The latest medical research on Clinical Pharmacology

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What does a pharmacist do? A time and motion study.

Research in Social

Pharmacists work in many different settings and have various responsibilities. However, pharmacists are expensive and need to be used efficiently. Previous studies have shown that prescription preparation, clinician interaction, and medical record evaluation take a large part of a pharmacist's day. Additionally, it is also estimated that almost half of their time is considered "non-value added," or that their tasks could be performed by a non-pharmacist.

To observe pharmacists in multiple practice settings and record their activities to gauge inefficiencies.

Time and motion methods were used to observe how pharmacists in retail, clinical, hospital, ambulatory, and academic settings perform daily tasks. Data was collected every 5 min for a total of 18 h from each setting, and sorted into 20 general categories of pharmacists' tasks.

Pharmacists spend more time verifying prescriptions than any other activity, accounting for 31% of their time. Other common activities were patient education, charting, counseling, and chart review.

Although most of pharmacists' daily activities add value to the healthcare team, there are ways to use their time more efficiently. Along with delegating tasks to other pharmacy personnel, new initiatives designed to help pharmacists increase time spent on value-added tasks are recommended.

Personality traits and personal values as retail pharmacy choice predictors in the context of pharmaceutical care requirements.

Research in Social

Pharmacists implementing and carrying out Pharmaceutical Care (PhC) need to possess interpersonal ("soft") competencies, similar to physicians, as well as the personality predisposition necessary to maintain effective interpersonal communication involved in a therapeutic relationship. This thesis agrees with John L. Holland's congruence theory according to which the decision to take up a given profession is a specific expression of personality.

The presented study aims to examine the premise that a specific personality may be a predictor for the career choices made by pharmacy students that entail building a therapeutic relationship with the patient as part of practising PhC.

The study was conducted in a group of 211 students at the Faculty of Pharmacy, Medical University in Lublin, ages 21-30 (M = 23.17; SD = 1.26). The reference group (n = 83) was composed of respondents declaring preference for a professional path that implies direct contact with the patient (mainly retail pharmacy in community pharmacies). The control group was composed of students who declared preference for a professional path which does not entail direct contacts with patients. The study employed the Polish version of the NEO-FFI Personality Inventory and the Schwartz Value Survey.

There are three key predictors of choosing a particular form of professional activity implying a direct contact with patients. These include the personality traits of neuroticism and openness to experience (negative predictors), as well as the value meta-category of conservation (the strongest positive predictor).

The presented results suggest the existence of a specific personality characteristic partly favourable for work in direct contact with patients, but not towards the implementation of more innovative forms of practising pharmacy.

Translating the atypical dopamine uptake inhibitor hypothesis toward therapeutics for treatment of psychostimulant use disorders.

Neuropsychopharmacology

Medication-assisted treatments are unavailable to patients with cocaine use disorders. Efforts to develop potential pharmacotherapies have led to t...

Correction: Striato-cortical tracts predict 12-h abstinence-induced lapse in smokers.

Neuropsychopharmacology

The original version of this article contained an error in the affiliation of Dahua Yu, which was incorrectly stated as affiliation 3 (Engineering ...

Multimodal neurocognitive markers of interoceptive tuning in smoked cocaine.

Neuropsychopharmacology

Contemporary neurocognitive models of drug addiction have associated this condition with changes in interoception -namely, the sensing and processi...

Superolateral medial forebrain bundle deep brain stimulation in major depression: a gateway trial.

Neuropsychopharmacology

Short- and long-term antidepressant effects of deep brain stimulation (DBS) in treatment-resistant depression (TRD) have been demonstrated for seve...

Role of THRB, ARG1, and ADRB2 Genetic Variants on Bronchodilators Response in Asthmatic Children.

Journal of Aerosol Medicine and

An interindividual variability in response to short-acting bronchodilator drugs (short-acting inhaled β2-agonists, SABA) exists and this is linked in part to genetic factors. The aim of this study was to verify the influence of single nucleotide polymorphisms (SNPs) of a previously studied gene (ADRB2) and of new candidate genes (THRB and ARG1) on the acute response to SABA in children with asthma.

One hundred asthmatic children (mean age 9.6 ± 3.0 years, 77 boys) underwent allergological and lung function evaluations. Spirometry was performed before and after bronchodilation test (BD test). The ADRB2 region containing the Arg16Gly (rs1042713) and Gln27Glu (rs1042714) variants were amplified by polymerase chain reaction, whereas ARG1 rs2781659 (A>G) and THRB rs892940 (G>A) SNPs were genotyped by high-resolution melting (HRM) analysis.

Seventy-seven percent of children developed asthma in the first 6 years of life. Allergic sensitization was observed in 92% (total immunoglobulin G: 529.8 ± 477. kU/L). All patients exhibited respiratory allergy: 43% has multiple respiratory, 22% to single respiratory, and 27% multiple respiratory and food allergies. Fifty four percent children showed positive BD response (forced expiratory volume in 1 second [FEV1] > 12%). Presence of Arg/Gly or Gly/Gly genotypes in position 16 of ADRB2 was significantly associated to a worse BD response (post-BD FEV1: 108.68% ± 15.62% in Arg/Arg vs. 101.86% ± 14.03% in Arg/Gly or Gly/Gly patients, p = 0.02). No significant association was found between spirometric parameters before and after BD for the other three examined SNPs.

The influence of genetic variability on responsiveness to drugs could become a key parameter to optimize a tailored therapy for young patients with asthma, especially if drug-resistance occurs.

Development of a High-Flow Nasal Cannula and Pharmaceutical Aerosol Combination Device.

Journal of Aerosol Medicine and

Aerosol drug delivery to the lungs is known to be very inefficient during all forms of noninvasive ventilation, especially when the aerosol is administered simultaneously with high-flow nasal cannula (HFNC) therapy. The objective of this study was to develop a new combination device based on vibrating mesh nebulizers that can provide continuously heated and humidified HFNC therapy as well as on-demand pharmaceutical aerosols with high efficiency.

The combination device implemented separate mesh nebulizers for generating humidity (humidity nebulizer) and delivering the medical aerosol (drug nebulizer). Nebulizers were actuated in an alternating manner with the drug nebulizer delivering the medication during a portion of an adult inhalation cycle. Aerosol entered a small-volume mixing region where it was combined with ventilation gas flow and then entered a heating channel to produce small particles that are desirable for nose-to-lung administration and potentially excipient enhanced growth delivery. Three assessment methods (analytical calculations, computational fluid dynamics [CFD] simulations, and in vitro experiments in three-dimensional [3D] printed devices) were used to improve the mixer-heater design to minimize depositional drug losses, maintain a small device volume, ensure sufficient droplet evaporation, and control the outlet thermodynamic conditions.

For an initial configuration (Design 1), good agreement in performance metrics was found using the three assessment methods. Based on insights gained from the CFD simulations of Design 1, two new designs were developed and produced with 3D printing. Experimental analysis indicated that the new designs both achieved <5% depositional loss in the mixer-heater even with cyclic operation and sufficiently dried the aerosol from an initial size of 5.3 μm to an outlet size of ∼1.0 μm. A combination of the applied methods indicated that the desired thermodynamic conditions of HFNC therapy were also met.

Multiple methodological approaches were used concurrently to develop a new combination device for administering HFNC therapy and simultaneous on-demand pharmaceutical aerosols to the lungs with high efficiency. The use of a small-volume mixer-heater (<100 mL), synchronization of the drug nebulizer with inhalation, and small outlet particle size should enable high efficiency lung delivery of the aerosol.

Peginterferon alfa-2a (40 kD) stopping rules in chronic hepatitis B: a systematic review and meta-analysis of individual participant data.

Antiviral Therapy

Peginterferon alfa-2a (PEG-IFN) treatment stopping rules in chronic hepatitis B (CHB) are clinically desirable. Previous studies exploring this topic contained important limitations resulting in inconsistent recommendations within the current treatment guidelines. We undertook a systematic review and individual patient data meta-analysis to identify the most appropriate PEG-IFN treatment stopping rules.

Roche's internal database, PubMed, and conference abstracts were searched for studies that enrolled >50 treatment-naïve patients with CHB who received PEG-IFN treatment for 48 weeks. Stopping rules were identified using receiver-operating characteristic curve analyses and pre-specified biomarker cutoff target performance characteristics (Sensitivity >95%, Specificity >10%, Negative Predictive Value >90%). Robustness of proposed stopping rules was assessed using internal/external validation analyses.

Eight study datasets were included in the meta-analysis (n=1,423; 765 HBeAg-positive, 658 HBeAg-negative patients). In general, performance of HBsAg and HBV DNA cutoffs at Weeks 12 and 24 was similar, and common biomarker cutoffs that met target performance criteria were identified across multiple patient subgroups. For HBeAg-positive genotype B/C and HBeAg-negative genotype D patients the proposed stopping rule is HBsAg >20,000 IU/mL at Week 12. Alternatively, HBV DNA level cutoffs of >8 log10 and >6.5 log10 IU/mL, respectively, can be used instead. The proposed stopping rules accurately identify up to 26% of non-responders.

The meta-analysis demonstrates that early PEG-IFN discontinuation should be considered in HBeAg-positive genotype B/C and HBeAg-negative genotype D patients at Week 12 of treatment based on HBsAg or HBV DNA levels.

Impact of pharmacists' interventions on physicians' decision of a knowledge-based renal dosage adjustment system.

International Journal of Epidemiology

Background Early interventions with clinical decision support system (CDSS) guidance have ensured appropriate drug dosing for patients with renal i...

Impact of an oral nutrition protocol in patients treated with elective radical cystectomy: a long term follow-up.

International Journal of Epidemiology

Background After radical cystectomy, delayed return of bowel function is relatively common. Although studies investigating on the best modality for...