Pharmacotherapy Recommendations Research Articles

Pharmacist-initiated interventions to test quantitative bone mineral density and prescribe osteoporosis medications to prevent steroid-induced osteoporosis.

Fragility fractures associated with glucocorticoid-induced osteoporosis (GIO) can markedly impair quality of life. However, only 20% of patients are treated in compliance with the relevant management guidelines, and bone mineral density analysis with dual-energy X-ray absorptiometry (DXA) is only rarely performed. We report the intervention methods suggested by pharmacists and describe their efficacy. Patients who visited the outpatient clinic of the General Medicine Department of Ogaki Municipal Hospital and received steroids were enrolled. The rates of DXA implementation and compliance with GIO pharmacotherapy guidelines before and after pharmacist to physician-suggested interventions were compared. Guideline compliance was defined as prescription of osteoporosis drugs to patients with a score of ≥3. Administered prophylaxes and bone mineral density were subsequently assessed. The before and after intervention DXA rates were 1% (1/100 patients) and 96.0% (96/100 patients; P<0.01), respectively. Overall, 96.9% (93/96) of the patients met the GIO criteria for pharmacotherapy initiation (score ≥3), and the guideline compliance rates before and after the intervention were 39.8% (37/93) and 93.5% (87/93; P<0.01), respectively. Of the 56 patients who did not receive prophylaxis, 52 were recommended treatment, yielding an acceptance rate of 82.7% (43/52). Among the 37 patients receiving prophylaxis, 20 (54.1%) had a DXA-related young adult mean of ≤70%, of whom 11 (55.0%) agreed to drug therapy. The acceptance rate of pharmacotherapy recommendations for patients not receiving prophylaxis was higher than that for those receiving prophylaxis (P=0.03). Pharmacist-initiated interventions for GIO facilitates the administration of appropriate pharmacotherapy.

Quantity and quality of shared decision making incorporation across major international cardiology guidelines

Abstract Background/Introduction Shared decision-making (SDM) is a key component of the provision of ethical care, but prior reviews have indicated that clinical practice guidelines poorly promote and facilitate SDM. Purpose To identify and characterize all pharmacotherapy recommendations integrating SDM within contemporary cardiovascular guidelines using a novel classification system. Methods The American College of Cardiology (ACC), Canadian Cardiovascular Society (CCS), and European Society of Cardiology (ESC) digital guideline libraries (2012–2022) were searched for current guidelines, or subsequent updates, that included at least one pharmacotherapy recommendation. We identified all pharmacotherapy recommendations for each guideline. Recommendations that incorporated SDM were rated according to a novel Supporting Higher Patient Autonomy in Recommendations (SHARE) rating framework – which evaluates the quality of SDM incorporation based on directness (1-3; assessing whether SDM was incorporated directly and impartially into the recommendation’s text) and facilitation (A-D; assessing whether decision aids or quantified benefits/harms were provided). Results From 65 guidelines and updates, 2,655 recommendations (35% of total) addressed pharmacotherapy. Of these recommendations, 171 (6%) incorporated SDM. By category, general cardiology guidelines contained the highest proportion of pharmacotherapy recommendations incorporating SDM (10%), whereas heart failure and myocardial disease contained the least (3%). The proportion of pharmacotherapy recommendations incorporating SDM was comparable across societies (ACC: 8%, CCS: 9%, ESC: 5%), with no trend for change over time. Only 5/171 (3%) of SDM recommendations met SHARE grade 1A (impartial recommendations for SDM supported by a decision aid), whereas 63% were SHARE grade 3D (SDM mentioned only in supporting text and without any tools or information to facilitate SDM). Conclusions Across guidelines published by three cardiovascular societies over the last decade, few recommendations incorporated SDM in any form, and even fewer adequately facilitated SDM. Guidelines should move away from merely advocating for consideration of patient preferences, and toward facilitating meaningful engagement in SDM.

Incorporation of Shared Decision-Making in International Cardiovascular Guidelines, 2012-2022

Shared decision-making (SDM) is a key component of the provision of ethical care, but prior reviews have indicated that clinical practice guidelines seldom promote or facilitate SDM. It is currently unknown whether these findings extend to contemporary cardiovascular guidelines. To identify and characterize integration of SDM in contemporary cardiovascular guideline recommendations using a systematic classification system. This cross-sectional study assessed the latest guidelines or subsequent updates that included pharmacotherapy recommendations and were published between January 2012 and December 2022 by the American College of Cardiology (ACC), Canadian Cardiovascular Society (CCS), and European Society of Cardiology (ESC). Data were analyzed from February 21 to July 21, 2023. All pharmacotherapy recommendations were identified within each guideline. Recommendations that incorporated SDM were rated according to a systematic rating framework to evaluate the quality of SDM incorporation based on directness (range, 1-3; assessing whether SDM was incorporated directly and impartially into the recommendation's text, with 1 indicating direct and impartial incorporation of SDM into the recommendation's text) and facilitation (range, A-D; assessing whether decision aids or quantified benefits and harms were provided, with A indicating that a decision aid quantifying benefits and harms was provided). The proportion of recommendations incorporating SDM was also analyzed according to guideline society and category (eg, general cardiology, heart failure). Analyses included 65 guideline documents, and 33 documents (51%) incorporated SDM either in a general statement or within specific recommendations. Of 7499 recommendations, 2655 (35%) recommendations addressed pharmacotherapy, and of these, 170 (6%) incorporated SDM. By category, general cardiology guidelines contained the highest proportion of pharmacotherapy recommendations incorporating SDM (86 of 865 recommendations [10%]), whereas heart failure and myocardial disease contained the least (9 of 315 recommendations [3%]). The proportion of pharmacotherapy recommendations incorporating SDM was comparable across societies (ACC: 75 of 978 recommendations [8%]; CCS: 29 of 333 recommendations [9%]; ESC: 67 of 1344 recommendations [5%]), with no trend for change over time. Only 5 of 170 SDM recommendations (3%) were classified as grade 1A (impartial recommendations for SDM supported by a decision aid), whereas 114 of 170 recommendations (67%) were grade 3D (SDM mentioned only in supporting text and without any tools or information to facilitate SDM). In this cross-sectional study across guidelines published by 3 major cardiovascular societies over the last decade, 51% of guidelines mentioned the importance of SDM, yet only 6% of recommendations incorporated SDM in any form, and fewer adequately facilitated SDM.

Extracorporeal cardiopulmonary resuscitation: A primer for pharmacists.

To describe the use of mechanical circulatory support in the setting of cardiac arrest and summarize pharmacists' role in extracorporeal cardiopulmonary resuscitation (ECPR). ECPR is increasingly used to reduce morbidity and improve mortality after cardiac arrest. ECPR employs venoarterial ECMO, which provides full circulatory perfusion and gas exchange in both adult and pediatric patients in cardiac arrest. After the emergency medicine team identifies potential candidates for ECPR, the ECMO team is consulted. If deemed a candidate for ECPR by the ECMO team, the patient is cannulated during ongoing standard cardiopulmonary resuscitation. A multidisciplinary team of physicians, nurses, perfusionists, pharmacists, and support staff is needed for successful ECPR. Pharmacists play a vital role in advanced cardiac life support (ACLS) prior to cannulation. Pharmacists intervene to make pharmacotherapy recommendations during ACLS, prepare medications, and administer medications as allowed by institutional and state regulations. Pharmacists also provide pharmacotherapy support in the selection of anticoagulation agents, ongoing vasopressor administration during ECMO cannulation, and the optimization of medication selection in the peri-ECPR period. With the growing use of ECPR, pharmacists should be aware of their role in medication optimization during ECPR.

Wewnątrzsercowe urządzenia wszczepialne w niewydolności serca

With widespread access to intracardiac implantable devices, the number of people with heart failure (HF) who underwent primary or secondary prophylaxis has increased. Technological progress has made it possible to construct modern high-energy intracardiac devices, allowing them to achieve the intended therapeutic goals. However, it should be considered that implantation of the device may be associated with complications, the frequency of which varies depending on the experience of the operator, the age of the patient, the degree of multi-organ failure and the patient’s coexisting conditions. Implantation of cardioverter-defibrillator or cardiac resynchronisation therapy, in a properly qualified patient and experienced team of interventional cardiologists, is associated with the risk of a relatively low percentage of early and distant complications. An important element of patient management is striving to eliminate inadequate interventions that adversely affect both the patient’s functioning and quality of life. It is important to educate the patient, as well as highlight the risks associated with alcohol and medication abuse, illegal sports and non-compliance with pharmacotherapy recommendations. Optimal pharmacological treatment of HF and co-existing diseases and systematic control of the device during visits to the clinic or using remote monitoring is necessary.

A Medication Assessment Tool to Evaluate Prescribers’ Adherence to Practice Guidelines in Acute-Phase Schizophrenia Treatment: Development and Psychometric properties

Background: Studies showed that the adherence to practice guidelines is associated with a higher quality of care and better patient’s outcomes. In psychiatric practice, there is a quality gap between Practice guidelines (PGs) and routine clinical practice for the patients with schizophrenia which potentially hinders their recovery. One of the important reasons for this persistent gap is the lack of systematic methods to evaluate prescribers’ adherence to practice guidelines. Objectives: This study aimed to develop and validate a medication assessment tool (MAT) to evaluate prescribers’ adherence to pharmacotherapy recommendations in PGs during the acute phase of schizophrenia (APSCZ) in Iran (MATAPSCZ). Methods: This methodological cross-sectional study was conducted from August 2021 to April 2022. According to the literature review and discussions in the research group, an item pool of 91 items was developed. Then face and content validity of the scale were evaluated. Then, exploratory factor analysis (EFA) was used to specify the factor structure. At last, the reliability and responsiveness of the scale were assessed. The study sample consisted of 200 Iranian psychiatrists and final-year psychiatry residents. Results: Eleven items were merged in qualitative content validity. Then, sixteen and six items were excluded from the scale in terms of having low content validity ratios and corrected item-total correlation, respectively. In exploratory factor analysis, the remaining 48 items were classified into six factors, which included 50.1% of the total variance. Based on the results, Cronbach’s alpha, and McDonald’s omega of all factors were higher than 0.7, AIC was 0.2 to 0.4 for all factors, and the intraclass correlation coefficient for MATAPSCZ was 0.914. The standard error of measurement was ± 4.5, and the percentage of minimum detectable change for the tool was calculated to be 6.15%, which indicates its excellent responsiveness. Conclusions: The MATAPSCZ has acceptable psychometric properties and could be a useful tool to evaluate prescribers’ adherence to practice guidelines pharmacotherapy recommendations during the APSCZ.

Developing and pre-testing a digital decision-tree smartphone application for smoking prevention and cessation among HIV care providers.

The diagnosis and continuous care of chronic conditions such as HIV infection present potential teachable moments for delivering smoking prevention and cessation interventions for patients. We designed and pre-tested a prototype of a smartphone application(app), Decision-T, specifically designed to assist healthcare providers when providing personalized smoking prevention and cessation services to their patients. We developed the Decision-T app based on transtheoretical algorithm for smoking prevention and cessation following the 5-A's model. We employed a mixed-methods approach among 18 HIV-care providers recruited from Houston Metropolitan Area for pre-testing the app. Each provider participated in three mock sessions, and the average time spent at each session was measured. We measured accuracy by comparing the smoking prevention and cessation treatment offered by the HIV-care provider using the app to that chosen by the tobacco specialist who designed the case. The system usability scale (SUS) was used to assess usability quantitatively , while individual interview transcripts were analyzed to determine usability qualitatively. STATA-17/SE and Nvivo-V12 were used for quantitative and qualitative analysis, respectively. The average time for completing each mock session was 5 min 17 s. The participants achieved an overall average accuracy of 89.9%. The average SUS score achieved was 87.5(±10.26). After analyzing the transcripts, five themes (app's contents are beneficial and straightforward, design is easy to understand, user's experience is uncomplicated, tech is intuitive, and app needs improvements) emerged. The decision-T app can potentially increase HIV-care providers' engagement in offering smoking prevention and cessation behavioral and pharmacotherapy recommendations to their patients briefly and accurately.

854: STUDENT-LED PODCASTS TO ENHANCE LITERATURE EVALUATION AND CRITICAL THINKING IN A PHARMACY PROGRAM

Introduction: Evaluation of primary literature is essential for pharmacists to provide pharmacotherapy recommendations that are safe and efficacious. Recent data has shown that up to 20% of graduating students and preceptors disagreed that students were prepared to evaluate scientific literature. Podcasts have become an effective educational tool for sharing healthcare related information in a shortened, easily digestible format. The objective of this project was to evaluate student learning outcomes in a critical care therapeutics course when podcasts were utilized as an active learning assignment. Methods: This learning activity took place in a critical care elective course for P3 students at the University of Houston. In groups, students created a 15–20-minute podcast episode discussing a landmark critical care trial. Skills lab sessions were used to listen to podcasts and for small group discussions. The primary objective was to determine if the learning activity improved student perceptions of their comfort and ability to critically evaluate literature. A 10-question pre-post class survey (Likert scale 1-5) was used to assess student perceptions and comfort in evaluating literature. Student performance on the literature evaluation assignments was assessed with a standardized rubric. Results: A total of 92 students participated in the activity. Student perceptions of their ability to evaluate literature improved on all 7 questions, including comfort in interpreting study designs (1.18-point increase, p< 0.001), interpreting results tables (1.05-point increase, p< 0.001), and applying findings to patient care (0.95-point increase, p< 0.001). Students also indicated improved confidence in ability to give an oral presentation on primary literature (1.32-point increase, p< 0.001). Students scored fully proficient on most components of the evaluation rubric, with accurate description of the results/conclusion being the lowest dimension (89% proficient). Conclusions: Incorporation of a student-led podcast activity resulted in improved student perceptions regarding comfort and ability to evaluate primary literature. Future research should assess the impact of student led podcasts on learning outcomes related to other areas of pharmacy and healthcare education.

Moving beyond first-line treatment options for OCD.

OCD is characterized by obsessions and compulsions that cause distress, are time-consuming, and interfere with a patient's social, occupational, or other areas of functioning. SSRIs are first-line pharmacologic treatment options and produce response rates of up to 60% in patients with OCD. Several potential strategies have been evaluated for enhancing patient response, including high-dose SSRI therapy, antipsychotic augmentation, and memantine augmentation. Three patient cases are used to explore treatment guidelines, evaluate existing literature, and provide pharmacotherapy recommendations for the management of patients with OCD when first-line therapy fails.

Main Aspects of Preparing Diabetic Patients in Poland for Self-Care.

Diabetes is a lifestyle disease which can cause many complications and organ-related disorders. The aim of the study was to analyze selected aspects of preparing patients with diabetes for self-care. The study group consisted of 190 people diagnosed with type 1 and type 2 diabetes, including 101 women and 89 men. The mean age of the respondents was 42.2 ± 13.4 years. The study was conducted using an anonymous self-designed questionnaire containing 50 questions. Among the respondents, 23.2% did not control their glucose levels at home. The respondents most often measured glucose once a day (33.6%) or three times a day (26.7%). A total of 64.7% of the respondents declared that they kept a self-monitoring diary. The knowledge of the symptoms of hypoglycemia and the ability to properly manage it was declared by 64.8% of the respondents. A total of 52.1% of the patients did not undertake any activity lasting more than 30 min at least 3 times a week, and 75.2% described their condition as very good and good. Independent participation in therapy, i.e., taking hypoglycemic drugs or insulin, was declared by 63.7% of the respondents. Despite undergoing therapeutic education, the study population diagnosed with diabetes still shows deficiencies in terms of awareness of proper health behaviors. Objective results showed that the patients had insufficient knowledge and skills in terms of self-care and self-observation, blood glucose and blood pressure measurements, physical activity, diet therapy as well as adherence to pharmacotherapy recommendations. Despite the good general preparation for self-care as declared by the respondents, these patients require further systematic, individual educational activities. The results of the present study have implications for nursing practice, patient therapeutic education, and the functioning of the public health and healthcare systems. The number of diabetic patients is constantly increasing. Patients require coordinated care and individualized therapeutic education in order to be prepared for self-care and self-management, thus reducing the risk of complications. Delaying the occurrence of potential complications provides patients with a chance to live an active private and professional life, and protects the health care system from carrying the cost burden of expensive highly specialized services.

Quality of critical care clinical practice guidelines involving pharmacotherapy recommendations.

To assess the quality of critical care clinical practice guidelines (CPGs) involving pharmacotherapy recommendations. A systematic electronic search was performed using PubMed, MEDLINE, and Embase for critical care CPGs published between 2012 and 2022 and involving pharmacotherapy recommendations. The Appraisal of Guidelines for Research &amp; Evaluation II (AGREE II) instrument was employed to appraise CPG quality through independent assessment by 2 appraisers. Twenty-one CPGs were evaluated. The number of recommendations in each guideline ranged from 2 to 250, with a total of 1,604 recommendations. The number of strong (vs weak) recommendations in each guideline ranged from 0 to 31, with a total of 116 strong recommendations, or 7.23% of the total number of recommendations. There was at least 1 pharmacist author for 9 (43%) of the guidelines. The AGREE II domains for which mean quality scores of evaluated guidelines were highest were scope and purpose (0.88; 95% CI, 0.85-0.92), rigor of development (0.80; 95% CI, 0.77-0.83), clarity of presentation (0.84; 95% CI, 0.81-0.87), and editorial independence (0.86; 95% CI, 0.79-0.94), while those for which mean scores were lowest were stakeholder involvement (0.69; 95% CI, 0.63-0.75) and applicability (0.49; 95% CI, 0.43-0.55). Involvement of a pharmacist in CPG development was associated with significantly higher scoring for stakeholder involvement (P = 0.0356). Strong recommendations accounted for less than 10% of the recommendations in the evaluated CPGs. Moreover, there are concerns related to guideline applicability (ie, advice or tools for putting recommendations into practice) and stakeholder involvement (ie, inclusion of individuals from all relevant groups). It is important to involve pharmacists in CPGs with pharmacotherapy recommendations.

Use of the AGREE II instrument to evaluate critical care practice guidelines addressing pharmacotherapy.

Clinical practice guidelines (CPGs) have been evaluated for reporting transparency and methodological quality in a number of studies in various disciplines, but few studies have focused on critical care and none on pharmacotherapy-related guidelines specifically. The objective of this study was to evaluate the quality of critical care CPGs with a focus on pharmacotherapy using theAppraisal of Guidelines, Researchand Evaluation(AGREE) II instrument. A cross-sectional study of CPGs published from 2013 through August 2021 was conducted. Following establishment of interrater reliability, guidelines were independently evaluated by three reviewers to rate guidelines on criteria set forth by the AGREE II instrument. Domain scores and item scores were calculated using the AGREE II user manual, and results described with descriptive statistics. Out of 192 guidelines identified, 73 met inclusion criteria and were screened using the AGREE II instrument. Most guidelines were authored by a professional organization or government agency. Domain quality scores were calculated for each domain as recommended by the AGREE II instrument. Domain 4 (clarity of presentation) had the highest AGREE II domain score with a median score of 87.0% (interquartile range: 79.6%-92.6%). Domain 5 (applicability) received the lowest domain score with a mean score of 41.8 ± 21.1%. The majority of guidelines were recommended for use as published or with modifications, while only six guidelines (8.2%) were not recommended for use. The majority of critical care guidelines that include pharmacotherapy recommendations were recommended for use by study authors when the AGREE II instrument was applied. While guidelines generally scored highly in clarity of presentation, additional time and effort should focus on providing solutions to guideline implementation and inclusion of patientpreferences.

Medication Management in Lactation—A Pharmacist Education Pilot Project: Part one survey

BackgroundPharmacists as the most accessible health professionals can serve as an important resource on medication safety for breastfeeding women. Previous research suggests that a barrier to pharmacists providing optimal pharmaceutical care for this population is a lack of knowledge. ObjectiveTo evaluate pharmacist perceptions and barriers related to medication management of patients who are breastfeeding. MethodsA 25-question electronic survey was distributed via e-mail list servers to members of state pharmacy organizations. Pharmacists were queried on the importance of breastfeeding, barriers to pharmaceutical care, comfort level in making pharmacotherapy recommendations, adequacy of pharmacy school’s curriculum, breastfeeding resources used, and need for continuing pharmacy education regarding medication use during breastfeeding. ResultsPharmacists from all geographic regions of the United States and diverse practice settings agreed to participate in the survey (N = 197). Most pharmacists reported feeling somewhat or extremely comfortable making recommendations and counseling breastfeeding patients on over-the-counter (102 of 187, 55%) and prescription medications (110 of 187, 59%). In contrast, 66% (123 of 187) reported feeling somewhat or extremely uncomfortable making recommendations and counseling on the use of herbal supplements in breastfeeding. Notably, 95% of pharmacists (171 of 180) responded that there is an unmet need for continuing pharmacy education on medication use in lactation. ConclusionPharmacists are generally uncomfortable when making recommendations and counseling breastfeeding patients on herbal and other supplements. Most pharmacists agree that there is a lack of available continuing pharmacy education on breastfeeding.

Glycemic control and associated factors in patients with type 1 diabetes mellitus in primary care in Southeastern Brazil

Diabetes is a self-managed condition with knowledge, attitudes and practices that can influence the overall treatment and outcomes delay the complications of diabetes. However, the few reported studies published point out that: low education level, poor adherence to pharmacotherapy and diet recommendations, infrequent monitoring of blood glucose, and insulin dosage regimen are associated with higher hemoglobin levels. This study aimed to assess the knowledge, adherence medication, and complexity of pharmacotherapy in T1DM patients in Brazil. A cross-sectional study was conducted involving 156 T1DM patients who were attending in primary care. Logistic regression analyses were conducted to assess the variables associated with glycemic control. The overall assessments of T1DM patients for the glycemic control were bad (121, 77.6%). However, T1DM patients with high MedTake Test (OR=2.4, CI=1.1-5.7) and Morisky-Green Test (OR= 2.5, CI=1.1-6.1), and in the use of dosage insulin (>40 units, OR=0.3, CI=0.1-0.7) and postprandial glucose (100-125mg/dl, OR=3.8, CI=1.1-14.6) had better glycemic control compared to uncontrolled patients. Glycemic control in Brazilians adults with T1DM is low. We suggested the screening patients with low MedTake and Morisky-Green Tests, increasing patient knowledge as part of a complex intervention that may lead to substantially improved treatment outcomes in primary care.

Promoting clinical pharmacy services through advanced medication review in the emergency department

Objectives: To determine if an advanced medication review carried out in the emergency departmen t (ED) increases the number of pharmacotherapy recommendations (PR) and the severity of the detected prescribing errors. Methods: We designed an analytic observational prospective cohort study with preintervention assessment (PRE) and postintervention assessment (POST). In PRE, prescription review was done by pharmacists located in the pharmacy department; they took into account only the information provided by the computerised physician order entry system. In POST, pharmacists were physically present in the ED and performed an advanced medication review. The main variables were number of PR and the severity of detected prescribing errors according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) severity index. Clinical variables were number of calls to physicians on duty during the first 48 hours of admission, readmissions at 30 days, visits to the ED at 30 days, inhospital mortality and length of stay. Results: The study population comprised 102 patients (51 in PRE and 51 in POST). In PRE, the number of PR per patient was 1.1; in POST, this value increased by 53% (1.7 PR per patient; P=0.014), especially in the case of PR related to home medications. The severity of prescribing errors was higher in POST (P=0.004). There was a trend towards better results for all clinical outcomes in POST although statistical significance was not reached. Conclusions: An advanced medication review in the ED increases the number of PR and the severity of the detected prescribing errors.

Arterial hypertension as a risk factor for myocardial infarction with non-obstructive coronary arteries (MINOCA)

Myocardial infarction with non-obstructive coronary arteries (MINOCA) as a relatively new disease entity distinguished from the group of acute coronary syndromes (ACS) is not a rare clinical problem and it requires in-depth diagnostics. MINOCA accounts for 5–10% of all ACS cases. MINOCA is most common between the ages of 50–60 and predominates in females. Coronary microvascular dysfunction and coronary vasospasm are among the potential mechanisms. The latest guidelines for the treatment of ACS in patients presenting without persistent ST-segment elevation emphasize the importance of searching for the causes of angina in patients with insignificant lesions in the coronary arteries by extending invasive diagnostics (e.g., acetylcholine provocation test) and using noninvasive diagnostics (e.g., CMR or SPECT). In the context of MINOCA, among the typical risk factors for coronary artery disease, arterial hypertension (HTN) seems to be the most important by inducing coronary microcirculation remodeling (mostly hypertrophy) and hence the narrowing of the lumen. Studies comparing patients with MINOCA and obstructive coronary artery disease (MI-CAD) in the context of risk factors, in particular HTN, were analyzed. In five out of nine analyzed studies, HTN occurred significantly more often in patients with MINOCA compared to patients with MI-CAD. The current pharmacotherapy recommendations focus on slowing the progression of coronary microvascular dysfunction (CMD), i.e., adequate treatment of risk factors and comorbidities, such as HTN. Therefore, it seems reasonable to conduct studies directly analyzing the relationship between HTN and MINOCA in order to improve diagnostics and establish appropriate pharmacotherapy that will improve prognosis.

NeoCheck: a prescription-screening tool to optimise pharmacotherapy for hospitalised neonates.

To develop a screening tool to optimise neonatal drug prescription, which is often based on low-quality evidence. Neonatal pharmacotherapy recommendations were identified by literature review and synthesised into NeoCheck tool statements. In a two-round modified Delphi process, experts from Swiss neonatal intensive care units (NICUs) rated their agreement with individual statements using a five-point Likert scale (5 = totally agree). Statements with &gt;65% scores &ge;4 in round 1 and &gt;75% scores &ge;4 in round 2 were selected. We identified 1375 clinical guidelines via literature review. After synthesis, 158 statements were submitted to 23 experts (1 clinical pharmacist, 22 neonatologists; 65% with &gt;10 years neonatology practice) from 10 Swiss NICUs. Nineteen items did not reach the agreement threshold and were eliminated in the second Delphi round. The final NeoCheck tool comprises 141 statements in 11 medical domains concerning 49 neonatal diseases. Most (79%) statements concern all neonates, 13% concern preterm (&lt;37 weeks gestational age) infants and 3% concern very preterm (&lt;32 weeks gestational age) infants CONCLUSIONS: NeoCheck is the first prescription-screening tool developed to optimise neonatal pharmacotherapy. In a future prospective study, its effect on NICU prescription optimisation and the quality of care will be assessed.

Student Pharmacists Self-Perceived Confidence in Communication Skills With Healthcare Practitioners Before and After a Seminar Course

Introduction: Competent pharmacy practice requires the ability to critically evaluate the medical literature and communicate pharmacotherapy information and recommendations to healthcare practitioners. Given the limited research on how these skills are taught, a seminar course in the third year of the pharmacy curriculum was designed to strengthen these skills and abilities. Methods: This was a prospective, pre- and post-cohort survey design. Students were informed of the study’s intent with participation being voluntary and not affecting their course grade. Students received the same survey at the beginning and end of the semester. The 20-question survey assessed self-perceived confidence in the domains of communication and literature evaluation using a 5-point, Likert-type Strongly Disagree-Strongly Agree Scale. Demographic information and students’ previous pharmacy work and internship experience were collected as a part of the survey. Descriptive statistics and Student’s t-test were used to assess the research question and comparisons of student demographics. Results: Sixty-eight of a possible 91 students (75% response rate) completed both the pre- and post-survey. There was no statistically significant differences between any of the measured demographics. Overall, students slightly agreed they were confident in their communication and literature evaluation skills in the pre-course evaluation, with communicating drug interactions as the least confident area. Post-course, students were significantly more confident in all but 5 of 20 measured areas. Conclusion: The Seminar course resulted in a positive change in students’ perception of confidence to communicate with healthcare professionals and ability to evaluate drug literature.

Adherence to Pharmacotherapy and Lifestyle Recommendations Among Hemodialyzed Patients and Kidney Transplant Recipients

Success in treatment with hemodialysis (HD) and kidney transplantation (KTx) requires good adherence. The objective of this study was to evaluate adherence to pharmacotherapy and health recommendations among HD and KTx patients using subjective and objective measures. Two hundred thirty-nine enrolled patients, with 132 KTx (39F, 93M) and 107 HD (48F, 59M) completed a questionnaire regarding over-the-counter (OTC) medications and dietary supplements (DS), adherence to pharmacotherapy, lifestyle recommendations, and self-evaluation of knowledge on them. The surveys were supplemented with objective data from patients' medical records, including interdialytic weight gain and laboratory parameters. About 42.1% HD and 39.4% KTx patients reported using OTC medications without medical consultation (P=.677); 43.9% HD and 31.1% KTx used DS (P=.040); more HD than KTx failed to notify a doctor about it (52.2% vs. 21.4%; P<.001). More HD patients skipped medication doses (33.6% vs. 9.7%; P<.001). About 40.2% HD and 20.5% KTx patients drank alcohol (P<.001), 22.4% HD and 10.5% KTx smoked (P=.013). About 46.7% HD and 66.4% KTx patients limited their caloric intake (P=.002), 73.8% HD and 84.9% KTx limited their salt intake (P=.030). HD patients drank 1.17±0.57L of fluids daily and KTx drank 2.51±0.67L (P<.001). In HD patients, interdialytic weight gains positively correlated with dialysis vintage (R=0.26, P=.02) and fluid (R=0.28, P=.011) but not salt intake (P=.307). The variability of trough levels of calcineurin inhibitors was unrelated to use of DS or OTC medications. KTx rated their knowledge on recommendations higher compared with HD (mean score 4.0±1.0 vs. 3.7±1.0, P=.040). KTx recipients exhibit better adherence and rate their knowledge on recommendations higher than HD patients.

Evaluation of pharmacotherapy recommendations in guidelines for inflammatory bowel disease.

The aim of this study was to systematically assess drug therapy in the guidelines for inflammatory bowel disease and to provide recommendations for the development of such guidelines. A systematic search was conducted in databases and on websites to identify guidelines for the treatment of inflammatory bowel disease. Qualified guidelines were assessed through the Appraisal of Guidelines for Research and Evaluation (AGREE II). Evidence from the guidelines was extracted from the guidelines themselves. The Oxford Centre for Evidence-based Medicine (OCEBM) evidence grading system was used to regrade and assess this evidence. A total of 11 guidelines for the medical treatment of inflammatory bowel disease (Crohn's disease and ulcerative colitis) (2015-2019) were finally included, and after scoring using the AGREE II tool, the median scores in each domain were as follows: Ⅰ. scope and purpose (median score=88.9%, range: 76.4%-91.7%), Ⅱ. stakeholder involvement (median =38.9%, range: 18.1%-61.1%), Ⅲ. rigour of development (median =69.3%, range: 39.6%-77.6%), Ⅳ. clarity and presentation (median =97.2%, range: 91.7%-100%), Ⅴ. applicability (median =45.8%, range: 24%-68.8%) and Ⅵ. editorial independence (median =94.0%, range: 0-100%). Most of the guidelines scored over 60%, which is worthy of clinical recommendation, but different guidelines suggest that there is a great difference in drug therapy, mainly due to various populations, diverse focuses of attention, distinct efficacy of drugs between Crohn's disease and ulcerative colitis, and the preference of guiding developers for select evidence. The quality of medical treatment guidelines for inflammatory bowel disease varies considerably. Over the past 5years, medical treatment has been heterogeneous among different guidelines. Consideration of factors leading to heterogeneity of recommendations for drug treatment, especially preferences for evidence selection, will help upgrade the guidelines.