UHSP Collections (University of Health Sciences and Pharmacy)
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Basic surface electrocardiogram interpretation for the pharmacist
No full textPurpose: The electrocardiogram (ECG) is an invaluable tool for clinicians that provides important information about a patient\u27s heart. As clinical pharmacists play an ever-increasing role in cardiovascular care, ECG interpretation is an important skill with which to become familiar. Summary: The ECG provides information on both electrical and biomechanical aspects of the heart. Electrical information such as the rhythm, rate, and axis of the electrical activity can all be provided by the ECG. Biomechanical information about the heart, such as the presence of ventricular hypertrophy and repolarization changes that may be associated with ischemia or myocardial injury, can also easily be gleaned from the ECG. Furthermore, the ECG plays a central role in both the diagnosis and treatment of common clinical conditions such as atrial fibrillation, ischemic heart disease, and QT interval prolongation Conclusion: The ECG is one of the most commonly performed diagnostic tests, and clinicians should become familiar with its basic interpretation
Evaluation of Guideline-Directed Medical Therapy for the Reduction of Stroke and Systemic Embolism in Hospitalized Patients with Nonvalvular Atrial Fibrillation
No full textBackground: Guidelines recommend antithrombotic therapy in patients with nonvalvular atrial fibrillation (NVAF) to reduce the risk of stroke and systemic embolism (SSE) based on an assessment utilizing the CHA2DS2-VASc score. However, a treatment gap exists regarding patients at risk for thromboembolic events. Objectives: The aim of this study was to characterize the use of guideline-directed medical therapy (GDMT) to reduce the risk of SSE in patients with NVAF upon hospital discharge. Methods: This retrospective review evaluated patients admitted to a community hospital with NVAF in 2016. All patients were included except for the following: \u3c 18 years of age, concomitant valvular heart disease, expired during hospitalization, or discharged on hospice care. Descriptive statistics were reported for all parameters. Results: A total of 2739 patients with NVAF were included with 59.9% discharged on GDMT to reduce the risk of SSE. A 1% increase in GDMT at discharge was observed in patients admitted with a history of NVAF (n = 2238; 60.1% vs 61.1%). Patients with first-detected NVAF (n = 501) were discharged on GDMT 54.5% of the time. In patients with a high stroke risk, concomitant heart failure (P =.001) and a lower HAS-BLED score (mean = 2.85 vs 3.18; P \u3c.0001) were associated with receiving GDMT upon discharge. However, patients with increased age (mean = 78.5 vs 76.4; P \u3c.0001), vascular disease (P =.02), prior major bleeding (P \u3c.0001), or first-detected NVAF (P \u3c.0001) were less likely to be discharged on GDMT. Conclusions: Consistent with published registry data, a gap was observed in the use of GDMT to reduce the risk of SSE in patients with NVAF at this institution. Further investigation into methods for improvement is warranted
The Impact of a Clinical Pharmacist in an Interdisciplinary Weight Loss Service: A Follow-Up Study
No full text: At an Internal Medicine outpatient clinic, patients are referred to a weight loss service by their primary care physician to be managed by a clinical pharmacist and dietician. . : This was a retrospective, single-center, cohort study including adults ≥18 years of age with BMI ≥30 or BMI ≥27 with at least one weight-related comorbidity such as hypertension, dyslipidemia, or type 2 diabetes mellitus, and referred to the clinic\u27s weight loss service or managed by their primary care physician. The primary outcome was percent weight loss from baseline. Key secondary outcomes included number of patients who had \u3e5% weight loss in 6 months, number of patients who received liraglutide after 6 months, and percent weight loss in patients prescribed liraglutide. Statistical analysis included descriptive statistics, t-test for continuous outcomes, and chi-square test for between-group differences. : A total of 86 patients met inclusion criteria with 43 patients in the weight loss service group (intervention) and 43 patients in the primary care group (standard care). The intervention group had a significantly higher baseline weight and BMI than the standard care group (120.44 kg vs. 95.72 kg, p \u3c0.001 and 45.34 kg/m vs. 37.62 kg/m, p \u3c0.001 respectively). The percent change in weight from baseline in the intervention group was a decrease of 3% compared to a decrease of 0.35% in the standard care group (p=0.03). : Involvement of clinical pharmacist in interdisciplinary weight loss management through pharmacotherapy and other medication related services, shows considerable improvement in weight loss, when compared to the standard care of weight management. However, prospective randomized studies are warranted to further assess the benefits of a pharmacist-driven, interdisciplinary weight loss service
Seroprevalence of Chlamydia trachomatis, herpes simplex 2, Epstein-Barr virus, hepatitis C and associated factors among a cohort of men ages 18-70 years from three countries
No full textObjectives To estimate the seroprevalence of Chlamydia trachomatis (CT), herpes simplex type-2 (HSV2), hepatitis C (HCV), Epstein-Barr virus (EBV) and nine human papilloma virus (HPV) types, and investigated factors associated with the seropositivity among men from three countries (Brazil, Mexico and U.S). Methods Archived serum specimens collected at enrollment for n = 600 men were tested for antibodies against CT, HSV2, HCV, EBV, and 9-valent HPV vaccine types (6/11/16/18/31/33/45/ 52/58) using multiplex serologic assays. Socio-demographic, lifestyle and sexual behavior data at enrollment were collected through a questionnaire. Results Overall, 39.3% of the men were seropositive for CT, 25.4% for HSV2, 1.3% for HCV, 97.3% for EBV, 14.0% for at least one of the seven oncogenic HPV (types: 16/18/31/33/45/52/58), and 17.4% for HPV 6/11. In the unadjusted models, age, race, smoking, sexual behavior variables, and seropositivity for high-risk HPV were significantly associated with the seropositivity for CT. In multivariable analyses, self-reported black race, higher numbers of lifetime female/male sexual partners, current smoking, and seropositivity to high-risk HPV were significantly associated with increased odds of CT seropositivity. Odds of HSV2 seroprevalence were elevated among older men and those seropositive for high risk HPV. Conclusion Exposure to STIs is common among men. Prevention and screening programs should target high-risk groups to reduce the disease burden among men, and to interrupt the disease transmission to sexual partners
Implementation and evaluation of clinical pharmacy services through quality improvement in a Tertiary Hospital in Malawi
No full textBackground: Clinical pharmacy services have been shown to improve patient outcomes, cost savings, and rational use of medications, yet there has been a slow transition from product-focused to patient-focused pharmacy practice in many low-income countries. Objective: The purpose of this study was to describe the implementation of a ward-based clinical pharmacy program using quality improvement methods in a 1000-bed tertiary hospital in Malawi and measure its associated impact on prescribing practices. Methods: This was a post-test only design with a nonequivalent control group evaluating the impact of a ward-based clinical pharmacy program. The program was implemented in the female adult medical ward using 1-month Plan-Do-Study-Act cycles. Data were collected on the number of clinical pharmacy recommendations and acceptance rate. Outcome measures were collected in the intervention ward and a corresponding control ward and evaluated changes in prescribing habits across rational prescribing and antimicrobial prescribing. Data were collected over time and plotted on run charts. Logistic regression was used to examine differences in the trend in probability of rational prescribing and antimicrobial prescribing. Results: Over 5 months, 321 clinical pharmacy recommendations were made and 67% were adopted by the medical team for implementation. For the intervention ward compared with the control ward, there was a significantly greater increase in probability of rational prescribing (P =.04), but no significant differences in antimicrobial prescribing (P =.48). Conclusions: This study demonstrated a positive impact on rational prescribing as a result of ward-based clinical pharmacy services in a low-income country. This study can be used to inform development or improvement of clinical pharmacy services in other low-income settings
Entrustable Professional Activities (EPAs) for Global Health
No full textPurpose As global health education and training shift toward competency-based approaches, academic institutions and organizations must define appropriate assessment strategies for use across health professions. The authors aim to develop entrustable professional activities (EPAs) for global health to apply across academic and workplace settings. Method In 2019, the authors invited 55 global health experts from medicine, nursing, pharmacy, and public health to participate in a multiround, online Delphi process; 30 (55%) agreed. Experts averaged 17 years of global health experience, and 12 (40%) were from low-to middle-income countries. In round one, participants listed essential global health activities. The authors used in vivo coding for round one responses to develop initial EPA statements. In subsequent rounds, participants used 5-point Likert-Type scales to evaluate EPA statements for importance and relevance to global health across health professions. The authors elevated statements that were rated 4 (important/relevant to most) or 5 (very important/relevant to all) by a minimum of 70% of participants (decided a priori) to the final round, during which participants evaluated whether each statement represented an observable unit of work that could be assigned to a trainee. Descriptive statistics were used for quantitative data analysis. The authors used participant comments to categorize EPA statements into role domains. Results Twenty-Two EPA statements reached at least 70% consensus. The authors categorized these into 5 role domains: partnership developer, capacity builder, data analyzer, equity advocate, and health promoter. Statements in the equity advocate and partnership developer domains had the highest agreement for importance and relevance. Several statements achieved 100% agreement as a unit of work but achieved lower levels of agreement regarding their observability. Conclusions EPAs for global health may be useful to academic institutions and other organizations to guide the assessment of trainees within education and training programs across health professions
Teaching Cheminformatics through a Collaborative Intercollegiate Online Chemistry Course (OLCC)
No full textWhile cheminformatics skills necessary for dealing with an ever-increasing amount of chemical information are considered important for students pursuing STEM careers in the age of big data, many schools do not offer a cheminformatics course or alternative training opportunities. This paper presents the Cheminformatics Online Chemistry Course (OLCC), which is organized and run by the Committee on Computers in Chemical Education (CCCE) of the American Chemical Society (ACS)\u27s Division of Chemical Education (CHED). The Cheminformatics OLCC is a highly collaborative teaching project involving instructors at multiple schools who teamed up with external chemical information experts recruited across sectors, including government and industry. From 2015 to 2019, three Cheminformatics OLCCs were offered. In each program, the instructors at participating schools would meet face-to-face with the students of a class, while external content experts engaged through online discussions across campuses with both the instructors and students. All the material created in the course has been made available at the open education repositories of LibreTexts and CCCE Web sites for other institutions to adapt to their future needs
Respiratory complex I: Bottleneck at the entrance of quinone site requires conformational change for its opening
No full textThe structure of the entire respiratory complex I is now known at reasonably high resolution for many species – bacteria, yeast, and several mammals, including human. The structure reveals an almost 30 angstrom tunnel-like chamber for ubiquinone binding in the core part of the enzyme, at the joint between the membrane and hydrophilic arms of the enzyme. Here we characterize the geometric bottleneck forming the entrance of the quinone reaction chamber. Computer simulations of quinone/quinol passage through the bottleneck suggest that in all structures available, from bacterial to human, this bottleneck is too narrow for the quinone or quinol to pass and that a conformational change is required to open the channel. Moreover, the bottleneck is too narrow even for isoprenoid tail free passage. The closed structure can be an artifact of the crystallization packing forces, low temperature, or other unnatural conditions occurring in the structural data acquisition procedure that affect this flexible part of the enzyme. Two of the helices forming the bottleneck are in direct contact with the subunit (ND3) that was recently demonstrated to be involved in conformational changes during the redox proton pumping cycle, which indicates flexibility of that part of the enzyme. We conclude that the published structures are all locked in the unfunctional states and do not represent correctly the functional enzyme; we discuss possible ways to open the structure in the context of possible mechanisms of the enzyme
Targeting e‐selectin to tackle cancer using uproleselan
No full textE‐selectin is a vascular adhesion molecule expressed mainly on endothelium, and its primary role is to facilitate leukocyte cell trafficking by recognizing ligand surface proteins. E‐ selectin gained a new role since it was demonstrated to be involved in cancer cell trafficking, stem-like properties and therapy resistance. Therefore, being expressed in the tumor microenvironment, E‐selectin can potentially be used to eradicate cancer. Uproleselan (also known as GMI‐1271), a specific E‐selectin antagonist, has been tested on leukemia, myeloma, pancreatic, colon and breast cancer cells, most of which involve the bone marrow as a primary or as a metastatic tumor site. This novel therapy disrupts the tumor microenvironment by affecting the two main steps of metastasis— extravasation and adhesion—thus blocking E‐selectin reduces tumor dissemination. Additionally, uproleselan mobilized cancer cells from the protective vascular niche into the circulation, making them more susceptible to chemotherapy. Several preclinical and clinical studies summarized herein demonstrate that uproleselan has favorable safety and pharmacokinetics and is a tumor microenvironment‐disrupting agent that improves the efficacy of chemotherapy, reduces side effects such as neutropenia, intestinal mucositis and infections, and extends overall survival. This review highlights the critical contribution of E‐selectin and its specific antagonist, uproleselan, in the regulation of cancer growth, dissemination, and drug resistance in the context of the bone marrow microenvironment
Analysis of medical tourism at the Andrade port of entry
No full textBackground: Medical tourism, a term used to describe the practice of traveling to obtain medical services or products, is known to occur along the U.S.–Mexico border and has for some time. Despite the ever-increasing number of local border crossings, there is little research or monitoring done on the prevalence of medical tourism or to show the products and services sought. Objectives: To identify which medications and services are most frequently obtained, the reasons for these instances of medical tourism, perceived efficacy or satisfaction of the medications and services, and the likelihood of continuing to receive health care in Mexico. Methods: Using a cross-sectional survey design, participants were recruited to participate in an anonymous electronic 12-question survey at or near the U.S.–Mexico border at the Andrade port of entry. All participants were waiting to cross or had just crossed the border through this port. Data were analyzed using descriptive statistics. Results: A total of 427 surveys were collected for analysis. The respondents reported traveling from 29 states within the United States, as well as from 3 other countries. The average age of the participants was 64.5 years, with a range of 19-93 years. Cost was reported by 92% (n = 394) as the major factor to participate in medical tourism, and the most common income bracket reported was between 50,000 annually (n = 103). Dental (n = 124) was the most common medical service, and antibiotics (n = 225) were the most common class of medications sought. Most of the participants expressed the intent to continue to participate in medical tourism (n = 404). Conclusion: Most survey respondents felt that Mexican health care services are of the same or better quality compared with those in the United States, for a lower cost, and plan to participate in medical tourism moving forward. Many opportunities for future research exist on this topic, including follow-up surveys and laboratory analyses to compare medication samples