Knowledge Of Pharmacology Research Articles

Standardizing Safety Assessment and Reporting for Neonatal Clinical Trials

Standardizing Safety Assessment and Reporting for Neonatal Clinical Trials

SELF-GLUCOSE MONITORING AND HYPOGLYCEMIA RISK IN OLDER RURAL VETERANS WITH TYPE 2 DIABETES

Hypoglycemia evaluation is expected in every encounter with diabetic patients. However, self-monitoring and self-management may not be complete at home, and limited by geriatric syndromes. Furthermore, hypoglycemia risk increases with age, and rurality may limit access to frequent monitoring. We identified 112 rural veterans with high hypoglycemia risk, using the local medication database (sulfonylureas and insulin), combined with age and glycated hemoglobin (HbA1c). Statistical analyses were conduct using SAS 9.4 (Cary, NC). We used Chi-square, Fisher’s, One-way ANOVA for baseline variables, and a multivariate logistic regression model to assess the association of hypoglycemia and risk factors, including age, HbA1c%, self-monitoring, and knowledge. Hypoglycemia was reported in 30.4% of cases, of whom the majority were younger than those not reporting hypoglycemia (72.0±4.3 vs 75.0±6.5 years, p=.015). Baseline HbA1c% was higher in cases with hypoglycemia compared to those without (7.7±1.6% versus 7.3±1.2%, not statistically significant). There were no significant differences between pharmacologic regimens, self-monitoring, and general knowledge. Veterans who knew hypoglycemia symptoms were 6 times more likely to reported hypoglycemia, compared with veterans who did not know any symptoms. We contacted primary care teams (PCT) for whom medications were adjusted. Hypoglycemia risk is high in the older population, and telemedicine programs can support primary care teams to improve management of their patients. Poor symptom knowledge needs to be addressed, while considering special attention for hypoglycemia unawareness in the oldest age group. We are implementing a project using continuous glucose monitoring in this high-risk population.

The eligibility criteria, training content, and scope of practice for prescriptive authority for midwives: a modified Delphi study†

Abstract Objective To investigate the necessary eligibility criteria for prescriptive authority for midwives, gather suggestions from experts on training content for prescriptive authority for midwives, and explore the scope of practice of their prescriptive authority in certain circumstances. The results of this study could serve as a reference for the development of policies on prescriptive authority for midwives. Methods Based on a literature search and semistructured interviews, a modified Delphi method was first used to conduct 2 rounds of expert consultation on eligibility criteria and training content for prescriptive authority for midwives. This stage included nursing experts (20) and medical experts (16) engaged in midwifery in many tertiary Grade A hospitals in China. Subsequently, consultation on the scope of practice of prescriptive authority for midwives was conducted with nursing experts (18) and medical experts (14) engaged in midwifery in many tertiary Grade A hospitals in China. The suggestions from the experts were analyzed using statistical methods to confirm the eligibility criteria for prescriptive authority, training content, circumstances, scope of practice for prescriptive authority, and the prescription forms. Results Among the consulted experts, 70.59% (the highest acceptance rate) considered an undergraduate degree to be the minimum educational requirement for midwives to be eligible for prescriptive authority, 85.29% (the highest acceptance rate) considered the supervisor nurse to be the minimum technical position experience necessary for midwives to be eligible for having prescriptive authority, and 50% (the highest acceptance rate) considered 5 years to be the minimum number of years of experience in the specialty for midwives to be eligible for prescriptive authority. The applicants should at least be practicing at Grade C hospitals, which was the consensus among 91.18% of the consulted experts. Among the consulted experts, 100%, 100%, 97.06%, 94.12%, and 94.12% agreed that the applicants should have knowledge in pharmacology, laws and ethics, nursing, diagnostics, and midwifery, respectively. The consulted experts confirmed 22 related course topics and identified 6 specific circumstances in which the midwives could partially practice prescriptive authority, including uterine atony, excessive uterine contraction, postpartum hemorrhage, premature rupture of fetal membranes, normal labor, and neonatal asphyxia. Under these 6 circumstances, the consulted experts commonly agreed that there were 20 medication prescriptions and 13 auxiliary examination prescriptions that could be prescribed by midwives. Of these prescriptions, 51.5% were independent prescriptions, 30.3% were protocol prescriptions, and the remaining 18.2% were both independent and protocol prescriptions. Conclusions Midwives who have an undergraduate degree, supervisor nurse position, and 5 years of practice in Grade C hospitals are considered eligible to apply for prescriptive authority. Partial prescriptive authority could be granted after regulated training in fundamental theories and practices, which could improve the independence and professionalism of midwifery.

Drug-Induced Small Bowel Injury: a Challenging and Often Forgotten Clinical Condition.

Most drugs are given by the oral route. Oral intake allows direct contact between the drug and the entire GI tract mucosa, exposing it to potential topical damage until absorption. Medication-induced GI symptoms and lesions are therefore commonly encountered in clinical practice. This review will examine the most common drugs or classes of drugs affecting small bowel function and/or structure. Since non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medicines, NSAID enteropathy is highly prevalent and brings about considerable morbidity. Antimicrobials and proton-pump inhibitors profoundly modify intestinal microbiota, affecting gut sensory and motor functions, while other drugs (like iron and gold derivatives) impair intestinal permeability. Olmesartan (and likely ACE inhibitors) induce villous atrophy and consequent malabsorption. Mycophenolate mofetil, cancer chemotherapeutic agents, and immune checkpoint inhibitors cause intestinal inflammation, abdominal pain, and diarrhea. Potassium chloride supplements may induce small bowel ulceration, stenosis, and perforation while the cotraceptive pill and anticoagulants are associated with intestinal ischemia and spontaneous intramural hematoma, respectively. In clinical practice, a deep knowledge of clinical pharmacology and toxicology and a high degree of suspicion of drug-related adverse events are mandatory. Only then, the practicing physician will be able to diagnose medication-induced small bowel lesions correctly and will implement the best strategies to treat them.

Ethnoveterinary Pharmacology: Knowledge Identification of Sukarame Society, Carita, Pandeglang, Banten

The use of chemical medicine in livestock soared. The price of expensive chemical medicine does not discourage people from turning to herbal medicines. The purpose of this study is to determine the level of public knowledge of ethnoveterinary pharmacology and diversity of herbal medicines in the village of Sukarame. This research is quantitative descriptive. Data was collected through observation, semi-structured interviews and identification. The sample in this study was the people in Sukarame village and the types of herbal medicines in Sukarame village. Data from the community was obtained through interviews and observations with the Purposive Sampling technique and data on the type of ethnoverinary obtained from identification. The results showed that public knowledge about ethnoveterinary pharmacology obtained an average score of 55%. The informants who provided data were men at 71% of the total informants. The types of herbal medicines used by the public are Zingiber officinale, Curcuma domestica, Physalis angulata, Piper betle.

Clinical pharmacology of antisecretory drugs. Focus on H2-histamine receptor blockers

The purpose of the review is to illuminate the physiology of hydrochloric acid secretion and the clinical pharmacology of H2-histamine receptor blockers, also known as H2-histamine receptor antagonists, H2-histamine blockers, and H2-blockers.The main provisions. Antagonists of H2-histamine receptors (cimetidine, ranitidine, famotidine, nizatidine, lafutidin) selectively block the histamine receptors of parietal cells, preventing the activation of acid secretion by histamine secreted by enterochromaffin-like cells of the stomach. When using the means of this pharmacological group, both the total amount of gastric juice and its acidity decrease. H2-histamine blockers are rapidly absorbed after oral administration and for a long time inhibit the basal and stimulated acidity of the gastric mucosa. This class of drugs is approved by the FDA for short-term use in the treatment of uncomplicated gastroesophageal reflux disease, peptic ulcer or duodenal ulcer, hypersecretion of the stomach and mild infrequent heartburn. Off-label H2-histamine receptor blockers can also be used to prevent stress ulcers, esophagitis, gastritis, and gastrointestinal bleeding. Sometimes H2-histamine blockers are included in the Helicobacter pylori eradication regimen. Due to their safety, H2-histamine blockers are sold over the counter. However, they are gradually replaced by even more effective drugs - inhibitors of H+,K+-ATPase (PPI).Conclusion. H2-histamine receptor antagonists inhibit basal, nocturnal and stimulated secretion. Despite the presence of powerful antisecretory drugs in the doctor’s arsenal, such as proton pump inhibitors, H2-histamine blockers have not lost their importance in clinical practice. The knowledge of the clinical pharmacology of H2-histamine receptor blockers allows a competent approach to the choice of a treatment strategy and monitoring the safety and effectiveness of treatment of patients with acid-dependent diseases.

A pharmacokinetic model of lead absorption and calcium competitive dynamics

Lead is a naturally-occurring element. It has been known to man for a long time, and it is one of the longest established poisons. The current consensus is that no level of lead exposure should be deemed “safe”. New evidence regarding the blood levels at which morbidities occur has prompted the CDC to reduce the screening guideline of 10 μg/dl to 2 μg/dl. Measurable cognitive decline (reduced IQ, academic deficits) have been found to occur at levels below 10 μg/dl, especially in children. Knowledge of lead pharmacology allows us to better understand its absorption and metabolization, mechanisms that produce its medical consequences. Based upon an original and very simplified compartmental model of Rabinowitz (1973) with only three major compartments (blood, bone and soft tissue), extensive biophysical models sprouted over the following two decades. However, none of these models have been specifically designed to use new knowledge of lead molecular dynamics to understand its deleterious effects on the brain. We build and analyze a compartmental model of lead pharmacokinetics, focused specifically on addressing neurotoxicity. We use traditional phase space methods, parameter sensitivity analysis and bifurcation theory to study the transitions in the system’s behavior in response to various physiological parameters. We conclude that modeling the complex interaction of lead and calcium along their dynamic trajectory may successfully explain counter-intuitive effects on systemic function and neural behavior which could not be addressed by existing linear models. Our results encourage further efforts towards using nonlinear phenomenology in conjunction with empirically driven system parameters, to obtain a biophysical model able to provide clinical assessments and predictions.

Gut Microbiota and the Alteration of Immune Balance in Skin Diseases: From Nutraceuticals to Fecal Transplantation.

The P.N.E.I. (Psycho-Neuro-Endocrine-Immunology) approach is represented by the interdisciplinary concept of bidirectional cross-talk between the psycho-neuro-endocrine and immune systems, which can influence the immune response. The well-known Gut-Brain Axis and the Gut-Skin Axis can be merged in a bigger network- the Gut-Brain-Skin Axis, with complex regulation by cytokines, neuro-peptides, neuro-hormones and another messenger (signalling) molecules and maybe the most important modulator of the Gut-Brain-Skin Axis/ the gut microbiota. The role of gut bacterial homeostasis is very important, and the homeostatic imbalance of the immune response may be a relevant etiologic/pathophysiologic factor for extra-intestinal and intestinal inflammatory, allergic and autoimmune diseases. The Low Dose Cytokines Medicine (LDM) is an innovative therapeutic approach. It is based on the most advanced knowledge in molecular biology and low dose pharmacology with the primary outcome. The SKA (Sequential Kinetic Activation) technology, codified and standardised by GUNA S.p.a. -Italy- makes the low doses of signalling molecules able to be active even below the minimum dose classically considered as effective and the significative efficacy of orally administered low-dose signalling molecules is the most representative aspect of LDM. The Physiologic Nutraceuticals and the Low Dose Medicine are two of the most promising approaches for the treatment of skin diseases based on the rebalance of the immune response and the recovery of gut dysbiosis.

A System-Level Investigation into the Mechanisms of Apigenin Against Inflammation

Apigenin is a natural flavone that possesses excellent biological activities especially against aging and cancer. However, the underlying mode of its action is not yet revealed. The purpose of this study was to examine the pharmacological mechanisms of apigenin using the knowledge of network pharmacology, protein-protein interaction (PPI) databases and biological processes analysis through Cytoscape. Apigenin targets were retrieved through PASS Prediction and STITCH database and the interactive associations between these targets were studied using STITCH, followed by GO (gene ontology) and pathway enrichment analysis. As a result of target search, 125 protein targets were retrieved. Moreover, 216 GO terms related to various biological processes, 16 GO terms for various molecular processes, 5 GO terms for the cellular components, and 52 Kyoto Encyclopedia of Genes and Genomes pathway terms were achieved by analyzing gene functional annotation clusters and abundance values of these targets. Most of these terms are strongly associated with inflammation through various pathways, for example, FOXO, mammalian target of rapamycin, tumor necrosis factor, p53, AMP-activated protein kinase, p13K-AKT, and mitogen-activated protein kinase, which play an important role in inflammation, aging and cancer. Apigenin can be used to treat inflammation, aging, and cancer with an underlying mechanism of inflammation suppression. This study contributed excellent information for a better understanding of the modes of action of apigenin. However, further studies such as docking and MD simulation are required to understand the therapeutic and toxicological roles of these targets of apigenin.

Ambulance nurse’s experience to relieve pain in patients with addiction problems in Sweden

BackgroundPain is a personal and subjective experience. Prehospital emergency nurses (PEN) should work on the basis that all people are equal and entitled to the same care regardless of gender, age, disability or social status. The objective of treatment in health care is that all the pain to be alleviated. People with addiction problems often seek emergency care and pain is a frequent symptom. Research shows that medical staff often under treats pain and treat patients with addiction differently. AimTo describe PENSs’ experiences of relieving pain in patients with addiction problems, otherwise called Substance Abuse Syndrome. MethodThe study is designed with a qualitative approach with semistructured interviews. Eight PENs were interviewed and the material was analyzed according to a manifest content analysis. ResultThe study's main finding is that the PENs wanted to give all patients equal care but often experienced uncertainty in the care of addicts. Many of the perceived emotions created a doubt in what situations would be resolved. Lack of information and knowledge about addiction and their own feelings and values of addicts made it difficult to decide what was right or wrong treatment. The difficulty was further increased when the unclear guidelines and lack of support meant that the treatment still perceived to be different. ConclusionPain management of patients with drug addiction can be characterized as a complex task that requires a high level of skill. PENs often encounter this population in their work. Several factors lead to their experiencing these care situations as difficult to manage. Treatment guidelines are perceived as unclear and giving weak support as to how patients with addiction and pain should be treated. To handle this, PEN sought support in their decision-making from colleagues in ambulance care and the Emergency Department. Their conclusion was that treatment would be different every time, and that patients with addiction and pain were all treated differently. Despite advances in treatment options, patients will continue to be under-treated. Unfortunately, it is not just better knowledge of pain physiology and pharmacology that is the solution. Knowledge about and attitudes to pain and addiction must be corrected before any behaviour can be changed. The results of this study will hopefully make knowledge more nuanced and raise awareness of shortcomings in order to optimize care and treatment in the prehospital environment.

Ready or not, here it comes: Direct-to-consumer pharmacogenomic testing and its implications for community pharmacists

ObjectiveTo explore the implications of direct-to-consumer pharmacogenomic testing for community pharmacy practice. SummaryIn October 2018, the U.S. Food and Drug Administration provided approval for direct-to-consumer genetic testing company, 23andMe (Mountain View, CA), to return select pharmacogenomic test results to their customers. Given the community pharmacist’s high accessibility to the public and in-depth knowledge of pharmacology, and the availability of direct-to-consumer genetic testing kits at pharmacies, it is likely that patients will present their pharmacogenomic test results to their pharmacists and expect them to incorporate those results into their care. It is important, therefore, that community pharmacists are aware of the clinical implications of these results, know where to turn for evidence-based clinical pharmacogenomics information, and be mindful of the need for confirmatory testing before changing therapy. ConclusionCommunity pharmacists are at the frontlines of health care, and as such will be at the frontlines of direct-to-consumer pharmacogenomic testing. In the near future, it is likely that community pharmacists will need to counsel patients on the interpretation and appropriate use of direct-to-consumer pharmacogenomic test results.

Rational use of medications and risk assessment during lactation

Pregnant and breastfeeding women are perhaps last true therapeutic orphans. Due to dearth of adequate research on certain medications and healthcare providers' poor knowledge of lactational pharmacology, nursing mothers are often ill-advised to give up breastfeeding or unlikely to receive appropriate treatment. Accumulating evidence-based data have shown that most medications are safe for nursing mothers. Besides safety concerns, infant's condition and maternal attitude should also be considered when making treatment decisions. Clear understanding of lactational pharmacology and risk assessment tools in breastfed infants would be beneficial to meet the medical needs of nursing mothers and promote breastfeeding. Key words: Breast feeding; Drug therapy; Risk assessment

Effectiveness of three-dimensional visualisation on undergraduate nursing and midwifery students' knowledge and achievement in pharmacology: A mixed methods study

BackgroundHistorically nursing and midwifery students have reported difficulty understanding the concept-based science underpinning the interactions between drugs and their targets. This knowledge is crucial for the administration and monitoring of the therapeutic and adverse effects of medications. Immersive three-dimensional technology is reported to enhance understanding of complex scientific concepts but the physical effects of motion sickness may limit its use. ObjectivesThis project compared the effectiveness of three-dimensional immersive visualisation technology with two-dimensional visualisation technology as a teaching method to improve student understanding of a pharmacological concept, and to assess levels of student discomfort and satisfaction associated with the experience. DesignTraditional lecture content and presentation about drug-receptor binding was followed by exposure to either a two- or three-dimensional artifact visualising β-adrenoceptor binding. Two student groups were compared by type of exposure: Group 1 watched the artifact via a three-dimensional immersive facility and Group 2 on a wide, two-dimensional screen. SettingsSchool of Nursing and Midwifery in a regional university in Southeast Queensland, Australia. ParticipantsTwo hundred and two second year undergraduate nursing and midwifery students. MethodsThe study used mixed methods methodology. Pre- and post- testing of student knowledge was collected using five multiple-choice questions. A post-intervention survey elicited students' self-assessed perceptions of discomfort and satisfaction with the learning experience. ResultsThe three-dimensional immersive learning experience was comparable to the two-dimensional experience in terms of satisfaction and comfort but resulted in statistically significant improvements in post-test scores. ConclusionsThe three-dimensional experience improved understanding when compared to two-dimensional viewing, satisfied students leaning needs, and caused minimal discomfort. The results are encouraging in terms of using three-dimensional technology to enhance student knowledge of pharmacological concepts necessary for competency in medication management.

Abulcasis (936-1013): his work and contribution to orthopaedics.

The purpose of this historic review is to summarize the life and work of Abulcasis (936-1013) and his contribution to surgery and orthopaedics. We conducted an extensive search in libraries as well as online in PubMed and Google Scholar. Abulcasis in his work combines the knowledge of ancient Greek and Roman physicians and surgeons with the extensive knowledge of Arabic medicine and pharmacology. He also pioneered surgical technique with the invention of numerous surgical instruments and with several revolutionary surgical techniques. Abulcasis made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and innovations in his work remained a work of reference in the West and East for many centuries to come.

Sleep and Memory: The Promise of Precision Medicine.

Given the complex and bidirectional nature of sleep and mild cognitive impairment/Alzheimer's disease and related dementias, a precision medicine approach to education, lifestyle changes, and early assessment in patients with a family history of snoring, sleep apnea, diabetes, and heart disease is warranted. Furthermore, a team-based approach allows for a coordinated precision diagnosis and management of common comorbid chronic illnesses. The significance of sleep disturbances in this population, contributing factors, assessment and diagnostic challenges, common sleep disorders and mechanisms, tailored behavioral and pharmacologic interventions, knowledge gaps, and future research ideas are discussed.

Benefits of an Outpatient Neuropsychiatry Rotation

Back to table of contents Previous article Next article Letter to the EditorFull AccessBenefits of an Outpatient Neuropsychiatry RotationAaron Winkler, M.D.Aaron WinklerSearch for more papers by this author, M.D.Published Online:6 Jun 2019https://doi.org/10.1176/appi.ajp-rj.2019.140606AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In the April 2019 issue, Drs. Lane and Lyndon (1) argued that postgraduate medical training should include "more neuroscience within psychiatric curricula and vice versa." They proposed "a two-pronged solution: integrating didactic curricula and building longitudinal clinical experiences." One clinical experience that fulfills this aim and might be integrated beneficially into both psychiatry and neurology programs is a year-long, full-day, outpatient neuropsychiatry rotation.In PGY-1, residents in our psychiatry program rotate 1 half-day each week for 2 months in the neuropsychiatry program at Sheppard Pratt Hospital System under the supervision of the program director, Vassilis Koliatsos, M.D. The residents mainly see patients who have survived severe traumatic brain injury (TBI) or anoxic brain injury, although many patients with dementia, autism, and other developmental conditions are seen in the clinic as well. Stable patients are generally seen every 3 to 6 months, such that residents are unlikely to encounter the same patient twice during their 2-month rotation. As a PGY-3, I have had the unique good fortune to spend a full day in the clinic each week for an entire year. The value of the longitudinal experience cannot be overstated. In addition to seeing the natural course of illness unfold, there grows a meaningful doctor-patient relationship with patients—a relationship that residents rarely share with survivors of severe brain trauma or other neuropsychiatric conditions.Importantly, the neuropsychiatry clinic is neither a neurology clinic nor a psychiatry clinic. It is both. Someone with a TBI from a car accident that occurred after years of alcohol use may have liver and kidney dysfunction from the accident or from premorbid substance use. This dysfunction might contraindicate lithium or valproate management of mood swings caused by, or worsened by, contusion to the right hemisphere. The same patient may also become violently aggressive with care staff and peers when levetiracetam is prescribed for posttraumatic epilepsy. But because of dense polypharmacy, the patient may be a poor candidate for carbamazepine therapy. Managing such complexity requires broad comfort with the pharmacopoeia and an awareness of nonpharmacologic treatments. Over the course of the full-year rotation, I have been pleasantly surprised to watch such patients make dramatic progress when there is careful, attentive management.I agree with Drs. Lane and Lyndon. One possible implementation of their recommendation is a full-year rotation treating patients in a neuropsychiatric outpatient clinic. One hones neurological exam skills and knowledge of the neurological basis of disordered function, and one has the first-hand opportunity to build and deploy solid and varied pharmacologic knowledge. The very same clinic may allow neurology residents to expand their experience treating mood, obsessional, and psychotic disorders among patients with concurrent neurological dysfunction. Perhaps most important, neurology and psychiatry residents could profitably work side by side, building skill as clinicians and also rapport as colleagues.Dr. Winkler is a third-year resident at the University of Maryland/Sheppard Pratt Psychiatry Residency Program in Baltimore.Reference1. Lane CE, Lyndon S: Strengthening synapses: a case for cross-discipline training in neurology and psychiatry. Residents J 2019; 14(4):2 Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 14Issue 6 June 6, 2019Pages 9-9 PDF download History Published online 6 June 2019 Published in print 6 June 2019

An Ethnobotanical Study of Medicinal Plants With Antianxiety and Antidepressant Effects in Shahrekord

Anxiety and depression are two highly prevalent disorders in all human communities. The purpose of the present study was to report medicinal plant species that local people, according to their ethnobotanical knowledge, in Shahrekord use as antianxiety and antidepressant agents. The present ethnobotanical study was carried out to report and collect indigenous knowledge in the studied region in 2017 via face-to-face interviews and by using a questionnaire distributed among 29 traditional therapists. To this end, interviewers referred to respondents in person to elicit their pharmacological and ethnobotanical knowledge, and then register their viewpoints related to herbal medicine. The data extracted from the questionnaires were appropriately and meticulously tabulated, and data analysis was done by the Excel software. In this study, the formula below was used to calculate the frequency of plant use. Medicinal plants that are used as antianxiety and antidepressant drugs according to the ethnobotanical knowledge in Shahrekord include Fritillaria imperialis L., Ducrosia anethifolia L., Anchusa italyca Retz. (L.) DC., Dracocephalum multicaule, Stachys lavandulifolia, Thymus vulgaris, Tripleurospermum parviflorum L., Crataegus persica, Hypericum scabrum L., Valeriana officinalis, Centaurea cyanus, Rheum ribes L. and Melissa officinalis L are the most herbal plants effective on anxiety and depression on shahrekord ethno-botany.

Analyzing Medication Documentation in Electronic Health Records: Dental Students' Self-Reported Behaviors and Charting Practices.

The aim of this two-part study was to assess third- and fourth-year dental students' perceptions, self-reported behaviors, and actual charting practices regarding medication documentation in axiUm, the electronic health record (EHR) system. In part one of the study, in fall 2015, all 125 third- and 85 fourth-year dental students at one U.S. dental school were invited to complete a ten-item anonymous survey on medication history-taking. In part two of the study, the EHRs of 519 recent dental school patients were randomly chosen via axiUm query based on age >21 years and the presence of at least one documented medication. Documentation completeness was assessed per EHR and each medication based on proper medication name, classification, dose/frequency, indication, potential oral effects, and correct medication spelling. Consistency was evaluated by identifying the presence/absence of a medical reason for each medication. The survey response rate was 90.6% (N=187). In total, 64.5% of responding students reported that taking a complete medication history is important and useful in enhancing pharmacology knowledge; 90.4% perceived it helped improve their understanding of patients' medical conditions. The fourth-year students were more likely than the third-year students to value the latter (p=0.0236). Overall, 48.6% reported reviewing patient medications with clinic faculty 76-100% of the time. The respondents' most frequently cited perceived barriers to medication documentation were patients' not knowing their medications (68.5%) and, to a much lesser degree, axiUm limitations (14%). Proper medication name was most often recorded (93.6%), and potential oral effects were recorded the least (3.0%). Medication/medical condition consistency was 70.6%. In this study, most of the students perceived patient medication documentation as important; however, many did not appreciate the importance of all elements of a complete medication history, and complete medication documentation was low.

Spanish Version of the Knowledge and Attitudes Survey Regarding Pain

A variety of valid tools are available to assess staff knowledge and attitudes regarding pain, among which is the Knowledge and Attitudes Survey Regarding Pain. Although this instrument has been widely and successfully used, a valid and adapted Spanish version is yet to be developed. The purpose of this study was to validate the Spanish version of the Knowledge and Attitudes Survey Regarding Pain. After translating and back-translating this tool, we conducted a cross-cultural adaptation and construct validation with 102 participants, including nursing professionals (in palliative care, oncology, and intensive care) from five health centers and final-year nursing students. All participants were recruited in the Principality of Asturias, Spain. We also evaluated the internal consistency and test-retest correlations. Cronbach's α was .781, and Pearson's r and the intraclass correlation coefficient between the test and retest scores were .881 and .883, respectively. The mean questionnaire scores in the test and retest phases were 65.8% and 67.6%, respectively. Palliative care nurses had the highest score, 70.8%, which differed significantly from the rest of the groups. The Spanish version of the Knowledge and Attitudes Survey Regarding Pain can effectively differentiate nursing staff in terms of their pain expertise. The results indicate that Spanish nurses have a gap in pharmacologic knowledge that is comparable to that found in other countries, but their foundation in general pain concepts was solid.

Chemistry, pharmacology, and cellular uptake mechanisms of thiometallate sulfide donors.

A clinical need exists for targeted, safe, and effective sulfide donors. We recently reported that ammonium tetrathiomolybdate (ATTM) belongs to a new class of sulfide-releasing drugs. Here, we investigated the cellular uptake mechanisms of this drug class compared to sodium hydrosulfide (NaHS) and the effects of a thiometallate tungsten congener of ATTM, ammonium tetrathiotungstate (ATTT). In vitro H2 S release was determined by headspace gas sampling of vials containing dissolved thiometallates. Thiometallate and NaHS bioactivity was assessed by spectrophotometry-derived sulfhaemoglobin formation. Cellular uptake dependence on the anion exchange protein (AE)-1 was investigated in human red blood cells. ATTM/glutathione interactions were assessed by LC-MS/MS. Rodent pharmacokinetic and pharmacodynamic studies focused on haemodynamics and inhibition of aerobic respiration. ATTM and ATTT both exhibit temperature-, pH-, and thiol-dependence of sulfide release. ATTM/glutathione interactions revealed the generation of inorganic and organic persulfides and polysulfides. ATTM showed greater ex vivo and in vivo bioactivity over ATTT, notwithstanding similar pharmacokinetic profiles. Cellular uptake mechanisms of the two drug classes are distinct; thiometallates show dependence on AE-1, while hydrosulfide itself was unaffected by inhibition of this pathway. The cellular uptake of thiometallates relies upon a plasma membrane ion channel. This advances our pharmacological knowledge of this drug class, and further supports their utility as cell-targeted sulfide donor therapies. Our results indicate that, as a more stable form, ATTT is better suited as a copper chelator. ATTM, a superior sulfide donor, may additionally participate in intracellular redox recycling. This article is part of a themed section on Hydrogen Sulfide in Biology & Medicine. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.4/issuetoc.