This study determined the degree of adherence to medications for glaucoma among patients refilling prescriptions in community pharmacies.
Data abstracted from the dispensing records for 3615 adult ...patients (18 years or older, predominantly over 45) receiving glaucoma medications from two retail pharmacy chains (64 stores in total) were analyzed. From a 24-month historic data capture period, the 12-month levels of adherence were determined using standard metrics, the proportion of days covered (PDC) and the medication possession ratio (MPR). The overall 12-month mean PDC was only 57%, and the mean MPR was 71%. Using a criterion by which 80% coverage was considered satisfactory adherence, only 30% had satisfactory overall 12-month PDC coverage, and only 37% had satisfactory overall 12-month MPR coverage. Refill adherence increased with age and was highest in the 65-and-older age group (p < 0.001). Differential adherence was found across medication classes, with the highest satisfactory coverage seen for those taking alpha2-adrenergic agonists (PDC = 36.0%; MPR = 47.6%) down to those taking direct cholinergic agonists (PDC = 25.0%; MPR = 31.2%) and combination products (PDC = 22.7%; MPR = 31.0%). Adherence to glaucoma medications in the community setting, as measured by pharmacy refill data, is very poor and represents a critical target for intervention. Community pharmacists are well positioned to monitor and reinforce adherence in this population.
Real-world outcomes in patients with chronic stable angina treated with ranolazine and other antianginal medications as second- or third-line therapy are limited. In a historical cohort study of ...veterans with chronic stable angina, we compared time with coronary revascularization procedures, hospitalizations, and 1-year healthcare costs between new-users of ranolazine versus conventional antianginals (i.e., calcium channel blockers, β blockers, or long-acting nitrates) as second- or third-line. Weighted regression models calculated adjusted hazard ratios (HR) at up to 8-year follow-up, and adjusted incremental costs in the first year. Weighted groups comprised 4,699 ranolazine users and 31,815 conventional antianginal users. Percutaneous coronary intervention (PCI) occurred more often in ranolazine users compared with conventional antianginal users (HR 1.16; 95% confidence intervals CI 1.08 to 1.25, p <0.001), and coronary artery bypass grafting occurred less often (HR 0.82; 95% CI 0.68 to 1.00, p <0.046). All-cause and atrial fibrillation (AF) hospitalizations were less common with ranolazine users compared with conventional users (all-cause: HR 0.94; 95% CI 0.90 to 0.99, p <0.010; AF:HR 0.74; 95% CI 0.67 to 0.82, p <0.001), and acute coronary syndrome was more common (HR 1.13; 95% CI 1.00 to 1.27, p <0.042). Adjusted 1-year costs were $24,517 in ranolazine users and $24,798 in conventional users (difference, $−280; 95% CI $−1,742 to $1,181, p = 0.71). In conclusion, ranolazine users had lower rates of coronary artery bypass grafting and all-cause and AF hospitalizations, but higher rates of percutaneous coronary intervention and hospitalizations due to acute coronary syndrome compared with conventional antianginal users. Healthcare costs were similar between ranolazine and conventional antianginal users.
Abstract
Enhanced in vitro human and ex vivo rat platelet aggregation from direct exposure to silver nanoparticles is previously reported. Given the increasing human use of engineered silver ...nanoscale products, platelet aggregation prompted by silver nanoparticles may contribute to human cardiovascular events. To understand how direct washed platelet exposure to silver nanoparticles translates to ex vivo platelet aggregation, the authors conducted a placebo-controlled, single-blind, dose-monitored, cross-over study design in 18 healthy human volunteers. After 2 weeks of daily oral silver nanoparticle ingestion, platelet aggregation was evaluated by light transmission aggregometry in response to collagen and ADP agonists, both at baseline and after silver nanoparticle or placebo diluent oral dosing. Final percent aggregation (PA) and the changes in PA were determined using a paired design (i.e., active and placebo solutions). Enhanced ex vivo platelet activation was not detectable at peak serum silver concentrations <10 µg/L. Further studies of colloidal silver nanoparticles on human platelet activities are warranted.
Abstract
Nanotechnology produces a wide range of medicinal compounds, including nanoparticulate silver, which are increasingly introduced in various forms for consumer use. As with all medicinal ...compounds, potential drug interactions are an important consideration for ingested silver nanoparticles. Nanoparticulate silver-drug interactions may be mediated through induced oxidative stress in liver tissue where the majority of systemically bioavailable silver nanoparticles is found. To investigate whether an orally ingested commercially available colloidal silver nanoproduct produces pharmacokinetic interference on select cytochrome P450 enzymes, a prospective, single-blind, controlled in vivo human study using simultaneous administration of standardized probes for P450 enzyme classes CYP1A2, CYP2C9, CYP2C19, CYP2D6 and CYP3A4 was conducted. Oral ingestion of a commercial colloidal silver nanoproduct produces detectable silver in human serum after 14 days of dosing. This silver, however, elicits no demonstrable clinically significant changes in metabolic, hematologic, urinary, physical findings or cytochrome P450 enzyme inhibition or induction activity. Given their increasingly broad, diverse human exposures, future characterization of human cytochrome P450 enzyme activity for other systemically bioavailable nanotechnology products are warranted.
Objectives: To review the pharmacology, pharmacokinetics, clinical trial data, adverse effects, and formulary considerations of icosapent ethyl for the treatment of high triglyceride (TG) levels. ...Data Sources: A literature search with keywords Vascepa, icosapent ethyl, AMR101, and eicosapentaenoic acid of articles up to July 2013, along with the package insert for Vascepa and current guidelines for hypertriglyceridemia. Study Selection/Data Extraction: Two phase-III, placebo-controlled, randomized, double-blind, 12-week clinical trials were included in this review: the MARINE trial and ANCHOR study. The MARINE trial consisted of mainly overweight Caucasian men with fasting TG ≥500 and ≤2000 mg/dL taking 4 g/day icosapent ethyl, 2 g/day, or placebo. The ANCHOR study consisted of mainly overweight Caucasians with type-2 diabetes mellitus on statin therapy, with fasting TG ≥200 and <500 mg/dL taking 4 g/day icosapent ethyl, 2 g/day, or placebo. Data Synthesis: The MARINE trial showed a placebo-corrected median decrease in TG of 33.1% for patients receiving 4 g/day icosapent ethyl, with no significant change in low-density lipoprotein cholesterol (LDL-C) levels. TG was reduced by 19.7% in those taking 2 g/day. The ANCHOR study showed a placebo-corrected decrease in TG of 21.5% with a 6.3% decrease in LDL-C for patients taking 4 g/day icosapent ethyl as add-on to statin therapy. TG was reduced by 10.1% in those taking 2 g/day. The main adverse effect observed was joint pain (2.3%). Conclusions: Icosapent ethyl is effective in reducing TG levels without increasing LDL-C, and has efficacy similar to other TG-lowering therapies with fewer adverse effects or interactions.
Introduction
Community pharmacies are the most accessible health care service locations. While providing greater patient health care access, there is a need for understanding consumer awareness and ...utilization of pharmacy‐provided services and their satisfaction and loyalty to the pharmacy setting.
Objectives
To determine consumer utilization and awareness of services and to identify what factors influence satisfaction and loyalty within a community pharmacy.
Methods
A 30‐minute online survey of 9202 adult consumers across the United States was conducted. Patient's self‐reported awareness and utilization, satisfaction with their community pharmacies, and likelihood to recommend their current pharmacy were scored. The likelihood to recommend scores was translated into a Net Promoter Score (NPS). Regression analysis was utilized to identify associated independent variables associated with consumer awareness, utilization, satisfaction, and loyalty to their community pharmacy.
Results
Consumer utilization of medication distribution services was more common than use of clinical services, even though many consumers are aware of available clinical services. Consumer satisfaction with and loyalty to their community pharmacy was ranked high (8.67 ± 1.39; 8.56 + 1.66 both strongly agree, respectively). Trusting the pharmacist to provide accurate medication and general health information were ranked as strongly agree (8.25 ± 2.04) and moderately agree (6.42 ± 2.84). Consumer's NPS (+49.9) was moderately‐high with a major proportion being promoters (60.1%) of their community pharmacy. Multivariate regression showed that community pharmacy satisfaction and loyalty were modestly associated with advanced age, the provision of accurate medication and health information, and medication dispensing functions.
Conclusion
Satisfaction and loyalty are vital aspects in the delivery and efficacy of health care, especially in the community pharmacy setting. The results of this study show that consumers are promotors of community pharmacies and that pharmacists are an important source for health and medication information.
EXECUTIVE SUMMARY. The Committee was charged with the responsibility for examining the need for change in pharmacy education and the models of leadership that would enable that change to occur across ...the academy. They also examined the question of faculty wellbeing in a time of change and made several recommendations and suggestions regarding both charges. Building upon the work of the previous Academic Affairs Committee, the 2018-19 AAC encourages the academy to implement new curricular models supporting personalized learning that creates engaged and lifelong learners. This will require transformational leadership and substantial investments in faculty development and new assessment strategies and resources. Recognizing that the magnitude of the recommended change will produce new stress on faculty, the committee identified the need for much additional work on student, faculty and leaders’ wellbeing, noting the limited amount of empirical evidence on pharmacy related to stress and resilience. That said, if faculty and administrators are not able to address personal and community wellbeing, their ability to support their students’ wellbeing will be compromised.
It is well established that individual organisms can acclimate and adapt to temperature to optimize their functioning. However, thermal optimization of ecosystems, as an assemblage of organisms, has ...not been examined at broad spatial and temporal scales.
Here, we compiled data from 169 globally distributed sites of eddy covariance and quantified the temperature response functions of net ecosystem exchange (NEE), an ecosystem-level property, to determine whether NEE shows thermal optimality and to explore the underlying mechanisms.
We found that the temperature response of NEE followed a peak curve, with the optimum temperature (corresponding to the maximum magnitude of NEE) being positively correlated with annual mean temperature over years and across sites. Shifts of the optimum temperature of NEE were mostly a result of temperature acclimation of gross primary productivity (upward shift of optimum temperature) rather than changes in the temperature sensitivity of ecosystem respiration.
Ecosystem-level thermal optimality is a newly revealed ecosystem property, presumably reflecting associated evolutionary adaptation of organisms within ecosystems, and has the potential to significantly regulate ecosystem–climate change feedbacks. The thermal optimality of NEE has implications for understanding fundamental properties of ecosystems in changing environments and benchmarking global models.
Abstract only
Objective:
Reduction of intracellular sodium accumulation through inhibition of late Na
+
current has been recognized as a target for cardiac calcium handling which underlies myocardial ...contractility and relaxation in heart failure (HF). This approach may augment neurohormonal balance to evade HF progression. Riluzole , a brain-type Na
+
channel blocker with enhancement of Ca
2+
-activated K
+
channel function, used for management of amyotrophic lateral sclerosis (ALS). The study aim was to investigate whether riluzole lowers HF incidence.
Methods:
Rates of incident HF were compared using a commercial insurance and Medicare supplement claims databases. Patients who filled a prescription for riluzole (treatment) between 06/2009 and 12/2019 were compared to those with no-riluzole (control). We excluded HF patients during the 180-day baseline period. Study endpoint was the first diagnosis of HF from the index riluzole prescription or ALS diagnosis. HF onset was compared using Kaplan-Meier cumulative incidence estimates and multivariable Cox proportional hazard regression model.
Results:
The study cohort consisted of 4,324 riluzole and 6,415 ALS control patients. The 24-month cumulative incidence of HF onset for riluzole vs. control patients was 4.71% vs. 8.73%, calculating hazard ratio (HR) 95% CI,
p
-value of 0.399 0.297 - 0.537, p<0.001. Adjusting for patient demographics and comorbid conditions, the 24-month HR: 0.495 0.367 - 0.668, p<0.01. The lower rate of HF onset was independent of age (<65 and ≥65 age groups, HR: 0.378 0.234 - 0.611, p<0.01 and 0.611 0.413 - 0.881, p<0.01) respectively.
Conclusions:
Riluzole is associated with a lower rate of HF onset, suggesting a potential prevention strategy for early management.
PDF
