UHSP Collections (University of Health Sciences and Pharmacy)
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Assessment of symptom burden and adherence to respiratory medications in individuals self-reporting a diagnosis of COPD within a community pharmacy setting
No full textObjectives: Data on symptom burden or medication adherence in patients with chronic obstructive pulmonary disease (COPD) within a community pharmacy setting are limited. This study assessed symptom burden and adherence to respiratory medications in individuals reporting COPD, chronic bronchitis, or emphysema diagnoses visiting community pharmacies. Design: This cross-sectional study enrolled participants visiting 35 community pharmacies in Missouri (October 2016 to April 2017). Participants: Eligible participants (aged 40 years or more with a self-reported history of COPD, prescription for at least 1 COPD maintenance medication during the previous 12 months, and able to complete an English questionnaire) were identified from pharmacy dispensing records. Main outcome measures: Participants completed a questionnaire assessing demographics, clinical characteristics, health literacy, COPD Assessment Test (CAT) modified Medical Research Council (mMRC) dyspnea scale scores, and exacerbation history. Recent spirometry data were obtained, if available, from participants’ physicians. COPD was classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016 criteria. Medication adherence was assessed as proportion of days covered (PDC) from dispensing records. Results: Of 682 participants (mean age 63.0 years; 57% female) with available pharmacy data, 251 (36.8%) had available spirometry data. Most participants had mMRC scores ≥ 2 (60.9%) and CAT scores ≥ 10 (90.2%); 57.2% reported at least 2 moderate or 1 or more severe exacerbations within the previous 12 months. GOLD classifications varied depending on the scale used (mMRC vs. CAT); more participants were classified as group C/D than group A/B, with the highest proportion classified as group D (higher symptom burden and exacerbation risk). Mean PDC was 0.46 ± 0.37; only 28.7% of participants were adherent (PDC ≥ 80%) to at least 1 COPD maintenance medication. Conclusion: Individuals self-reporting a COPD diagnosis receiving respiratory medications from community pharmacies in Missouri have a high symptom burden and low medication adherence. Further research should determine reasons for low adherence and ways to reduce COPD symptoms
Outcomes Associated With De-escalating Therapy for Methicillin-Resistant Staphylococcus aureus in Culture-Negative Nosocomial Pneumonia
No full textBackground: In culture-positive nosocomial pneumonia, de-escalation (DE) from broad-spectrum empirical antimicrobials to narrower-spectrum agents has shown to decrease broad-spectrum antibiotic use without compromising patient outcomes. However, uncertainty exists regarding the safety of anti-methicillin-resistant Staphylococcus aureus (MRSA) agent DE in culture-negative nosocomial pneumonia. This study aimed to determine if anti-MRSA agent DE in culture-negative nosocomial pneumonia affects 28-day and hospital mortality, ICU and hospital length of stay (LOS), treatment failure, and safety. Methods: This single-center retrospective cohort study included adult patients admitted from 2012 to 2017 with nosocomial pneumonia and a negative respiratory culture. DE was defined as anti-MRSA agent discontinuation within 4 days of initiation. Secondary outcomes included hospital mortality, hospital and ICU LOS, treatment failure, and occurrence of acute kidney injury (AKI). Results: Of 279 patients included, 92 were in the DE group and 187 were in the no DE (NDE) group. Patients who were not de-escalated received 5 more days of MRSA coverage than patients who were de-escalated; however, there was no difference in 28-day mortality (NDE group, 28% vs DE group, 23%; difference, −5.5%; 95% CI, −16.1 to 6.5). Patients who were de-escalated had shorter hospital (DE group, 15 days vs NDE group, 20 days; difference, 3.2 days; 95% CI, 0.1-6.4) and ICU (DE group, 10 days vs NDE group, 13 days; difference, 2.2 days; 95% CI, −0.3 to 4.9) LOSs after the index date. The incidence of AKI was significantly higher in patients who were not de-escalated (DE group, 36% vs NDE group, 50%; difference, −13.8%; 95% CI, −26.9 to −0.4). Conclusions: Although anti-MRSA agent DE in culture-negative nosocomial pneumonia did not affect 28-day mortality, it was associated with a shorter hospital LOS and lower incidence of AKI
Recreational prescription opioid misuse among college students in the USA: An application of the theory of planned behavior
No full textIntroduction: Young adults aged 18-25 are at elevated risk for prescription drug misuse compared to other age groups. The purpose of the current study was to utilize the Theory of Planned Behavior (TPB) to predict the intention to engage in recreational prescription opioid misuse (RPOM) among college students while identifying specific salient beliefs that underlie this behavior. Methods: A random sample of college students in the USA completed an electronic survey measuring TPB constructs, salient beliefs, RPOM, and demographic items. Salient beliefs regarding RPOM were identified through a qualitative elicitation process using a subsample (n = 17) of the target population. Content analysis identified specific beliefs that would form questionnaire items to be assessed among the larger sample. Results: Among the entire sample (n = 776), 20.7% reported lifetime RPOM with 11.9% reporting past 6-month RPOM. Ten behavioral, two normative, and eight control beliefs identified in the subsample significantly and positively correlated with intention for RPOM when measured among the entire sample. A staged hierarchical logistic regression model examined the relationship between TPB constructs and intention. With the exception of perceived behavioral control, all constructs were significantly related to intention to engage in RPOM in the next six months. Descriptive norms had the strongest relationship to intention (OR = 1.37, 95% CI 1.23 to 1.54, P \u3c .001), followed by subjective norms (OR = 1.33, 95% CI 1.20 to 1.48, P \u3c .001), and finally attitude (OR = 1.13, 95% CI 1.09 to 1.17, P \u3c.001). Further, attitude significantly moderated the descriptive norm-intention relationship. Conclusion: The beliefs identified by this study may benefit interventions aimed at preventing prescription opioid misuse among this population. Further, targeting global perceptions of peer behavior, as well as, attitudes toward recreational use of prescription opioids may be particularly efficacious
Concerted Two-Electron Reduction of Ubiquinone in Respiratory Complex i
No full textRespiratory complex I catalyzes two-electron/two-proton reduction of a ubiquinone (Q) substrate bound at its Q-binding pocket; upon reduction, ubiquinole carries electrons further down the electron transport chain. The mechanism of this two-electron transfer reaction is poorly understood. Here we consider a hypothetical scheme in which two electrons transfer together with two protons in a concerted fashion. On one side, a coupled electron/proton transfer occurs from the reduced N2 FeS cluster and protonated His38 residue, respectively, while on the other side a hydrogen atom transfer occurs from the neutral Tyr87 residue, generating a tyrosyl radical. A method to evaluate the coupling matrix element that corresponds to a concerted tunneling of two electrons was developed. Overall, our calculations indicate that the concerted reaction is feasible, in which case a transient tyrosyl radical is formed during the catalytic cycle of the enzyme
Using the Behaviour Change Wheel to explore potential strategies for minimising harms from non-recreational prescription medicine sharing
No full textIntroduction: Non-recreational sharing of prescribed medicines can have positive outcomes under some circumstances, but can also result in negative health outcomes. This paper describes a theoretically underpinned and systematic approach to exploring potential interventions to reduce harm. Methods: Individual, semi-structured, face-to-face interviews were conducted with purposively sampled pharmacists (n = 8), doctors (n = 4), nurses (n = 6) and patients (n = 17) from Auckland, New Zealand. Thematic analysis of suggested interventions was undertaken, and these were linked to relevant intervention functions of the Behaviour Change Wheel (BCW). Analysis of previously defined factors influencing sharing were mapped onto the “Capability, Opportunity, Motivation – Behaviour” (COM-B) model of the BCW. Results: COM-B analysis of the factors influencing sharing behaviour revealed: (i) ‘Capability’-related factors, such as patient misconceptions about the safety of certain medicines, forgetting to refill or to carry around own medicines, and lack of knowledge about safe disposal of leftover/unused medicines; (ii) ‘Opportunity’-related factors included lack of access to health facilities, lack of time to see a doctor, linguistic and cultural barriers, lack of information from healthcare providers about risks of sharing, and having leftover/unused medicines, and (iii) ‘Motivation’-related factors included altruism, illness denial, embarrassment about seeing a doctor, not carrying around own medicines, habit, and fear of negative health consequences from missing a few doses of medicines. Five intervention functions of the BCW appear to be the most likely candidates for targeting the factors which relate to medicine sharing. These are education, persuasion, enablement, environmental restructuring and restriction. Conclusions: A variety of personal and external factors which influence sharing behaviours were identified, and the BCW provided a means by which theoretically underpinned interventions to reduce potential harms from this behaviour could be proposed. The findings can help with the design of approaches to reduce harm associated with non-recreational medicine sharing
ROR regulates the NLRP3 inflammasome
No full textRAR-related orphan receptor (ROR) is a nuclear receptor that plays an essential role in the development of T helper 17 (Th17) cells of the adaptive immune system. The NLRP3 inflammasome is a component of the innate immune system that processes interleukin (IL)-1 into a mature cytokine. Elevated activity of the NLRP3 inflammasome contributes to the progression of an array of inflammatory diseases. Bone marrow–derived macrophages (BMDMs) isolated from ROR-null mice displayed reduced capacity to secrete IL-1, and they also displayed a reduction in Nlrp3 and Il1b gene expression. Examination of the promoters of the Il1b and Nlrp3 genes revealed multiple putative ROR response elements (ROREs) that were occupied by ROR. ROR inverse agonists were effective inhibitors of the inflammasome. ROR inverse agonists suppressed lipopolysaccharide (LPS)/ATP-stimulated IL-1 secretion and expression of Il1b and Nlrp3 in BMDMs. Additionally, the ability of the ROR inverse agonists to suppress IL-1 secretion was lost in Nlrp3-null macrophages. The potential for targeting the NLRP3 inflammasome in vivo using ROR inverse agonists was examined in two models: LPS-induced sepsis and fulminant hepatitis. Pharmacological inhibition of ROR activity reduced plasma IL-1 as well as IL-1 production by peritoneal macrophages in a model of LPS-induced sepsis. Additionally, ROR inverse agonists reduced mortality in an LPS/D-galactosamine–induced fulminant hepatitis mouse model. These results illustrate a major role for ROR in regulation of innate immunity via modulation of NLRP3 inflammasome activity. Furthermore, these data suggest that inhibiting the NLRP3 inflammasome with ROR inverse agonists may be an effective method to treat NLRP3-associated diseases
Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era
No full textGuidelines advocate universal, prompt treatment of hepatitis C (HCV) infection in HIV/HCV co-infected patients, but barriers to uptake of HCV direct-acting antivirals (DAAs) remain unclear in this population. This retrospective study investigated the care cascade from HCV diagnosis to sustained virologic response (SVR) at an urban infectious disease clinic in Saint Louis, Missouri during the first 18 months of interferon-free DAA availability in the United States. Of 1949 HIV patients seen in clinic, 91.9% were screened for HCV and 5.4% (n = 106) had chronic HCV infection with follow-up. Of these 106 co-infected patients, 100 underwent fibrosis testing, 55 were offered DAAs, 38 completed treatment, and 37 achieved SVR. Delayed DAA treatment was associated with no insurance, substance abuse, poor HIV control, and younger age. Providers delayed DAA treatment most commonly for substance abuse, psychiatric disease, and uncontrolled HIV. Mean time to insurance decision from initial prescription was 20.9 ± 29.6 days and mean time to final decision was 29.9 ± 40.1 days. DAAs are highly successful in co-infected patients in this early period but insurance delays and misconceptions from the interferon era can ultimately limit uptake. Addressing these factors in a comprehensive treatment model may bridge disparities and improve real-world SVRs
Evaluation of the effect of prior antiarrhythmic drug use on the success of atrial fibrillation catheter ablation
No full textWhat is known and objective: Current guidelines recommend catheter ablation (CA) for atrial fibrillation (AF) refractory to at least one antiarrhythmic drug (AAD), but do not specify an adequate number of AADs to be trialed prior to considering ablation. The objective of this study was to evaluate the effect of CA success based on the number of AADs failed in patients with paroxysmal or persistent AF. Methods: This retrospective cohort study evaluated patients with paroxysmal or persistent AF who underwent an initial CA at a community hospital. Patients with unknown AAD histories, those who did not achieve acute procedural success, or who were lost to follow-up or death unrelated to thromboembolic stroke within 6 months post-ablation were excluded. Catheter ablation success was defined as freedom from AF. The primary outcome was the incidence of AF or atrial flutter captured on an electrocardiogram or other recording device at 3, 6, 9 and 12 months after the procedure. Results and discussion: Overall, 99 out of 103 patients completed 1 year of follow-up. Of those patients, 34 of 99 (34.3%) experienced AF recurrence within 1-year post-ablation. There was no significant difference among the categories of number of failed AADs and the recurrence of AF within 12 months post-ablation for zero AADs, 1 AADs and ≥2 AADs (41.7%, 31.3% and 40%, respectively; P = 0.658). What is new and Conclusion: The results of this study do not support preferentially performing CA on patients who have failed a certain number of AADs. Results are limited by the nature of the study design and a small sample size. Conclusive results would best be addressed by a prospective randomized trial
Improving rating scales: Applying Rasch analysis to student pharmacists\u27 attitudes towards herbal medications
No full textBackground: This study analyzed the psychometric properties of a cross-sectional survey of student pharmacists\u27 attitudes regarding herbal medications using a polytomous Rasch model. Seven items assessed students\u27 attitudes towards herbal medications using a 6-point agreement scale (0 to 5). Student responses were reviewed to identify outliers and aberrant response patterns, assess scale fit, and perform item analysis. Scale performance was assessed to determine if response categories were independent and equally represented. Items were reviewed for model fit and construct validity with significant item gaps identified using a z-test. Impact: A total of 324 students completed the survey. The initial 6-point scale was analyzed. Student responses with outfit mean-square (MNSQ) values \u3e5 were removed, yet the scale did not have appropriate functionality. The categories were merged to form a 4-point scale with no improvement. Therefore, two different 3-point scale options were analyzed: response categories of 0, 1 to 3, and 4 to 5; and response categories of 0, 1 to 4, and 5. With ten students removed, both 3-point scales met the requirements for functionality and all items exhibited good fit with MNSQ values between 0.6 and 1.4, person-separation value of 1.29, and person-reliability value of 0.62. Recommendations: Both 3-point scales met the requirements for Rasch analysis. The most optimal scale was the 0, 1 to 4, and 5 option. Discussion: This study provides findings from the survey validity assessment alongside the survey results, which is useful for readers to have confidence in the quality of the study findings
Alzheimer\u27s disease medication and risk of all-cause mortality and all-cause hospitalization: A retrospective cohort study
No full textIntroduction: Identifying Alzheimer\u27s disease (AD) pharmacologic treatment options that effectively reduce the risk of mortality and hospitalization in real-world settings is critical. Methods: We compared donepezil, galantamine, memantine, oral rivastigmine, and transdermal rivastigmine with regard to all-cause mortality and all-cause hospitalization risk among fee-for-service Medicare beneficiaries with AD (aged ≥ 65 years) using a retrospective cohort study design. Our primary analysis was based on intention to treat (ITT), but we also present as-treated analysis. Results: In our final study sample (N = 21,558), significant difference in survival among index AD medication groups were observed with donepezil being associated with better survival than memantine, and oral and transdermal forms of rivastigmine for both ITT and as-treated analysis. Difference in hazards of all-cause hospitalization among index AD medication groups was observed in ITT analysis but not in as-treated analysis. Discussion: Significant differences exist in terms of mortality and hospitalization risk with different AD medication initiation in real-world setting