Background
Pneumonia is a global disorder and a common reason for prolonged hospitalization. Angiotensin‐converting enzyme inhibitors (ACEi) have pleiotropic effects that support a role in modulating ...pneumonia, but results have been controversial.
Objectives
The present study was conducted to elucidate an ACEi‐induced pneumonia benefit in at‐risk neurologically impaired population and to determine whether a mortality benefit exists.
Methods
A cohort study using a large health‐system of 29,011 unique ACEi users and 1635 case patients 65 years of age or older without neurological disorders affecting swallowing who were admitted with community‐acquired pneumonia hospitalization and followed up from January 1, 2015 to December 31, 2019 (5 years). The association between ACEi use and pneumonia hospitalization and mortality were determined after propensity score matching using Cox and logistic regression.
Results
The experimental cohort was 74.9 ± 7.3 years and 51% were male. ACEi users had lower odds of acquiring pneumonia versus ACEi non‐users (odds ratio) 0.72 95% Confidence Interval (CI) 0.51 to 0.99; p = 0.048. The risk of short‐term mortality (<30 days) (HR) 0.42, p < 0.001 and long‐term mortality (≥30 day) (HR) 0.83, p < 0.002 was significantly lower for ACEi users compared with the ACEi non‐users.
Conclusions
ACEi use in patients at risk of pneumonia without neurological swallowing disorders is associated with reduction in hospitalization and lowering of short‐ and long‐term mortality. Given the high incidence of morbidity and mortality associated with pneumonia, and the susceptibility in older populations with underlying cardiovascular or renal disease or social dependencies, our data support the prescribing of ACEi in these populations to reduce pneumonia hospitalization risk as well as short‐ and long‐term mortality.
Background
Non‐steroidal anti‐inflammatory drugs (NSAIDs) are one of the most frequently used medications for pain, even though they increase the risk for adverse cardiovascular events.
Objectives
...The objective of this study was to determine cardiovascular, cerebrovascular, and renal event rates between NSAIDs versus NSAIDs plus misoprostol.
Methods
A population‐based historical cohort of U.S. veterans receiving prescription NSAIDs (1,681,609) versus NSAIDs plus misoprostol (5972 misoprostol users) was followed for 5 years. In an intent‐to‐treat analysis, NSAID and NSAID plus misoprostol groups were compared using propensity score‐weighted Poisson regression models to estimate incident rate ratio (IRR) and Cox regression to estimate hazard ratio (HR).
Results
The most prescribed NSAIDs were diclofenac and ibuprofen. The mean follow‐up was 35.2 ± 14.5 months. There were 439 total cardio‐renal events (5.62/1000 patient‐months) in the NSAID group and 419 patients (5.01/1000 patient‐months) in the NSAID plus misoprostol group (Hazard Ratio (HR): 0.89; 95% confidence interval CI: 0.78–1.019; p = 0.09). The risk of cardiovascular event was lower in the NSAID plus misoprostol group (HR: 0.56; 95% CI: 0.34–0.93; p < 0.0001). Cerebrovascular event rates were lower in the NSAID plus misoprostol group (HR: 0.74; 95% CI: 0.60–0.94, p < 0.0001) and for renal (HR: 0.67; 95% CI: 0.49–0.89, p < 0.0001) events. All‐cause mortality rate was not different between the two groups (HR: 1.05; 95% CI: 0.88–1.25, p = 0.61).
Conclusion
Compared with NSAID use alone, the concomitant use of NSAID plus misoprostol is associated with a reduced risk of NSAID‐induced cardiovascular, cerebrovascular, and renal adverse events. These data support the development of a safer NSAID when combined with misoprostol.
The glucose-dependent secretion of the insulinotropic hormone glucagon-like peptide-1 (GLP-1) is a critical step in the regulation of glucose homeostasis. Two molecular mechanisms have separately ...been suggested as the primary mediator of intestinal glucose-stimulated GLP-1 secretion (GSGS): one is a metabotropic mechanism requiring the sweet taste receptor type 2 (T1R2) + type 3 (T1R3) while the second is a metabolic mechanism requiring ATP-sensitive K(+) (K(ATP)) channels. By quantifying sugar-stimulated hormone secretion in receptor knockout mice and in rats receiving Roux-en-Y gastric bypass (RYGB), we found that both of these mechanisms contribute to GSGS; however, the mechanisms exhibit different selectivity, regulation, and localization. T1R3(-/-) mice showed impaired glucose and insulin homeostasis during an oral glucose challenge as well as slowed insulin granule exocytosis from isolated pancreatic islets. Glucose, fructose, and sucralose evoked GLP-1 secretion from T1R3(+/+), but not T1R3(-/-), ileum explants; this secretion was not mimicked by the K(ATP) channel blocker glibenclamide. T1R2(-/-) mice showed normal glycemic control and partial small intestine GSGS, suggesting that T1R3 can mediate GSGS without T1R2. Robust GSGS that was K(ATP) channel-dependent and glucose-specific emerged in the large intestine of T1R3(-/-) mice and RYGB rats in association with elevated fecal carbohydrate throughout the distal gut. Our results demonstrate that the small and large intestines utilize distinct mechanisms for GSGS and suggest novel large intestine targets that could mimic the improved glycemic control seen after RYGB.
PURPOSEThe perceived demand for and barriers to pharmacist prescribing in the community pharmacy setting were studied.
METHODSQualitative interviews were conducted with 19 consumers, 20 community ...pharmacists, and 8 reimbursement decision-makers from payer organizations between April and June 2015. Respondents were invited to participate in a daylong interview process online. Interviews with consumers and pharmacists were conducted using online bulletin board technology. Telephone interviews were conducted with reimbursement decision-makers. As with all qualitative research, the sample sizes used were restrictive and sufficient to gauge the perceptions of those respondents only. Interview responses were not intended to be generalizable to the groups or populations from which the respondents came.
RESULTSThere was a continuum of interest in pharmacist prescribing across the three constituencies. Consumers were predominantly resistant to the notion; however, one third were more positive about the idea. Community pharmacists were more open, particularly when prescribing was restricted to a limited set of conditions or medications. Reimbursement decision-makers were most receptive to the notion. Key barriers to pharmacist prescribing included low awareness of current pharmacist prescribing authority among consumers, concerns about the adequacy of pharmacist training, potential conflicts of interest when the prescriber was also a dispenser, and potential liability issues.
CONCLUSIONConsumer respondents were generally resistant to the notion of pharmacist prescribing, with most viewing pharmacists as dispensers and not prescribers. Community pharmacists were more open to the idea, while reimbursement decision-makers were the most receptive to the notion of pharmacist prescribing.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
To differentiate angiotensin II receptor blockers (ARBs) by vascular effects and outcomes in trials on cardio-protective endpoints.
MEDLINE searches were conducted from January 2003 to March 2009 ...using the following search terms: renin-angiotensin-aldosterone system (RAAS) blockade or inhibition; angiotensin II receptor blocker (ARBs); cardio-protection; vascular protection; end-organ protection; candesartan; eprosartan, irbesartan; losartan; olmesartan; telmisartan; and valsartan. Ongoing and recruiting clinical trials were identified via Clinicaltrials.gov (July 2008).
Pertinent basic science research and clinical trials with cardiovascular endpoints and information from reviews, American Heart Association 2009 statistics, and The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines were included in this review.
ARBs differ in their vascular protective pleiotropic effects and pharmacokinetic properties, which may contribute to their pharmacological protection to reduce cardiovascular morbidity and mortality, independently of their blood pressure (BP)-lowering effects.
Emerging data show that ARBs are effective in hypertension, left ventricular hypertrophy, postmyocardial infarction, and heart failure. To what extent their pleiotropic effects, independent of BP lowering, contribute to these outcomes will be the focus of research in the coming years. Well-designed, comparative-effectiveness studies are needed to clinically differentiate this class of agents. The future will be marked by multifunctional ARBs that will pharmacologically do more than antagonize the angiotensin type I (AT(1)) receptor.
The University of Utah College of Pharmacy conducted an annual survey to gauge the relationship between multiple dimensions of students' satisfaction, and stress, with the doctor of pharmacy (PharmD) ...program and perceptions of future career plans.
An online survey of professional year one (P1) through professional year four (P4) students was conducted from 2015 to 2019.
There were a total of 953 non-unique survey respondents. The overall response rate was 86.8%. The study population was 51% female and 49% male with a mean age of 26.7 ± 3.3 years. Students were moderately to very satisfied with the curriculum across the four years of the program. Students were highly to moderately likely to recommend the program. Likelihood to recommend the pharmacy career was similar for the P1 and second professional year 2 (P2) but declined over the four years. Students were moderately to neutrally affected by stress, highest in the P2 and third professional year. Financial issues were rated as the highest stress across the four years. Gender was not statistically associated with satisfaction, although women had higher stress impacting their health than men. Likelihood to recommend the PharmD program and pharmacy career was rated higher by younger students.
Student satisfaction with the PharmD program should be a priority since higher education is a service industry. Academic pharmacy should consider whether pedagogical and social mechanisms are in place to ensure that their programs are helping students manage stress and promote satisfaction.
ObjectivesThe study objective was to determine the level and correlates of self-reported medication low adherence in the US general population.SettingA 30 min cross-sectional online survey was ...conducted with a national sample of adults.Participants9202 adults (aged 18+) who had filled at least three or more prescriptions at a community pharmacy in the past 12 months.Primary and secondary outcome measuresSelf-reported medication adherence was measured with the 8-item Morisky Medication Adherence Scale.ResultsLow adherence was reported by 42.0%, 29.4% had medium adherence and 28.6% had high adherence. Low adherence was significantly associated with: lower age, being of Hispanic origin or African-American, having difficulty with healthcare, medication or transportation costs, needing the support of others to access primary care, health limiting activity, using multiple providers, infrequent visits to primary care providers and visiting an emergency department >3 times in last 12 months.ConclusionsA very high level of low medication adherence is seen in the general population, particularly for ethnic minorities, those who use multiple healthcare providers and those who experience barriers to access for regular primary care. As clinical, patient education and counselling, and healthcare policy initiatives are directed to tracking the problem of low medication adherence, these should be priority populations for research and interventions.
Venous thromboembolism (VTE) including deep vein thrombosis (DVT) or pulmonary embolism (PE) is associated with reduced survival, poorer quality of life, and substantial health-care-costs. Limited ...research, primarily qualitative, suggests that those with VTE may have elevated fear of recurrence, and associated emotional dysfunction and distress.
A national online survey was administered to 907 patients who had experienced a VTE event in the past two years. The survey assessed for the prevalence of self-reported bleeding harms associated with VTE, the levels of anxiety, depression, cognitive dysfunction and distress experienced by patients, and a range of potential psychosocial correlates that may be associated with these bleeding or emotional harms.
The majority (63.0%) of respondents had experienced at least one bleeding related harm following their VTE diagnosis, and 40.6% indicated they experienced fear of another clot often or almost all the time. One-in-four (24.7%) and one-in-ten (11.6%) had abnormal levels of anxiety and depression, respectively. Structural equation modeling was used to define two composite latent bleeding harm and emotional harm factors. Emotional and bleeding harms were associated with younger age, a belief that one's health is due to luck, having multiple comorbidities, having a history of prior VTE events, having multiple barriers to VTE care, and experiencing medical mistakes in diagnosis or treatment. Emotional harms were uniquely predicted by having poorer health literacy, having low self-reported medication adherence, belief others are responsible for one's health, and more recent VTE events. Bleeding harms were uniquely predicted by having a lower frequency of primary care provider contact and having a history of switching between warfarin and direct oral anticoagulants for VTE treatment.
The findings show high levels of self-reported bleeding and emotional harms in a general population of VTE sufferers that are clearly associated with readily identifiable demographic, health status, and psychosocial characteristics. These represent targets for intervention and changes in clinical practice.
•In a sample of 907 patients with VTE from across the US, a large proportion experienced bleeding events post VTE diagnosis•VTE patients also had high fears of clot recurrence, and elevated levels of anxiety and depression•Bleeding and emotional harms were associated with a variety of demographic and psychosocial factors•Demographic and psychosocial factors could be used to identify at-risk patients and represent intervention targets
Abstract
Introduction
Bibliometric analysis of publications is a valuable tool for quantification of academic productivity and impact. United States (US) Departments of pharmacy practice scholarship ...by tenure‐track (DPP‐TT) faculty is vital for future evolution of the field.
Objectives
To quantify journal and faculty metrics based on scholarly activity among US DPP‐TT faculty over a 10‐year period.
Methods
A search of PubMed was performed of single terminal‐degree DPP‐TT faculty from January 01, 2010 to 31 December, 2019. DPP‐TT faculty housed in DPP were determined through online published faculty rosters in American Association Colleges of Pharmacy rosters or college/school internet sites. For each DPP‐TT faculty publication, the journal name, journal impact factor (JIF), and number of citations were collected. DPP‐TT faculty members' Hirsch index (
h
‐index) and National Institutes of Health iCite weighted relative citation ratio (RCR) value were determined. Descriptive statistics and analysis of variance were used to compare data across demographic strata.
Results
One hundred and thirty‐seven institutions employed 1805 single terminal‐degree pharmacy practice faculty that produced 12 670 (7.0 ± 16.3/10 years/faculty member) publications. The number of citations/publications was (mean ± standard deviation SD) 24.7 ± 80.8 cited most frequently in medicine, pharmacy education, and drug therapy journals with a JIF of 4.7 ± 11.5. Individual faculty members'
h
‐index was 6.5 ± 8.9 with a mean iCite weighted RCR of 22.1 ± 65.3. Individual metrics increased with academic rank progression (
p
< 0.0001).
Conclusion
These national single terminal‐degree DPP‐TT faculty metrics are similar to other healthcare professions, including publishing in high‐quality medicine, pharmacy education, and drug therapy journals.
Venous thromboembolism (VTE) is a major health care problem. There are common barriers to quality healthcare but are these barriers the same for VTE patients? A national online survey was ...administered to adults who had experienced a recent VTE event. The survey assessed perceptions of VTE care barriers: (1) Difficulty to meet healthcare costs related to VTE care; (2) difficulty to meet costs for VTE prescription medications; (3) difficulty with transportation to get VTE care; and (4) the degree of support of others needed to get VTE care. Each question was correlated with patient demographics including income level, place of residence, current work status, and health insurance; care related patient harms experienced with the VTE episode; number of lifetime VTE events; beliefs concerning VTE outcomes, and oral anticoagulant therapy type. Logistic regression analysis was used to determine the effect of independent variables on barriers to VTE care. Approximately 30% of VTE patients reported at least one significant barrier to VTE care. Patients rated healthcare costs and VTE prescription medication costs mildly difficult. The odds of reporting barriers were positively associated with the number of DVTs experienced in the previous 2 years. VTE-related depression was also moderately associated with increased odds of reporting significant VTE care barriers. Nearly 1 in 3 VTE sufferers reported significant barriers to VTE care, with healthcare costs and VTE medication costs being the most common. Efforts to identify patients who may experience barriers should be sought early in care.
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