patients and their values in the healthcare decision-making process. Shared decision-making is essential for patient ...