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S.NO Title & Authors Name page
*Jeffrey C. Keimer and Shaker A. Mousa
 Abstract                  View                 Download                 XML
We evaluated the clinical and economic impact of generic drug discount programs (GDDPs), pharmacy based immunization services and convenient care clinics (CCCs) based upon existing literature, reviewing original research and case study reports using library databases, primarily MEDLINE and EBSCOHost.  Keywords used included “generic discount list,” “four dollar generic,” “pharmacy immunization,” “flu shot,” “pharmacist immunizer,” “convenient care clinic,” “retail health clinic,” and “minute clinic.”  We then added other terms such as “clinical impact,” “cost-effectiveness,” “outcomes,” and “perceptions.” While all 3 programs have the potential to clinically benefit patients and provide some level of cost-effectiveness, there are also concerns that need to be addressed. Some concerns include: a) GDDPs have the potential to cause fragmentation of care owing to patients going to other pharmacies in search of lower prices and prescription claims data not being captured by patients’ pharmacy benefit managers, b) GDDPs may be less cost effective in pharmacies with less purchasing power compared to larger chains, c) pharmacy based immunization services still face legal and social barriers that prevent pharmacists from being recognized as legitimate vaccine administrators, d) some insurance carriers still don’t pay for pharmacist-administered vaccinations, e) CCCs may not currently be located in areas that could best benefit from their services, f) CCCs may disrupt a patient’s continuity of care with their primary care physicians, and g) CCCs may hinder the efforts of pharmacists to expand their own professional roles by lessening the need for them to do so. Expanding the roles of community pharmacies has the potential to improve patient care by increasing patients' access to healthcare services. While strong evidence exists to support pharmacist-delivered immunizations, less is known regarding GDDPs and CCCs.  More studies are required to assess the clinical and economic questions raised regarding these types of programs.
*Akram Ahmad, S. Parimalakrishnan, Guru Prasad Mohanta, Isha Patel and PK Manna
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Infectious diseases are a prominent cause of death in developing countries. The antibiotic resistance caused by emergence of antibiotic resistant microorganisms, is a health problem leading to poor treatment outcomes and increased cost, increased mortality, morbidity and adverse drug reactions. The government of India proposed to introduce the New Drug Policy in 2011which calls for the making of a new schedule, Schedule HX, under the Drugs and Cosmetics Act. A cross-sectional and observational study was conducted in a private community pharmacy situated in Chidambaram, a city in rural South India to determine the appropriateness of the higher generation antibiotics (cephalosporin, flouroquinolone and coamoxiclav groups) in the out-patient department. The prescriptions were collected from the patients after they purchased the medicine from the pharmacy. All prescriptions containing higher generation antibiotics were assessed for the inappropriateness using a modified Medication Appropriateness Index. 300prescriptions containing higher generation antibiotics were analyzed. Out of the 77.66% of the prescriptions containing, 69.95% of prescriptions contained higher generation antibiotics. When assessed for the appropriateness of the prescription, 51%of the prescriptions containing higher generation antibiotics were prescribed inappropriately. <br />
Interns Experiential Training Perspectives with Pharmacist Prescribing Protocol Development
Elhaum Khobahy, Nkechiamaka Nwosu, Reza Abbasgholizadeh, Mousa Abkhezr, Valerie U. Oji
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Pharmacist intern impressions on prescribing roles and protocol development in the course of their advanced experiential training experiences are described. The objectives of this qualitative study were to: 1) Identify core protocol requirements, 2) Compare/Contrast protocols from U.S. states with extensive pharmacist prescribing protocol history and 3) Design a pharmacist prescribing protocol based on integrated or collaborative care theory. Feedback on prescribing protocol development and pharmacist prescribing roles was gathered from a focus group of pharmacist interns’ activities that included 1) review of the local State Pharmacy law requirements (TX); and 2) comparison of these requirements with six other states or territories (CA, MD, DC, KS, VA, WA) where services are provided by the experiential training site and/or that state has a long history of experience with collaborative drug therapy management; 3) review of local state and out-of-state sample protocols; and 4) key general discussion questions. Prescribing protocols were obtained via Freedom of Information Act (FOIA), known samples, and data on hand. A concise, comprehensive prescribing protocol was developed for application of collaborative chronic care. Core protocol requirements identified were State Pharmacy and Medical Board approval and guidelines; pharmacist and physician licensure; specified prescribing-related and medication-management activities to be delivered by the pharmacists; how medication-management decisions would be made, documented and evaluated. Differences across U.S. states included the issuance of Pharmacist DEA numbers, pharmacist educational requirements, treatment algorithms, state/local guidelines and protocols. Interns\' shared experiences led to a perceived underutilization of pharmacists in meeting existing patient health service access needs and addressing medication-related problems. They also identified potential implementation challenges such as time and staffing limitations, provider status recognition, third-party reimbursement, overcoming multidisciplinary stereotypes of pharmacists’ roles, unfamiliarity with pharmacist prescribing as compared to other providers, educational needs for reinforcement on patient diagnoses, laboratory value orders/interpretations, medical record and claims documentation, and interprofessional communication. A positive interest in prescribing roles and protocol development was identified in contributing to patient health service needs. Implementation can be facilitated with an understanding of core protocol requirements, state laws, treatment guidelines and algorithms, potential service implementation challenges, and educational strategies for clinicians, administrators and policy-makers. Educational preparedness should consider the incorporation of these experiences, especially across multidisciplinary settings, to improve collaborative care.
Engi Nakhla, Ehab Daoud, Shyam Gelot
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Dexmedetomidine is a novel sedative that was approved for use in the US at the end of the last century. Currently, the FDA labeling for its use are: sedation in non-intubated patients prior to and during surgical and other procedures, and in intubated and mechanically ventilated patients during treatment in an intensive care setting and to be administered by continuous infusion not to exceed 24 hours. Multiple investigations for other indications and prolonged durations have caused controversies for its use. Given the risks of this medication, strict adherence to guidelines for its use is recommended. The aim of this review is to discuss the approved and the not yet approved indications to use this medication.
Rania Tarek Malatani
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“When the gut works, use it” is a common expression used to encourage the use of the enteral route for nutrition over the parenteral route in hospitalized patients. The same access device is often used to deliver both the enteral formula and medications without regard to the administration site (gastric versus small bowel). Changes in drug response as well as complications of drug administration may result from delivering enteral nutrition and medication together through the same tube. Currently, there is no standard of practice regarding the administration of specific medications when patients are receiving tube feeding, and if the feeding should be held for a period of time before and after drug administration. This report provides a general review regarding interactions between enteral feeding and the fluoroquinolones antibiotic class.
Mousa Abkhezr, Valerie U. Oji
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Practicing abroad in the global health arena is a desired objective by many foreign pharmacy graduates. By definition, a pharmacist whose undergraduate pharmacy degree was conferred by a recognized school of pharmacy outside of the 50 United States and the District of Columbia, and Puerto Rico is considered a foreign pharmacy graduate. These pharmacists in order to be licensed in the USA have to pass four tests including: 1-foreign pharmacy graduate equivalency examination (FPGEE), 2- test of English as a foreign language (TOEFL), 3- North American pharmacist license examination (NAPLEX), and 4-multistate pharmacy jurisprudence examination (MPJE). There is a last requirement to complete 1500 hours internship; this may be required before or after passing NAPLEX and MPJE, depending on the specific state of intended practice. This internship has to be under the supervision of a licensed pharmacist known as preceptor. Studying and practicing abroad may be challenging, but there are opportunities and resources to navigate through the process. 
Remy Pacifique Ntirenganya , Valens Mugiraneza, Bethany L. Hedt-Gauthier, Marie Paul Nisingizwe, Anicet Nyawakira, John Nyiligira Felix Rwabukwisi Cyamatare, Isaie Nsabimana, Regis Habimana, Frederic Muhoza, Cheryl L. Amoroso
 Abstract                  View                 Download                 XML
Inappropriate prescribing is a global health problem and main challenges include over prescription of antibiotics, over-use of injections, over-spending by failing to prescribe generic medicines and prescription of multiple medicines. This cross-sectional study included patient encounters at outpatient departments of three rural hospitals in Rwanda to assess prescribing patterns of essential medicines using the WHO core prescribing indicators. Patient encounters were randomly sampled. Chi-square and Kruskal-Wallis statistical tests were used to compare results. Our findings show that the average number of medicines prescribed per patient (1.8) was within WHO targets, the percentage of encounters with an antibiotic prescribed (37.2%) was above targets, while the percentage of encounters with an injection prescribed (7.2%) and percentage of medicines prescribed in generic names (75.0%) or from the National Essential Medicines List (70.5%) were below WHO targets. Clinicians, researchers, academics and policymakers should use these findings to plan for interventions like problem-based learning or Drug and Therapeutics Committees that promote good prescribing practices.
Platelets as Regulators of Wound Healing
Wayne Roberts
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Wound healing occurs through a well-orchestrated series of events encompassing hemostasis, inflammation, cellular proliferation and tissue remodeling. Platelets are specialized vascular secretory cells that rapidly accumulate at sites of injury, quickly becoming the most prevalent cell type. They undergo expansive activation within damaged tissue, initiated by the exposure of extracellular matrix proteins and by the local generation of thrombin. Platelets contain numerous granule types which hold more than 300 biological active components. The content of these granules are released upon platelet activation. A wealth of studies now demonstrates that the contents of these granules are able to regulate most stages of wound healing. In the past two decades an increased understanding of the physiological roles of platelets in wound healing has led to the idea of using platelet products as therapeutic tools to enhance skin repair. This article highlights the mechanisms by which platelets enhance wound closure and discusses the clinical effect of platelet therapy on wound healing.
Exploring Over-The-Counter Medication Use among College Students and the Role of Pharmacists
Olufunmilola Abraham
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Over-the-counter (OTC) medications are easily accessible and allow access to treatment options for people who do not or are too busy to receive care from physicians or other healthcare providers [1]. Consequently, OTC medications provide treatment to 60 million people in the U.S [1]. Besides convenience, OTC medications are also affordable treatment options [1]. Therefore, self-medication is a common practice, particularly with the use of OTC medications [2]. However, this practice puts people at risk of developing adverse events, side-effects, or adverse drug reactions (ADRs) [2]. Additionally, self-medication could lead to misusing or abusing OTC medications [2]. Previous studies have shown that a common misconception about OTC medications is that they are safe [3,4]. However, these medications are only safe when used as directed. This perception that OTC medications are safe is a problem because risks of self-medication include incorrect self-diagnosis, delays in seeking medical treatment, incorrect medication choice, masking of a severe disease, and the risk of dependence or abuse [5].
Management of Drug Toxidermia: Experience of the Pharmacovigilance Service of Oran EHU
Toumi H
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Introduction: Cutaneous reactions are among the most frequently observed adverse effects after drug treatment. They are a common problem, almost daily for doctors and represent an important part of drug iatrogenic. Aims: The objective of this work is to study the cases of cutaneous adverse reactions declared in the pharmacovigilance department of UHE Oran to identify the iatrogenic character of the rash. Material and method: A prospective study was carried out over a period of 30 months from January 2013 to June 2015. It involved 61 notifications accompanied by reporting forms, from different departments of the EHU of Oran. We carried out an analysis of the declaration forms with estimation of the accountability. Results and discussion: The results of our study show that the toxidermia account for 58% of the reported side effects. 61 patients were collected, the average age was 45 years, and there were a female predominance with a percentage of 54%. The dermatology department is the most reputable service with a rate of 41%. The most common clinical forms were: maculopapular exanthema (31.8%) and pruritus (22.9%). The most incriminated drugs were antibiotics (42.2%) and cytotoxics (22.7%). Accountability was plausible in 32.1% cases and likely in 27.6% of cases. Serious toxidermias account for 21% of reported cases with Stevens Johnson syndrome occurring in half of the reported cases and the class of antibiotics was the most incriminated in the occurrence of these reactions. Conclusion: The results of our study have highlighted the importance of surveillance for adverse effects in a hospital setting, as well as the role of pharmacovigilance in the management of patients who have had side effects to the use of drugs.
Medication Non-Adherence among Pediatric Patients with Chronic Illness
Ranjani Varadarajan*, Song Hee Hong
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Introduction: The pediatric populations face unique challenges in adhering to medication therapy because of their care dependency and varying developmental capacities. This review aims to provide a critical appraisal of recently published studies (1980-2013) on medication non-adherence among children. Specifically, it intends to summarize factors associated with pediatric medication non-adherence and to describe strengths and limitations of the interventions frequently used for improving medication adherence among the pediatric population.

Methods: A review of the literature was conducted for studies published in English on pediatric adherence to medication and therapeutic regimen between 1980 and 2013. Studies were included, if: (1) study populations were children and adolescents under 18 years of age; (2) study patients had chronic illnesses such as diabetes, asthma, HIV and mental health disorders; and (3) study outcomes and interventions concerned medication non-adherence.

Results: The number of studies reviewed was 76. Risk factors associated with pediatric medication non-adherence included age, peer pressure, disease, type of medication, health providers, and socio-demographic factors. Intervention strategies were education, cognitive/behavioral therapies, technologies, and multi-front approaches. However, few interventions were customized for the pediatric population with varying developmental capacities.

Conclusion: Improving medication adherence among pediatric patients requires individually tailored and patient-centered approaches that reflect varying developmental capacities of children.

Review of Pharmacy-Based Management of Uncomplicated Urinary Tract Infections (UTIS) In Community Pharmacy Settings
Julie M Akers*, Alex J Adams, Michael E Klepser
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Urinary tract infections (UTIs) are among the most common infections affecting adult women. One-half of all women will experience at least one UTI in their lifetime. Recurrence of UTIs is common, with a reported rate of 25% within 6 months of the first occurrence. UTIs are responsible for nearly 10.5 million medical visits annually in the United States (US), accounting for 0.9% of ambulatory visits. Estimates show emergency room visits for UTIs lead to $4 billion annually in unnecessary healthcare costs. Enhanced access to care at lower cost venues holds significant promise to improve patient care more efficiently.