Showing papers in "Journal of the American Pharmaceutical Association in 1997"
TL;DR: It is suggested that pharmacist administration of influenza vaccination in a rural community pharmacy increases access and, possibly, immunization rates among high-risk younger adults who are often overlooked and would not normally have received the immunization.
Abstract: Objective: To increase accessibility of influenza vaccine in a rural community by establishing a community pharmacy-based influenzc vaccination program. Setting: An independent pharmacy in a rural eastern Iowa community of 5,000 people. Practice Description: Protocols for identification and screening of patients, administration of vaccine, and treatment of emergencies were developed by the pharmacist and approved by the county health department medical director. Administration of vaccine began October 15, 1996, and was completed on December 6, 1996. Practice Innovation: Patients were prospectively and retrospectively identified to receive the vaccination. Informed consent was obtained. Vaccine was administered by the pharmacist after screening for contra indications and counseling the patient. Weekly vaccination records were forwarded to the collaborating physician to update patient charts. Main Out· come Measurements: To determine whether accessibility of influenza vaccine in the community was increased through pharmacis1 administration, the proportion of patients immunized in the pharmacy who were not vaccinated the previous year was determined. Results: The pharmacist administered 343 doses of vaccine. Two-thirds of the immunized patients (67.9%) reported also being immunized the previous year. These patients were generally older (65 years of age ± 13) than the previously nonimmunized patients (54 years of age ± 16). However, 60.8% of the patients not immunized the previous year reported either they would not have gone else· where for the immunization (45.3%). or were unsure (25.5%). Conclusion: The data collected suggest that pharmacist administration of influenza vaccination in a rural community pharmacy increases access and, possibly, immunization rates. This may be especially true among high-risk younger adults who are often overlooked and would not normally have received the immunization.
68 citations
TL;DR: The training program developed and presented to pharmacists proved to be an effective way to increase the number of problems identified and addressed by pharmacists and to examine the ability of these pharmacists to provide pharmaceutical care in a community pharmacy setting.
Abstract: Objective: To develop and present a pharmaceutical care training program for pharmacists, and to examine the ability of these pharmacists to provide pharmaceutical care in a community pharmacy setting. Design: Prospective, randomized study. Intervention: A 40-hour pharmaceutical care training program was developed and presented to pharmacists, and 1 ,078 patients were randomly assigned to receive either (1) traditional pharmacy services or (2) pharmaceutical care, consisting of initial patient work-up and follow-up with documentation in a patient record. Measurements: The study period was six months. Pharmacists documented problems identified, actions taken, and time required for all patients. Results: Pharmacists consistently identified and intervened to address problems in both study groups. Patients receiving pharmaceutical care were more than seven times as likely to have any problems identified (odds ratio [OR] 7.5; confidence interval [Cll 4.2-13.1), more than eight times as likely to have an intervention performed (OR 8.1 ; CI 4.7-14.2), and more than eight times as likely to have a drug-related problem identified (OR 8.6; CI 4.8-15.5) than were patients receiving traditional pharmacy services only. Time spent counseling patients was similar for the two groups. Conclusions: The training program proved to be an effective way to increase the number of problems identified and addressed by pharmacists.
67 citations
TL;DR: The TOM project was successful from a technical but not a marketing perspective, and the concept is not likely to spread spontaneously within the existing market for pharmaceutical services.
Abstract: Objective: To design a pharmaceutical care model, and develop and field test a set of community pharmacy guidelines and practice support materials-Therapeutic Outcomes Monitoring (TOM) modules. Design: Concept interviews with pharmacists, physicians, and patients; development and field testing of practice guidelines. Setting: Community pharmacies. Participants: Five independent, five chain, and two clinic site pharmacies. Interventions: A prototype TOM module for asthma was developed through a seven-step process. Concept interviews were held with pharmacists, physicians, and patients to determine the desirability and feasibility of the TOM concept, prototype, and materials. Two field tests were completed and modifications made. Results were gathered through further concept interviews at the completion of the second field tests. Main Outcome Measures: Participants' opinions and experiences. Results: Pharmacists, physicians, and patients expressed favorable attitudes about community pharmacists' participation in this pharmaceutical care model. Of the 12 participating pharmacists, 7 successfully implemented TOM in their practice sites and participated in the project throughout the testing; 49 patients were recruited into the study; and 22 patients remained in the program at the end of the second field test. In providing TOM services to these patients, the two most problematic areas for the pharmacists were in documenting care and reporting to physicians. A final phase of the TOM project has not been conducted in the United States because of insufficient numbers of patients for evaluating patient outcomes. Conclusion: The TOM project was successful from a technical but not a marketing perspective. Useful practice guidelines can be written and taught to pharmacists. Enrollment of patients was difficult, and the concept is not likely to spread spontaneously within the existing market for pharmaceutical services.
57 citations
TL;DR: The results support the theory behind the TTM; that is, with any behavior change, individuals will fall into several stages of readiness for change, and the vast majority will not be ready to take action within the next six months.
Abstract: Objective: During the 1970s and 1980s, Prochaska and DiClemente developed the Transtheoretical Model (TIM) of Change to explain, predict, and change multiple human behaviors. This study applied the TIM to measure pharmacists' readiness for rendering pharmaceutical care. It also identified and measured factors that facilitate rendering pharmaceutical care and factors that are barriers, as well as the strength of these factors for each stage of readiness. Design: Data were collected using an instrument developed following the work of Prochaska. Pharmacists completed this survey at the 1996 APhA Annual Meeting & Exposition. Results: The results support the theory behind the TIM; that is, with any behavior change, individuals will fall into several stages of readiness for change, and the vast majority will not be ready to take action within the next six months. Also consistent with the theory, the cons of engaging in a behavior tended to be more salient for individuals in the precontemplation/contemplation stages than for those in the action/maintenance stages. Individuals in administrative positions are more likely to engage in behavior that leads to submitting documentation for compensation. Conclusion: Continuing education efforts must address the needs identified in each stage of readiness. Acknowledgments : This study was funded through a grant by the American Pharmaceutical Association and the National Wholesale Druggists Association as part of the Concept Pharmacy Project.
54 citations
TL;DR: The pharmacy-based asthma management program was developed, pilot tested, and successfully marketed to a local HMO, and has proved to be an effective, practical, and profitable addition to the portfolio of services offered by the pharmacy.
Abstract: Objective: To develop a community pharmacy-based asthma management program and successfully market the program to a man·aged care organization. Setting: Community-based ambulatory care. Practice Description: Independent community pharmacy. Practice Innovation: Development of a structured, stepwise approach to creating, testing, delivering, and marketing a community pharmacy-based disease management program. Main Outcome Measurements: Peak expiratory flow rates, quality of life, use of health care services, HMO contract renewal. Results: A pharmacy-based asthma management program was developed, pilot tested, and successfully marketed to a local HMO. During the first full year of the program, HMO patients experienced significant improvements in quality of life and decreases in use of health care services, including a 77% decrease in hospitalization, a 78% decrease in emergency room visits, and a 25% decrease in urgent care visits. A contract that pays the pharmacy a flat fee for each patient admitted to the program has recently been renewed for a third year. Conclusion: The program has proved to be an effective, practical, and profitable addition to the portfolio of services offered by the pharmacy.
41 citations
TL;DR: Only three out of nine multivitamin products met USP specifications for folic acid release, and the authors believe that prompt action should be taken to ensure that folic-acid-containing products are of the highest quality possible.
Abstract: Objective: To determine whether prescription prenatal vitamins meet United States Pharmacopeial Convention (USP) standards for folic acid dissolution. Methods: Dissolution was measured using USP Apparatus II and test conditions specified in the 23rd revision of the United States Pharmacopeia ( USP 23). Folic acid was assayed by a chromatographic method modified from that specified in the official monographs, for oil- and water-soluble vitamins with minerals tablets, in USP 23 . Results: Only three out of nine multivitamin products met USP specifications for folic acid release. Most missed by a wide margin; folic acid dissolution from two products was less than 250/0. Conclusions: Because a wide variety of brand-name and generic prescription prenatal multivitamin products were tested, these results are likely to be representative of the multivitamin products on the market. Given the significance of folic acid to public health, the authors believe that this subject should be studied further and that prompt action should be taken to ensure that folic-acidcontaining products are of the highest quality possible.
40 citations
36 citations
TL;DR: The findings may help FDA develop specific regulations to improve label readability and Pharmacists who recommend OTC products to consumers should be aware of these issues and evaluate requests by consumers regarding OTC drugs accordingly.
Abstract: Objective: This study evaluated information on over-the-counter (OTC) medication labels. Brand-name OTC products were examined to determine compliance with the Label Readability Guidelines recommended by the Nonprescription Drug Manufacturers Association (NOMA). Additionally, the use of pictures on OTC medication labels was assessed. The effect of pictures on other aspects of label design that may affect comprehension was also evaluated. Design: We evaluated 100 OTC medication labels (20 analgesics and 80 cold/cough products). Assessment of label content was based on certain aspects of label design, such as package size, font size of written information, format of information on warnings and indications, use of pictures, and use of advertising claims on product labels. Results: Many products evaluated did not meet NOMA guidelines. Even when font size of product name increased with increase in package size, font size on warnings and indications remained constant at 6 points. Lack of boldface (63%), use of all uppercase font (30%), use of hyphenation (49%), lack of paragraph breaks (19%), and the small font size of 6 points or less (98%) could reduce readability. Packages containing pictures were significantly larger than packages without pictures. Several packages (30%) contained pictures in the indications section. Many products contained advertising claims that were classified as "green" or "quality" (41%) and "free" (38%). Additionally, 43 different advertising claims were identified; some of these may be difficult for patients to interpret. Conclusions: The findings may help FDA develop specific regulations to improve label readability. Pharmacists who recommend OTC products to consumers should be aware of these issues and evaluate requests by consumers regarding OTC drugs accordingly. Acknowledgments : This research was partially supported by the Department of Pharmacy Practice and Administrative Sciences, and by a grant from the Graduate Students Research Committee, Idaho State University.
33 citations
TL;DR: Vaccine administration may soon become an integral function in community pharmacists responsibilities for the health and well-being of patients.
Abstract: Objective: This article describes requisite components of a community pharmacy·based vaccine administration program and provides resources for obtaining training and materials to facilitate implementation in the pharmacy. Data Sources: Published medical literature accessed via Medline; interviews of pharmacists who initiated vaccine administration programs; government publications; professional publications including manuals and newsletters; and the resources of the Washington State Board of Pharmacy. Data Synthesis: Pharmacists in several states have initiated vaccine-administration programs for adults, adolescents, and children within their pharmacies with acceptance by patients, third party payers, and other health professionals. In some states, collaborative prescribing agreements between physicians or nurse-practitioners and pharmacists enable pharmacists to implement high-volume immunization clinics as well as individual patients services. Standardized training is available from several sources, and in most settings vaccine administration services can be implemented with low initial investment. Conclusion: Vaccine administration may soon become an integral function in community pharmacists' responsibilities for the health and well-being of patients. Acknowledgments: Many thanks to Don Downing for editorial review.
31 citations
Journal Article•
TL;DR: Thalidomide is currently being used clinically to treat such conditions as cachexia associated with HIV and cancer, mycobacterial disease, and autoimmune diseases.
Abstract: The epidemic of birth defects in Europe in the early 1960s attributed to thalidomide led to stringent and unprecedented drug safety requirements in many countries. No definitive mechanism of action has been determined for the biological activities associated with thalidomide. Food and Drug Administration and congressional concerns about the handling of clinical investigations of thalidomide led to sweeping new regulations for clinical trials. Thalidomide is currently being used clinically to treat such conditions as cachexia associated with HIV and cancer, mycobacterial disease, and autoimmune diseases.
28 citations
TL;DR: If drug information on the Internet contains inaccuracies, its ready accessibility may pose a public health problem.
Abstract: Objective: To determine the accuracy and potential harmfulness of the drug information in a newsgroup on the Internet, sci . med . pharmacy . Design: In this cross-sectional study, two independent reviewers analyzed the nonsubjective drug information in this newsgroup. Drug information was classified as correct, incorrect, or could not verify. Information was determined to have no harm, minor harm, moderate harm, or severe harm. Results: About one-half of the drug information was found to be correct in this newsgroup. Although 680/0 of the drug information was found to result in no harm, 19.4 % was classified as harmful. Conclusions: If drug information on the Internet contains inaccuracies, its ready accessibility may pose a public health problem. With the number of Internet users growing, health professionals need to be aware of the potential for dissemination of misinformation, and need to become familiar with the Internet and the various health information resources available to the public.
TL;DR: In this paper, the authors investigate the barriers that minority populations face with respect to the use of pharmacy services and propose seven broad strategies that pharmacists might use to minimize the effect of the barriers.
Abstract: The barriers that minority populations face with respect to the use of pharmacy services may differ from those faced by other populations. A pretested questionnaire was administered to a convenience sample of 96 Vietnamese residents of a mid-size Midwestern city. Perceptions of five common barriers to pharmacy services were investigated. Financial difficulty (47%), language (25%), and physical illness (14%) were the most serious barriers to pharmacy services, followed by transportation and unemployment. These researchers propose seven broad strategies that pharmacists might use to minimize the effect of the barriers. The use of these strategies could benefit patients by improving their health, and increase opportunities for pharmacists to provide pharmaceutical care to the rapidly growing Vietnamese community and other ethnic populations.
TL;DR: In this paper, the authors assess the impact of OBRA '90 regulations on the counseling practices of community pharmacists in Nebraska and find that only 44.60% of respondents reported that their time devoted to patient counseling had increased as a result of the regulations.
Abstract: Objective: To assess the impact of OBRA '90 regulations on the counseling practices of community pharmacists in Nebraska. Methods: A telephone survey was conducted of 80 randomly selected community pharmacies throughout Nebraska. A modified written survey was mailed to the 34 telephone nonrespondents and to another 86 randomly selected community pharmacists. A composite response rate (combining both survey methods) of 67.5% (112 of 166) was obtained, and responses were sorted into an independent community pharmacy group (n = 80) and a chain pharmacy group (n = 32). Results: Only 44.60/0 of respondents reported that t ime devoted to patient counseling had increased as a result of OBRA '90. Chain pharmacists generally devoted more time to counseling after OBRA '90 became effective than did independent community pharmacists. Conclusion: While more than three out of four pharmacists felt adequately prepared for mandated patient counseling, fewer than half reported that time devoted to counseling had increased. Although the profession is moving toward the standard of pharmaceutical care, many pharmacists are not yet counseling as the law requires.
TL;DR: Given the potential adverse effects of the drugs used to treat these conditions, pharmacists are in a unique position to recommend appropriate therapies and to refer patients to other health care providers as needed.
Abstract: Objective: To describe the signs and symptoms of and recommend treatments for Candida vulvovaginitis, bacterial vaginosis, and Trichomonas vaginitis. Data Sources: Current clinical literature. Data Synthesis : Patients with candidal vulvovaginitis often present with itching, burning, white discharge, vulvar or vaginal erythema, painful intercourse, and stinging on urination. It is treated with oral or topical antifungal agents. Bacterial vaginosis is characterized by a musty or fishy vaginal odor and a thin, white vaginal discharge. It is treated with oral or topical metronidazole or clindamycin. Patients with trichomoniasis usually complain of profuse, yellow-green discharge and vaginal or vulvar irritation. The standard treatment is a single 2 gram dose of oral metronidazole for both the patient and sexual partners. Conclusion: Given the potential adverse effects of the drugs used to treat these conditions, pharmacists are in a unique position to recommend appropriate therapies and to refer patients to other health care providers as needed.
TL;DR: Thalidomide is currently being used clinically to treat such conditions as cachexia associated with HIV and cancer, mycobacterial disease, and autoimmune diseases.
Abstract: The epidemic of birth defects in Europe in the early 1960s attributed to thalidomide led to stringent and unprecedented drug safety requirements in many countries. No definitive mechanism of action has been determined for the biological activities associated with thalidomide. Food and Drug Administration and congressional concerns about the handling of clinical investigations of thalidomide led to sweeping new regulations for clinical trials. Thalidomide is currently being used clinically to treat such conditions as cachexia associated with HIV and cancer, mycobacterial disease, and autoimmune diseases.
TL;DR: The most common unclaimed medication categories were anti-infectives, cough and cold/allergy medications, and birth control/hormones, and the most common reasons for not picking up their medication were transfer to another pharmacy, prescription was forgotten, the patient no longer wanted or needed the prescriptioll because they had medication left over, or patient decided they did not need the medication.
Abstract: Objective: To quantify the number of unclaimed prescriptions, document the reasons patients did not claim prescriptions, investigate the effect of telephone contact on the pickup rate, and document the types of medications .involved and the frequency of this type of non-compliance. Design: A total of 549 unclaimed prescriptions were evaluated during a nine-month study. Pharmacy students contacted patients whose prescription orders had been dispensed but not claimed. Patients contacted by telephone were asked why they had not claimed their prescriptions. The types of medications involved were documented, and a follow-up check was made of the patient's profile on the pharmacy computer system to determine whether the telephone contact affected the pickup rate. Results: Reasons given for not claiming the prescriptions included: transfer to another pharmacy, prescription was forgotten, the patient no longer wanted or needed the prescriptioll because they had medication left over, or patient decided they did not need the medication. Telephone contact had minimal impact on the compliance rate of this patient group. The most common unclaimed medication categories were anti-infectives, cough and cold/allergy medications, and birth control/hormones. Conclusions: Patients cited many reasons for not picking up their medication. Follow-up telephone calls did not increase the number of prescriptions picked up by patients in this study.
TL;DR: The Transtheoretical Model is a behavior-change model that provides a functional approach through which pharmacists can help patients to reach specific behavioral goals and stage-specific examples of patient-pharmacist dialogue are provided to show how the model may be used to promote progression through the stages.
Abstract: The strategic position of pharmacists within the community allows frequent interactions with many patients, thus making pharmacists potentially valuable resources for assisting patients in making behavioral changes regarding adherence to treatment. The Transtheoretical Model is a behavior-change model that provides a functional approach through which pharmacists can help patients to reach specific behavioral goals. The model is described and stage-specific examples of patient-pharmacist dialogue are provided to show how the model may be used to promote progression through the stages.
TL;DR: Pharmacists are uniquely qualified to provide a wide range of pharmaceutical care services to HIV-positive patients and should lead to improved outcomes and decreased costs for a chronic and very expensive disease.
Abstract: Objective: To present a brief overview of human immunodeficiency virus (HIV) infection and to describe the implementation of pharmaceutical care services for adult patients with HIV infection. Setting: University hospital clinic. Practice Description: A pharmacist joined a multidisciplinary team serving HIV-infected patients in January 1994. Practice Innovation: Current pharmacy services include taking medication histories, educating patients, counseling patients on compliance, monitoring response to therapy, identifying drug-related problems, documenting all interventions, and making therapeutic decisions and formulary choices. The pharmacist also participates in research. Interventions: The pharmacist sees patients immediately after their physician appointments. Patients with one or more of the following characteristics are targeted to receive pharmaceutical care: multiple drugs, history of noncompliance, initiation of new drug therapy, recently discharged from hospital or emergency department, identification of potential adverse effects, identification of potential drug-drug interactions, and presence of drug toxicities. Conclusion: Pharmacists are uniquely qualified to provide a wide range of pharmaceutical care services to HIV-positive patients. Pharmacy interventions should lead to improved outcomes and decreased costs for a chronic and very expensive disease.
TL;DR: Protease inhibitors have changed opinions about the futility of the treatment of HIV disease and dramatically improve patients' surrogate markers and even show mortality benefits, especially when combined with additional antiretroviral agents.
Abstract: Purpose: To provide a basic review of the four currently available protease inhibitors: saquinavir, ritonavir, indinavir, and nelfinavir. Included are sections on surrogate markers of HIV disease and resistance to protease inhibitor therapy, as well as dosing information, pharmacokinetics, studies, adverse effects, and drug interaction potential. Data Sources: Conducted a review of published literature (MEDLlNE), abstracts from national meetings and conferences, and product labeling and information available at the time of preparation through July 1997. Study Selection and Data Extraction: Material was selected for inclusion based on relevance to objectives, publication in English, and presence of useful information for practicing pharmacists. Data Synthesis: Limited published information is currently available on the protease inhibitors, especially with regard to randomized, controlled, comparative trials and establishment of guidelines for direct therapy. Much of the available information relies heavily on product information and trials that are published only in abstract form. The evaluation of the protease inhibitors (with regard to place in therapy as well as resistance and toxicities) is an ongoing process. Conclusion: Protease inhibitors have changed opinions about the futility of the treatment of HIV disease. Protease inhibitors dramatically improve patients' surrogate markers and even show mortality benefits, especially when combined with additional antiretroviral agents. The optimism surrounding these new drugs is tempered by the toxicity profile, development of resistance, drug interaction profiles, and added costs to current regimens. Designing tolerable, effective regimens will require careful monitoring for compliance, adverse effects, and potential drug interactions. Received January 14, 1997, and in revised form May 9, 1997. Accepted for publication June 17, 1997.
TL;DR: The findings of the Lake Superior Rural Cancer Care Project may be a harbinger of impeding shortages of pharmacists in most rural areas of the United States.
Abstract: The findings of the Lake Superior Rural Cancer Care Project may be a harbinger of impeding shortages of pharmacists in most rural areas of the United States. Elderly patients, the population that is most reliant on medication, constitute a large portion of the citizens who are potentially underserved in terms of pharmaceutical care in rural areas. Education for rural practice is largely overlooked in current pharmacy curricula. The national pharmacy leadership must develop a sensible workforce policy that considers the needs of rural patients.
TL;DR: A telephone callback program to reinforce basic patient counseling given at the time of dispensing is an effective and inexpensive mechanism for assessing and improving drug therapy outcomes.
Abstract: Objective: To develop a telephone callback program to reinforce basic patient counseling given at the time of dispensing. Design: At the time each prescription was filled, the pharmacist or pharmacy student recorded the patient's name, telephone number, date of birth, diagnosis, drug regimen, prescriber, relevant concurrent medications, initial comments, and date. Follow-up phone calls were then made when appropriate to assess patient progress in therapy. Results: Telephone assessment of 521 patients revealed that while 51.1 % reported their condition had improved, 15.1 % had worsened. Of the 79 therapeutic failures, 47 patients repeated the initial therapy or received a different antibiotic without another physician visit, 32 were referred back to their physicians, and 5 each resulted from noncompliance or adverse effects. Conclusions: A callback program is an effective and inexpensive mechanism for assessing and improving drug therapy outcomes.
TL;DR: It is demonstrated that many types of DUR messages are useful to pharmacists; however, additional research and further refinement of D UR messages appear necessary.
Abstract: Community pharmacists are encountering on-line drug utilization review (DUR) messages with increasing frequency. DUR messages are sent by third party claims processors and generated by pharmacies' in-house computer systems. The purpose of this study was to ascertain community pharmacists' attitudes toward on-line DUR messages and the actions most often taken by pharmacists after receiving these messages. A 28-item questionnaire was mailed to a random sample of 1,500 community pharmacies throughout the United States. Four hundred twenty-seven questionnaires were returned and analyzed (a 28.5% response rate). The majority of respondents were male pharmacists practicing in independent community pharmacies in cities with populations of less than 50,000. The low response rate from chain pharmacies was an important limitation of this study. The results indicate that pharmacists find DUR messages related to medication overuse and drug interactions to be the most useful. Interventions are not performed for all DUR messages received, and interventions usually consist of telephoning physicians and talking to patients. This study demonstrates that many types of DUR messages are useful to pharmacists; however, additional research and further refinement of DUR messages appear necessary.
TL;DR: In this article, the authors reviewed the epidemiology, societal costs, clinical presentation, pathophysiology, etiology, and treatment of Alzheimer's disease in women, with an incidence greater than expected from longevity alone.
Abstract: Alzheimer's disease (AD) occurs more frequently in women, with an incidence greater than expected from longevity alone--a finding possibly related to reduced estrogen levels. The epidemiology, societal costs, clinical presentation, pathophysiology, etiology, and treatment of AD are reviewed. At present, only two drugs, tacrine and donepezil, are approved for treatment of AD. These drugs enhance central cholinergic activity by inhibiting cholinesterase. The goal of current drug development research is to halt progress of AD, and efforts are underway to discover ways to restore neuronal activity via neurotrophins and to prevent neuronal loss. Pharmacists are well positioned to assist AD patients (in the early stages) and caregivers by encouraging early intervention and by presenting realistic expectations about the disease and its treatment. A number of easily accessible resources for health care providers and consumers are presented.
TL;DR: The evaluation of survey administration procedures primarily concerns determining whether or not a pilot study was conducted, whether proper statistical analyses were conducted, and whether multiple mailing procedures were used.
Abstract: Objective: To present overall guidance enabling the reader to critically evaluate survey research conducted via mail questionnaire. Also considered are the sources of error that may operate during the conduct of survey research and the threats they pose to both the internal rigor of the study and the generalizability of the results. Study Selection: Not applicable. Data Extraction: Not applicable. Data Synthesis: Not applicable. Conclusion: Survey research has been used so commonly and for such a wide range of purposes in a large number of fields, that some people may mistakenly conclude that surveys are easy to conduct. Survey research involves much more than generating a set of questions to ask a group of subjects. To draw valid conclusions about the topic of a survey, the pharmacist must be prepared to evaluate the results in light of how well the investigators approached four sources of error—overage, sampling, measurement, and nonresponse. The evaluation of survey administration procedures primarily concerns determining whether or not a pilot study was conducted, whether proper statistical analyses were conducted, and whether multiple mailing procedures were used. Failure to account for these sources of error, or inappropriate survey administration, could seriously affect both the generalizability and validity of the results.
TL;DR: Pharmacists appear ready to accept a majority of the practice standards used in this study, but lower ratings by respondent pharmacists may be indicative of apprehension about embracing a new practice paradigm and a belief that the provision of pharmaceutical care services has a limited impact on therapeutic outcomes.
Abstract: Objective: This study assessed pharmacists' perceptions of the feasibility and relevance of a set of community-based pharmaceutical care practice standards. Design: Practice standards generated in a Delphi study were rated for feasibility of implementation and relevance to improving therapeutic outcomes by a randomized sample of 315 pharmacists on two 7-point Likert-type scales. These ratings were compared with assessments by Delphi panel experts. Results: Pharmacists judged many of the standards favorably; however, Kruskal-Wallis ANOVA revealed that they were less confident in the standards' feasibility of implementation and relevance to improving patient outcomes than were the Delphi panel experts. Conclusion: Pharmacists appear ready to accept a majority of the practice standards used in this study. The lower ratings by respondent pharmacists may be indicative of apprehension about embracing a new practice paradigm and a belief that the provision of pharmaceutical care services has a limited impact on therapeutic outcomes. Acknowledgments : The author would like to express his gratitude to the participants in the Delphi study: Doris Anderson, JoAnn Anderson, Ray 8aretto, Marialice Bennet, PharmD, Stuart Bergstein, Robert Clayton, Jan Hastings, PharmD, Alan Lukazewski, Ron Matson, Mark Paley, Sherwin Schnall, Michelle Shibley, Michelle Valentine, Orsula Voltis-Thomas, PharmD, Anne Williamson, and Marijo Winston. Received June 3, 1996, and in revised form November 21, 1996. Accepted for publication February 10, 1997.
TL;DR: Animal studies suggest that famciclovir (but not valacyclovir) can affect subsequent latent infection with HSV-1; the relevance of these findings to humans requires further investigation.
Abstract: Limitations of acyclovir in treating infections caused by herpes simplex virus include the development of resistant isolates and relatively poor oral bioavailability. Penciclovir and famciclovir may have added clinical utility in the treatment of herpes virus infections in humans. Intracellular pharmacokinetics differ for valacyclovir and famciclovir, but the importance of these differences is unknown. Animal studies suggest that famciclovir (but not valacyclovir) can affect subsequent latent infection with HSV-1; the relevance of these findings to humans requires further investigation. Famciclovir and valacyclovir appear to decrease time to resolution of pain compared with acyclovir in patients with herpes zoster infections.
TL;DR: An understanding of the impact of physiologic, hormonal, and neurotransmitter changes associated with different life phases should provide valuable insight into the treatment of neuropsychiatric disorders in women and gender differences in psychopharmacology.
Abstract: Objective: To review the most common psychiatric disorders in women and to address gender-related pharmacokinetic and pharmacodynamic differences in psychotropic medications Data Sources: Recent clinical literature selected by the author Data Synthesis: Women have higher prevalence rates of anxiety, mood, and eating disorders than do men, and they are prescribed the majority of psychotropic medications In general, women experience more comorbid illnesses, have a higher rate of morbidity and disability, and suffer more from reversible drug-induced or medically induced psychiatric conditions Biological factors such as hormonal and neurotransmitter fluctuations during the menstrual cycle, pregnancy, postpartum, perimenopause, and postmenopause may affect the pharmacokinetics of psychotropic medications Information is needed about gender differences in the incidence and diagnosis of psychiatric disorders; sex differences in the treatment, response, pharmacokinetics, and adverse effects of psychotropic medications; and safety of psychotropic medications in the fetus and in the breast-fed infant Conclusion: An understanding of the impact of physiologic, hormonal, and neurotransmitter changes associated with different life phases should provide valuable insight into the treatment of neuropsychiatric disorders in women and gender differences in psychopharmacology