Opportunities For Pharmacy Research Articles

Modification of Proliferation and Apoptosis in Breast Cancer Cells by Exposure of Antioxidant Nanoparticles Due to Modulation of the Cellular Redox State Induced by Doxorubicin Exposure.

In this report, we investigated whether the use of chitosan-carrying-glutathione nanoparticles (CH-GSH NPs) can modify proliferation and apoptosis, and reduce cell damage induced by doxorubicin on breast cancer cells. Doxorubicin is a widely used antineoplasic agent for the treatment of various types of cancer. However, it is also a highly toxic drug because it induces oxidative stress. Thus, the use of antioxidant molecules has been considered to reduce the toxicity of doxorubicin. CH-GSH NPs were characterized in size, zeta potential, concentration, and shape. When breast cancer cells were treated with CH-GSH nanoparticles, they were localized in the cellular cytoplasm. Combined doxorubicin exposure with nanoparticles increased intracellular GSH levels. At the same time, decreasing levels of reactive oxygen species and malondialdehyde were observed and modified antioxidant enzyme activity. Levels of the Ki67 protein were evaluated as a marker of cell proliferation and the activity of the Casp-3 protein related to cell apoptosis was measured. Our data suggests that CH-GSH NPs can modify cell proliferation by decreasing Ki67 levels, induce apoptosis by increasing caspase-3 activity, and reduce the oxidative stress induced by doxorubicin in breast cancer cells by modulating molecules associated with the cellular redox state. CH-GSH NPs could be used to reduce the toxic effects of this antineoplastic. Considering these results, CH-GSH NPs represent a novel delivery system offering new opportunities in pharmacy, material science, and biomedicine.

182. Missed Opportunities to Discontinue Unnecessary Vancomycin During Pharmacist Therapeutic Monitoring

BackgroundUnnecessary and prolonged IV vancomycin exposure increases risk of adverse drug events, notably nephrotoxicity, which may result in prolonged hospital length of stay. The purpose of this study is to identify areas of improvement in antimicrobial stewardship for vancomycin appropriateness by clinical pharmacists at the time of therapeutic drug monitoring (TDM).MethodsRetrospective, observational cohort study at an academic medical center and a community hospital. Inclusion: patient over 18 years, received at least three days of IV vancomycin where the clinical pharmacy TDM service assessed for appropriate continuation for hospital admission between June 19, 2019 and June 30, 2019. Exclusion: vancomycin prophylaxis or administered by routes other than IV. Primary outcome was to determine the frequency and clinical components of inappropriate vancomycin continuation at the time of TDM. Inappropriate vancomycin continuation was defined as cultures positive for methicillin-susceptible Staphylococcus aureus (MRSA), vancomycin-resistant bacteria, and non-purulent skin and soft tissue infection (SSTI) in the absence of vasopressors. Data was reported using descriptive statistics and measures of central tendency.Results167 patients met inclusion criteria with 38.3% from the ICU. SSTIs were most common indication 39 (23.4%) cases, followed by pneumonia and blood with 34 (20.4%) cases each. At time of vancomycin TDM assessment, vancomycin continuation was appropriate 59.3% of the time. Mean of 4.22 ± 2.69 days of appropriate vancomycin use, 2.18 ± 2.47 days of inappropriate use, and total duration 5.42 ± 2.94. 16.4% patients developed an AKI. Majority of missed opportunities were attributed to non-purulent SSTI (28.2%) and missed MRSA nares swabs in 21% pneumonia cases (table 1).ConclusionVancomycin is used extensively for empiric treatment of presumed infections. Appropriate de-escalation of vancomycin therapy is important to decrease the incidence of adverse effects, decreasing hospital length of stay, and reduce development of resistance. According to the mean duration of inappropriate therapy, there are opportunities for pharmacy and antibiotic stewardship involvement at the time of TDM to optimize patient care (table 1).Missed opportunities for vancomycin de-escalation Disclosures All Authors: No reported disclosures

The Need for Disruptive Innovation in Pharmacy

Disruptive innovation became a buzz phrase in the mid-1990s in the business world. In this commentary, the application of this term to pharmacy within the context of the current status of pharmacy education and practice, highlighting barriers, discussing requirements, and identifying implications for future innovative opportunities in pharmacy is discussed.

Development of Novel Formulas to Determine Hospital and Pharmacy Opportunities to Reduce Extended Length of Stay

Background: Hospital length of stay (LOS) is an important measure to determine resource utilization and efficiency of care for inpatients. No existing objective methodology is available to determine where and how pharmacy departments can have maximal impact on reducing extended LOS. Objective: An objective methodology to guide decisions by hospital pharmacy departments on reducing extended LOS is described. Methods: University of North Carolina Medical Center’s LOS was compared to hospitals with similar inpatient bed size and case mix index. Objective methodology using pharmacy intensity weight, LOS index, and relative number of cases overall and by hospital service was developed to identify targets of impacting LOS for a pharmacy department. Results: The novel Pharmacy Opportunity Length of Stay (POLOS) formula was developed to prioritize each Medicare Severity Diagnosis Related Group (MSDRG) based on the overall impact pharmacy can have on reducing extended LOS at an individual institution. An additional novel formula, Service Specific POLOS (SSPOLOS), was created to strategically target hospital services, as opposed to MSDRGs, allowing for effective deployment of targeted pharmacy interventions to decrease extended LOS. Conclusion: POLOS and SSPOLOS are novel formulas to guide pharmacy departments in objectively prioritizing and targeting resources to reduce extended LOS. The novel formulas can be used to quantify LOS performance at the hospital and pharmacy specific levels, in addition to providing a hospital service approach to launch LOS initiatives at health care institutions. To our knowledge, this represents the first opportunity for hospital pharmacy departments to objectively target and reduce extended LOS.

APhA2016; Advanced Preceptor Training; APhA member spotlight; BPS specialty certification

APhA2016; Advanced Preceptor Training; APhA member spotlight; BPS specialty certification

Research highlights opportunity for pharmacy to fill gap in flu vaccinations

Research highlights opportunity for pharmacy to fill gap in flu vaccinations

North Carolina innovates with pharmacists in medical homes

The patient-centered medical home model of care is a hot spot for pharmacy innovation in North Carolina, where pharmacy educators are working to create expectations among clinicians that pharmacists belong on patient care teams. “I have not been this excited about opportunities for pharmacy

Challenges and opportunities for pharmacy in 2013

Challenges and opportunities for pharmacy in 2013

An opportunity for pharmacy

An opportunity for pharmacy

Pharmacists: First responders

Pharmacists: First responders

New Pharmacy — Where Healthcare Interfaces Innovation

On July 25, 2012, the University of Waterloo's School of Pharmacy held its 3rd annual Pharmasave Industrial Case Competition (ICC), the capstone component of PHARM 350: Fundamentals of Business Administration and Management, created and coordinated by Professor Roderick Slavcev. The course is a rigorous and integrated 10 hour/week mini-MBA requisite of the third-year curriculum that aims to arm pharmacy students with much needed skills in leadership and strategic management and to realize and capitalize on the opportunities in pharmacy. The ICC represents a $5,000 incentivized final assessment piece sponsored by Pharmasave and accounts for 30% of students' final grade. The competition represents the first component of a powerful entrepreneurial thrust in the business program at UW. This year's case, “New Pharmacy — Where Healthcare Interfaces Innovation,” had the class distributed into 21 teams. Groups were required to propose a sustainable health-carebased venture in a manner aligned with Ontario's health care regulations. Students were expected to capitalize on existing opportunities available to pharmacists, but were not limited in their approach to creating value through the revision or invention of new health care innovation(s). In line with class teachings in strategic management, proposals were expected to illustrate corporate, business and functional level planning aligned with the mission and vision. The project scenario had each team beginning with $50,000 towards their ventures, available immediately and based on reasonable expectations of initial amassable equity. Teams had exactly 12 days to complete the exercise and were required to first present a 7-minute pitch to a panel of judges (that included a Dragon's Den-like QA David Windross, Teva; Rosemary Killeen, Canadian Pharmacists Journal; Conrad Amenta, Pharmacy Blueprint, CPhA; Paul Smith, Scotiabank; Omid Esmaili, Scotiabank; David McNally, KPMG; and Dr. Roderick Slavcev, University of Waterloo. Among many innovative and outstanding ideas and a very close race, this year's first place finisher of the Industrial Case Competition was “First Class Pharma,” comprised of Caitlin Meyer, Nicole Seymour, Robyn McArthur, Peter Rempel and Jaspreet Sahota, who were awarded the $5,000 prize. The team's proposed venture specializes in travel medicine and health care. The pharmacy consists of 2 pharmacists and a nurse practitioner who are trained in travel medicine and vaccinations. They are the first pharmacist-led travel service in the Greater Toronto Area (GTA) and serve a niche patient population that is looking for comprehensive and efficient travel health care services. In brief, First Class Pharma (FCP) aims to eliminate the miscommunications and inefficiencies in service between pharmacies and physicians and provides both on- and off-site vaccinations and consultations. With the collaboration of pharmacists and a nurse, they complete health assessments looking at all relevant patient health history and medications. Primarily, FCP functions as a consultant operation, customizing services to the patient's trip destination and activities. FCP also aims to collaborate with employers to minimize any adverse health-related outcomes while travelling, by offering immunizations and travel consultations to employees travelling abroad for both recreation and work-related endeavours. An honourable second place went to “OptimetRx,” consisting of Lois Chung, David Hughes, Annick Nguyen, Jamie Rafuse and Alina Rashid. Closely following in third place was “First Nations Integrative and Sustainable Healthcare” (FISH), consisting of Chelsea Barr, Kiel Cattle, David Clark, Parveen Dulku, Carly Fitzsimmons, Maggie Gareau, Nishi Gupta, Cassandra Jung, Derek Lam and Johnny Walsh.

Health care reform: Pharmacy's opportunity to move forward

Health care reform: Pharmacy's opportunity to move forward

Leading Up: Moving Pharmacy Toward the 2015 Vision

Discussions about leadership generally assume the model that leaders lead and followers follow. Many thoughtful analyses of leadership have provided varying assessments about leadership styles and motivational strategies. But what if the followers chose to lead? What would this model and its impact look like? Perhaps it would be the study of a revolution! But what if the leaders embraced, encouraged, and even expected leadership from the followers? What if they truly listened to the voices of the followers? And further, what if the followers were focused on the greater good of their cause rather than self-interest? What if their goal was to create positive change as the first result, rather than the outcome of a second or third effort? What if this happened in pharmacy? Arguably, pharmacy is on the cusp of the greatest opportunity it will have for professional practice change in the 21st century. I draw this conclusion based on the following 2 facts. First, our collective national pharmacy leadership, both volunteers and staff members, are actively working to achieve the vision for pharmacy practice in the year 2015 articulated by the Joint Commission of Pharmacy Practice (JCPP). Closely aligned with the work by JCPP, the American Society of Health System Pharmacists (ASHP) is well into their fourth year of Health-system Pharmacy 2015. This is their contribution to improving the practice of pharmacy in health systems by the year 2015. A parallel effort specific to community pharmacy's advancement of health care, which is labeled Project Destiny, was initiated in July 2007 by the American Pharmacists Association (APhA), National Association of Chain Drug Stores (NACDS), and the National Community Pharmacists Association (NCPA). This level of energy, and the associated commitment of resources, is remarkable, but perhaps more exciting is the level of cooperation among our national organizations. I can only assume they realize the magnitude of the opportunity as well. The second fact has to do with a force completely outside of pharmacy, which is the unprecedented and pending impact of the baby boomer generation. A 2003 article in USA Today by Fred Bayles highlights that the wealth and size of the baby boomer generation alone makes then impossible to ignore. (1) Most are aware of the size, but consider that between 2003 and 2030, which is when all the boomers turn 65, the number of Americans 65 and older will double from 35.6 million to 71.5 million. This will represent nearly 20% of the US population, which is an increase from 12% in 2003. Specific to wealth, Bayles points out that this cohort will ultimately control 40% of the nation's disposable income and 77% of the private investments. As the boomer's health care needs increase, one can only imagine the time they will spend seeking counsel from a pharmacist and the opportunity for pharmacists to receive compensation for this effort. Remember, baby boomers have always played by their own rules. They have rejected everything from their parent's car, which they replaced with a painted van, to their parent's clothes and music! We clearly have a reason to suppose that boomers will reject their parent's health care expectations for pharmacy when they reach the years of increasing medication use. If one envisions this reality, then what will be the expected model of pharmacy service? And, for a generation that has redefined our expectations of consumers, what will they pay for? Again, the opportunity for pharmacy is significant and unprecedented. If we view the professional practice model that supports the pharmacist in 2015 as a three-legged stool, then the efforts by our national leaders and the impact of baby boomers turning 65 serve as 2 sturdy legs of this stool. They represent our practice model and our patients, respectively. My suggestion is that the critical third leg is every pharmacist who we can respectfully characterize as a follower, and the individual and collective efforts of this group to lead toward the 2015 vision. …

Opportunities for pharmacy

To summarize key points from the most recent Institute of Medicine (IOM) report, Preventing Medication Errors, and their relevance to health-system pharmacists. Creating a culture of safety is an important antecedent to making changes needed to reduce medication errors. The patient can play an important, but often unrealized, role in preventing medication errors. There are considerable opportunities to improve the application of technology to prevent medication errors. The National Hospital Pharmacy surveys conducted ty the American Society of Health- System Pharmacists have demonstrated the slow rate of adoption of technologies. Pharmacists can play a leadership role in improving both the patients' role and the use of technology to improve medication-use safety. There are major opportunities for pharmacists to re-think how involved patients are in their care in the institutional setting, by seeing patients as building another check into the medication-use system and by recommitting ourselves to getting patients involved. There are also opportunities to help with patient-safety technology decisions. These extremely expensive technologies almost always involve people changing what they do and their implementation and use often involve other people besides pharmacists, yet the potential is great for new technologies to reduce medication errors.

Leadership qualities that can help increase opportunities in pharmacy: A look at three traits common among leaders

Leadership qualities that can help increase opportunities in pharmacy: A look at three traits common among leaders

Leadership qualities that can help increase opportunities in pharmacy: A look at three traits common among leaders

Leadership qualities that can help increase opportunities in pharmacy: A look at three traits common among leaders

Gene Therapy: Opportunities for Pharmacy in the 21st Century

Gene Therapy: Opportunities for Pharmacy in the 21st Century

The ethics of leadership in pharmacy.

The pharmacy profession's responsibility to provide ethical leadership to its members is explained, and areas where pharmacy should take a leadership role are described. Changes taking place in health care offer many opportunities for pharmacy in its transformation into a fully clinical discipline. The profession needs to address the ethical issues that will affect it as part of this revolution. The role pharmacy is taking to eliminate medication misadventuring will be a test case for the profession's ability to exert the leadership it must, as part of its new definition of itself. Pharmacy needs to define the structure, process, and outcomes necessary to improve its own practice to avoid drug misadventuring, with a clear set of practice and ethical standards, and engage medicine and nursing to adopt similar standards. Pharmacy should also take a leadership role in health care reform, working with other clinicians to ensure that the changes provide better outcomes for patients. Health care professionals are bound together by a common moral purpose: to act in the patient's best interest. Thus, each health profession is a moral community, which must determine and promote ethical behavior among its members. Pharmacy must practice ethical leadership: it must define and prove its contribution to patient outcomes, further develop legal and ethical standards, and examine its responsibilities for vulnerable patient groups such as children. It must work to overcome the traditional dominance of medicine; pharmacy, nursing, and medicine must come together in service of the patient and develop a cross-professional conception of ethics. Pharmacy also must participate in the broader debate about health care. Pharmacy has begun to take a leadership role among the health professions through its efforts to eliminate medication misadventuring. Additional leadership challenges for the profession are suggested.

Opportunities and responsibilities in pharmaceutical care

Pharmacy's opportunity to mature as a profession by accepting its social responsibility to reduce preventable drug-related morbidity and mortality is explored. Pharmacy has shed the apothecary role but has not yet been restored to its erst-while importance in medical care. It is not enough to dispense the correct drug or to provide sophisticated pharmaceutical services; nor will it be sufficient to devise new technical functions. Pharmacists and their institutions must stop looking inward and start redirecting their energies to the greater social good. Some 12,000 deaths and 15,000 hospitalizations due to adverse drug reactions (ADRs) were reported to the FDA in 1987, and many went unreported. Drug-related morbidity and mortality are often preventable, and pharmaceutical services can reduce the number of ADRs, the length of hospital stays, and the cost of care. Pharmacists must abandon factionalism and adopt patient-centered pharmaceutical care as their philosophy of practice. Changing the focus of practice from products and biological systems to ensuring the best drug therapy and patient safety will raise pharmacy's level of responsibility and require philosophical, organizational, and functional changes. It will be necessary to set new practice standards, establish cooperative relationships with other health-care professions, and determine strategies for marketing pharmaceutical care. Pharmacy's reprofessionalization will be completed only when all pharmacists accept their social mandate to ensure the safe and effective drug therapy of the individual patient.

The Geriatric Patient and Long-term Care: An Opportunity and Challenge for Pharmacy

A significant interest in the elderly population has occurred over the last decade as evidenced by the increase in journals, journal articles, books, and research regarding the aged patient. This explosion of data concerning the elderly is essential since our educational background in disease process and therapy is generally learned from the young adult perspective. Additionally, the elderly patient represents a high-risk patient to health care professionals for a variety of reasons: (1) the elderly person has in many cases multiple chronic diseases; (2) has complicated, multiple drug regimens; (3) has an increased incidence of adverse drug reactions compared to younger adults; (4) exhibits atypical presenting symptoms of disease and adverse drug reactions; (5) is at risk for iatrogenic disease; and (6) is neglected generally due to negative stereotypical attitudes held by health care professionals. The elderly population, however, represents an opportunity for pharmacy services due to the increasing numbers of elderly, the opportunity to provide new, nontraditional, and innovative services, as well as the emergence of new practice areas of health care delivery for our elderly. Additionally, there is a need to enhance educational experiences in long-term care and conduct geriatric and gerontologic research in these settings.