Background: Pharmaceutical care for diabetic patients has demonstrated benefits in many countries. Nevertheless, in Laos, diabetes care has been provided without pharmacists' involvement. This study aimed to evaluate the outcomes of pharmacist-led interventions in diabetes care in Laos. Methods: A single blinded randomized controlled trial with pre-test and post-test was designed. The study was undertaken in type 2 diabetes patients registered at a hospital from June 2019 to July 2020. Patients in the intervention group received pharmaceutical care in six months, while the control group received standard care. Primary outcomes were hemoglobin A1c (HbA1c) and fasting plasma glucose. Secondary outcomes included blood pressure, lipid profiles, renal function, 10-year risk, patient satisfaction, and quality of life. Intention-to-treat analysis was applied. Results: One hundred forty-four diabetes patients were recruited and randomly assigned to groups (73 intervention, 71 control); 121 included in the analysis (64 intervention, 57 control). Of the 67 pharmacist's interventions, adding statin/aspirin (doctor acceptance rate of 79.10%) was predominant. After six months, achievement of hemoglobin A1c and LDL goals showed improvement (OR 1.31, 95%CI .50-3.43, p=.589; OR 1.35, 95%CI .61-3.01, p=.465), however, no statistically significant differences in clinical outcomes were found between groups. Compared to the pretest, the intervention group showed significant improvements in HbA1c, cholesterol, and low-density lipoprotein levels (p<.05). Nevertheless, the control group also showed significant improvement in HbA1c (p<.05). Patient satisfaction with pharmacists' competency was statistically significantly higher in the intervention group than the control group (p=.010). Conclusion: Pharmacist-led diabetes care could provide clinical benefits and improve patient satisfaction to pharmacists' competency. Although pharmacist's intervention did not yield statistically better clinical outcomes than usual care, there was a trend toward better HbA1c and cholesterol controls. Continuous pharmacists' contributions in diabetes care with advancing the collaborative protocol should be further supported.

Background The U.S.-Thai Consortium for Pharmacy Education is a long-standing collaboration between the U.S. and Thailand that primarily focuses on faculty development. The success of this partnership has contributed to the improvement of pharmacy education and the advancement of pharmacy practice in Thailand. It may also serve as a model for collaborative efforts in pharmacy education and practice across Association of Southeast Asian Nations (ASEAN) countries. This study was designed to explore the views and perceptions on goals, directions, and trends for the new U.S.- ASEAN Consortium for Pharmacy Education.Methods A qualitative study was used. A focus group with semi-structured questions was conducted with 12 representative faculty members from nine ASEAN countries and the U.S. Verbatim transcriptions were used to perform thematic analysis with investigator triangulation.Results Four key themes emerged: perceptions, challenges, expectations, and directions. Participants perceived the U.S.-ASEAN Consortium as a strategic networking platform for expanding international collaborations. Challenges were identified at both the institutional and national levels, with curriculum differences, financial constraints, and administrative issues affecting institutions, while cultural and language differences pose further obstacles. At the national level, top-down administrative structures were identified as restrictions. The main expressed benefit of joining the Consortium was enhancement of student experiences, including student exchange programmes. Gaining insights into organisational administration was also perceived as one of the benefits. Participants recognised that a successful collaboration required identifying common interests, setting goals, and proposing strategies, including developing a master plan, harmonising programmes, and establishing a uniform competency framework. Regular meetings and resource-sharing were identified as also essential to maintaining the engagement of Consortium members.Conclusion The U.S.-ASEAN Consortium was perceived as a platform to increase opportunities to collaboratively connect with other pharmacy schools internationally. The establishment of common interests and strategies was recommended to keep the collaboration moving forward.

Purpose: To establish a pharmacist-led olaparib follow-up program for ovarian cancer patients, provide patient education, get information on adverse drug reactions (ADRs), and identify and manage drug-related problems. Methods: Ambulatory adult patients with ovarian cancer receiving olaparib were enrolled. At least one follow-up session was conducted by clinical pharmacists. Pharmacists collected data on the type and grade of ADRs, drug adherence, olaparib dosing, concomitant medications, and pharmacists’ suggestions. Results: 83 patients were enrolled with the median age of 58. The average number of the follow-up sessions provided to each patient was 1.31, and the average duration of each follow-up was 17.78 min. The olaparib starting dose for most patients (97.59%) was 600 mg/d. 36.14% of the patients had missed olaparib doses and 27.71% of the patients had dose adjustments due to ADRs. The most common ADRs (incidence≥10%) were: fatigue (40.96%), anemia (36.14%), leukopenia (36.14%), nausea (28.92%), thrombocytopenia (16.87%), anorexia (16.87%), dyspepsia (15.66%). The tolerability profiles were generally similar between patients treated for “first-line maintenance” and those treated for “recurrence maintenance” (p > .05). There were 42% of the patients who were concomitantly taking medications without exact chemical contents (such as formulated Chinese medicines and Chinese decoctions), and common types of concomitant medications with exact drug names were antihypertensive, anti-hyperglycemic, and anti-hyperlipidemic medications. The pharmacists identified 4 clinically significant drug-drug interactions (DDIs) in two patients. Pharmacists made 196 suggestions mainly related to rational use of the medications and management of ADRs. Conclusion: The study provides the first report about pharmacist-led follow-up service for olaparib. The types of ADRs were similar to those previously observed in clinical trials, and the profiles of ADRs in different types of patients (first-line maintenance vs. recurrence maintenance) were also similar. Pharmacists identified drug-related problems (such as adherence, DDIs and management of ADRs) and offer suggestions for the patients.

In recent years, with an increasing number of oncology patients and continuous introduction of new antitumor drugs in China, the demand for oncology clinical pharmacy services is growing rapidly, which is both an opportunity and a challenge for clinical pharmacists. However, there have not been many reports about different types of oncology clinical pharmacy services in China. In this report, we have summarized different oncology clinical pharmacy services commonly practiced in Chinese hospitals based on our review of the literature and current practice in our hospital. We are reporting the training programs and the certification process for oncology clinical pharmacists, basic and advanced patient services, pharmacist-driven and pharmacist-participated guidelines/expert consensuses/books on oncology pharmacotherapy, as well as professional and public health education performed by pharmacists. Based on what we have observed, oncology clinical pharmacy services in China are relatively comprehensive, however, there are needs for expanding certain advanced pharmacy services. Increasing the time spent on clinical services, improving pharmacists' competency, and optimizing clinical pharmacy workflow and evaluation mechanisms are important for enhancing the value of oncology clinical pharmacists in China.

Objectives: To evaluate the educational experience and teaching methods of the collaborative Doctorate of Pharmacy (PharmD) program between the University of Malta (UM) and the University of Illinois at Chicago (UIC). Methods: A 41-question survey was developed to identify student demographics, satisfaction with the PharmD program and the utility of the current curricular components. Students who enrolled in the program in May 2017 were invited to participate. The survey contained open-ended, 5-point Likert, and multiple-choice type questions. The primary outcomes were the overall satisfaction and student motivations for pursuing the program. Secondary outcomes included the level of difficulty of courses, evaluation of assessment methods, and confidence in an interdisciplinary team. Results: Thirty-six students completed the survey (a response rate of 83.7%). The mean age was 30.1 ± 7.9 years. The majority of the students pursued the PharmD program to improve their knowledge, skills, and opportunity for obtaining a clinical position. The mean overall satisfaction of the program was 3.81 ± 1.1 (5 = very satisfied). Among the core courses, Pharmacotherapeutics had the highest overall satisfaction (4.45 ± 0.91) and level of difficulty (3.84 ± 0.51). Students felt that the tutorials/recitation case discussion sessions were the most effective teaching method (48.4%) and ranked faculties conducting case-based lectures highest for overall performance. Most students felt somewhat confident (54.8%) for participating in a multidisciplinary team. Conclusions: The UM/UIC PharmD Program is a unique program, utilizing a hybrid model of teaching, including distance education, to expose students to a broad and challenging curriculum in clinical pharmacy practice. Students are satisfied with this collaborative, international postgraduate PharmD program.

This book presents concise, comprehensive summaries of topics necessary to understand rheumatoid arthritis (RA) management, aligned with patient needs, as a reference suitable for practitioners and st

There has been a recent plethora of studies uncovering the newly discovered physiological and pharmacological effects of vitamin D. With an increasing recognition of hypovitaminosis D worldwide, there is much interest to address the clinical significance of vitamin D deficiency and identify the most optimal regimen to replenish the body stores through supplementation. With our growing understanding of the non-mineral/bone activities of vitamin D, such as its effects on immune system, cancer and cardiovascular disease, there is a need to establish the optimal means of assessing vitamin D sufficiency and deficiency, the amount of vitamin D needed for optimal body function and how much vitamin D supplementation is required among individuals. As vitamin D is a pre-hormone that can both be synthesized in the body and obtained from the diet, there are challenges in deriving a recommendation. In addition, the amount of vitamin D present in the body is also influenced by factors such as aging, skin pigmentation, concomitant interacting medications and renal disease. For now, 25(OH)D is commonly used to determine vitamin D body stores in studies and clinical practice. This chapter seeks to discuss the issues surrounding vitamin D supplementation in the light of these new findings and address the concern over the vitamin D deficiency with the view that “more vitamin D is not necessarily better”.

Abstract Background Benefits of early nephrology care are well-established, but as many as 40% of U.S. patients with end-stage renal disease (ESRD) do not see a nephrologist before its onset. Our objective was to evaluate the effect of proactive, population-based nephrologist oversight (PPNO) on chronic kidney disease (CKD) progression. Methods Retrospective control analysis of Kaiser Permanente Hawaii members with CKD using propensity score matching methods. We matched 2,938 control and case pairs of individuals with stage 3a CKD for the pre-PPNO period (2001–2004) and post-PPNO period (2005–2008) that were similar in other characteristics: age, gender, and the presence of diabetes and hypertension. After three years, we classified the stage outcomes for all individuals. We assessed the PPNO effect across all stages of progression with a χ2- test. We used the z-score test to assess the proportional differences in progression within a stage. Results The progression within the post-PPNO period was less severe and significantly different from the pre-PPNO period (p = 0.027). Within the stages, there were 2.6% more individuals remaining in 3a in the post-period (95% confidence interval [CI], 1.5% to 3.8%; P value < 0.00001). Progression from 3a to 3b was 2.2% less in the post-period (95% [CI], 0.7% to 3.6%; P value = 0.0017), 3a to 4/5 was 0.2% less (95% CI, 0.0% to 0.87%; P value = 0.26), and 3a to ESRD was 0.24% less (95% CI, 0.0% to 0.66%, P value = 0.10). Conclusions Proactive, population-based nephrologist oversight was associated with a statistically significant decrease in progression. With enabling health information technology, risk stratification and targeted intervention by collaborative primary and specialty care achieves population-level care improvements. This model may be applicable to other chronic conditions.

Lanthanum carbonate, a chewable noncalcium-containing phosphorus (P) binder, is useful for treating secondary hyperparathyroidism in patients who have hypercalcemia and cannot swallow whole tablets. However, some patients cannot chew tablets or prefer to crush and mix them with food. This study was conducted to determine the P-binding efficacy of crushed lanthanum and compare it with chewed lanthanum in hemodialysis (HD) patients. After a 1-week washout period, 11 hemodialysis patients (7 men, 4 women) were randomized to receive, in a crossover fashion, lanthanum 1000 mg 3 times daily chewed with meals and lanthanum 1000 mg 3 times daily crushed into a fine powder, mixed with applesauce and taken with meals, for 4 weeks each. Serum P was measured at the end of each washout (baseline) and weekly during treatment. Changes in serum P from baseline for crushed lanthanum were compared with chewed lanthanum using paired sample t test. Administration of crushed lanthanum resulted in a significant reduction in serum P from baseline (P reduction [mg/dL] for crushed lanthanum in week 1: 2.1 +/- 0.4, week 2: 1.7 +/- 0.5, week 3: 1.7 +/- 0.5, week 4: 1.7 +/- 0.4, P < 0.05). No statistically significant differences were observed in serum P reduction from baseline and serum P attained during treatment with crushed when compared with chewed lanthanum. Crushed lanthanum is effective in reducing serum P and have similar P-binding efficacy to chewed lanthanum. Crushing lanthanum and mixing it with food can thus be an option for patients who are unable to chew or swallow whole tablets.

Patients with chronic kidney disease (CKD) develop mineral and bone disorder (MBD), a common and important complication, as a result of impaired phosphorus excretion and reduced vitamin D activation. Altered mineral metabolism is now recognized as an independent cardiovascular risk factor in end-stage renal disease patients and contributes to the risk for accelerating vascular calcification. CKD patients are at high risk for cardiovascular disease and vascular calcification which account for the high morbidity and mortality in this patient population. Pharmacotherapeutic interventions are necessary to manage and treat the condition. Multiple classes of agents including phosphorus binders, vitamin D analogs, and calcimimetics are now available to treat CKD-MBD. Recent data have shown that treatment with sevelamer and vitamin D analogs are associated with a reduction in calcification and cardiovascular mortality and improved survival. This article provides an overview of the strategies and considerations for the management of CKD-MBD, as well as their implications on clinical outcomes.

BACKGROUND AND OBJECTIVESPhosphate binders such as calcium salts or sevelamer, a cationic polymer, can markedly reduce absorption of oral ciprofloxacin. This randomized, open-label, two-way, crossover study examined the influence of the cation lanthanum on systemic ciprofloxacin exposure after oral administration.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTSTwelve patients randomly received in a crossover manner a single oral dose of ciprofloxacin 750 mg alone and plus lanthanum carbonate 1 g three times daily with meals for six doses, with a washout interval of 7 to 14 d. Serial blood and urine samples were collected for 24 h after ciprofloxacin administration, and ciprofloxacin concentrations were determined using reverse-phase HPLC. Pharmacokinetic parameters of ciprofloxacin were calculated by noncompartmental methods, and the effect of lanthanum on ciprofloxacin pharmacokinetic parameters was assessed using ANOVA.RESULTSLanthanum decreased (P < 0.001) the mean ciprofloxacin area under the plasma concentration-time curve by 54% and the maximum plasma concentration by 56%. The 24-h urinary recovery of ciprofloxacin was reduced by 52% by lanthanum (P < 0.001). No statistically significant differences in ciprofloxacin time to maximum plasma concentration, elimination half-life, and renal clearance occurred between the two arms.CONCLUSIONSLanthanum carbonate significantly reduces the systemic exposure to orally administered ciprofloxacin. Concomitant administration of both drugs should be avoided to prevent possible suboptimal response to ciprofloxacin.

Patients with end‐stage renal disease often experience malnutrition as a result of decreased dietary intake; inadequate dialysis; loss of nutrients into the dialysate; abnormal protein, carbohydrate, and lipid metabolism; and concomitant diseases, which may contribute to an increase in morbidity and mortality. Intradialytic parenteral nutrition (IDPN) is being used to improve nutritional status, in conjunction with other methods of nutritional supplementation. The biggest advantage of IDPN is probably its convenience since it is administered during dialysis treatment and thus does not require additional clinic visits or prolonged dialysis time. Although IDPN has several disadvantages, its ability to improve nutritional status and reduce morbidity and mortality in patients with end‐stage renal disease is promising. Well‐designed, large‐scale, prospective studies are required to confirm its beneficial effects.

Different methods are available for rapid assessment of renal function using the patient's serum creatinine concentration and body weight without obtaining urine collection over 24 hr. However, the reliability of these methods in patients with liver diseases has not been established. The purpose of this study was to determine the accuracy and precision of the estimated creatinine clearances obtained by the methods of Cockcroft-Gault, Jelliffe, Mawer, and Siersbaek-Nielsen in patients with liver diseases who have different degrees of renal function. Creatinine clearances obtained from 24-hr urine collection were used as the standard. The different methods for rapid renal function estimation had limited accuracy and reliability in patients with severe liver dysfunction (Child-Pugh class C) and also in those with creatinine clearances of less than 60 ml/min. Creatinine clearances were overestimated by about 40-100%. Using lean body weights, instead of total body weights, reduced the prediction errors. In patients with mild liver dysfunction (Child-Pugh class A), all four estimation methods provided reasonable estimation of the creatinine clearances.

The Smye method has been proposed to estimate the equilibrated post-dialysis BUN based on an additional intradialytic sample obtained approximately one hour into dialysis. However, the effects of access recirculation (AR) and cardiopulmonary recirculation (CPR) on the Smye computation and the corresponding details of how blood is sampled have not been studied. We examined the accuracy of two variations of the Smye technique. In one method, the intradialytic and postdialysis blood samples were obtained at full blood flow. In the other, the samples were obtained after two minutes of slow flow, to obviate the effects of both AR and CPR. Seventeen patients undergoing high efficiency dialysis and three- to four-hour treatment times were studied, in whom substantial AR was excluded based on two-minute slow flow urea rebound measurements during and just after dialysis. In this group equilibrated Kt/V (eKt/V) values computed using the Smye-derived equilibrated postBUN estimates (full flow samples, 1.22 +/- 0.058 SEM, slow flow samples, 1.23 +/- 0.064) were similar to eKt/V calculated from the 30-minute postdialysis BUN specimen (1.23 +/- 0.049, P = NS). In eight other patients with severe AR (mean 35% +/- 4.5), the accuracy of the full flow Smye estimates was poor when the degree of AR was not constant throughout the dialysis session. Accuracy of the slow flow Smye estimates of eKt/V was unaffected by the presence of severe AR. One advantage of using the full flow Smye method, however, was that a large delta Kt/V value ( < -0.40) was highly suggestive of severe AR.(ABSTRACT TRUNCATED AT 250 WORDS)

Flucytosine is effective in the treatment of serious fungal infections. Some of the patients might have acute renal failure requiring continuous hemofiltration as renal replacement therapy. We evaluated the removal of flucytosine in a patient who received the drug for systemic Candida infection while undergoing continuous hemofiltration for acute renal failure. Arterial, venous, and ultrafiltrate sample pairs were collected to evaluate flucytosine removal. Ultrafiltrate/arterial drug concentration ratios and sieving coefficients obtained with the polysulfone membrane were higher than those obtained with the polyacrylonitrile membrane. Between 2.54 and 22.56 mg of flucytosine was removed from the patient per hour when the serum drug concentrations were 21.1-126.5 mg/l. The amount of hemofiltration flucytosine removal was related to ultrafiltration flow rate, serum drug concentration, and hemofilter type. The mean continuous arteriovenous hemofiltration flucytosine clearance for the polysulfone membrane was 77.0 +/- (SD) 15.6% of the ultrafiltrate flow rate, while the clearance for the polyacrylonitrile membrane was 51.0 +/- (SD) 5.7%. In patients with renal failure, continuous hemofiltration can remove an appreciable quantity of flucytosine when the ultrafiltrate flow rate is high. Serum drug concentration determination is necessary to devise an optimal dosage regimen for the patient.