Prevalence and acceptance of methadone recommendations in hospice and palliative care

Background:Clinical pharmacists play an important role in the care of patients in hospice/palliative care, particularly for the treatment of pain. Methadone, a long-active opioid, is particularly useful in this population, but may be underutilized. The objective of the study was to evaluate the prevalence ofpharmacist recommendations and subsequent physician acceptance for the use of methadonefor painin newly admitted hospice/palliative care patients. Methods: The study was conductedfrom October-December 2019in coordination with a locally-based pharmacy services organization which works with hospice/palliative care providers. A selectedgroup of pharmacists at the organization identified patients reviewed as new admissions as part of their usual clinical careprocess.A data collection tool was utilized to collectinformation onpatient demographics, type of pain, medication history, pain intensity and palliative prognosis score at the time of admission; furthermore, it identified whether a recommendation for methadone was made by the pharmacist based onindividualindications/contraindications. Patients who had recommendations for methadone rendered were followed up with additional data collection by a member of the research team. Further datacollectedincluded whether the provided recommendation was accepted or not, as well as additional patient information includingallergies, comorbidities, hepatic/renalfunction, nutritional status pain medication history, current pain intensity and palliative prognosis score. Results/Conclusion:Datawas collectedby pharmacistsfor158 patients, including 37(23.4%)who wereprovidedrecommendationsfor methadoneby pharmacists, most commonly asaswitch for maintenance treatment (26; 70.3%). Out of the 37 recommendations, 6 (16.2%) were accepted by physicianswithin the follow-up period. Ongoing analysis will continue to assessthe data collectedto identify patterns in recommendations that were accepted versus those that were not

Coworkists

The final thesis commercial project was a complete commercial interior designing package. The final presentation of this thesis book met the interior decorating field standard and was presented to a client in a digital format. The book has a strong and professional appearance. The project starts with the research phase; that includes the investigation of the project area including site location, demographics, and neighborhood, understanding the client and their interaction with the built environment, client target market, gathering planning data as a comprehensive source for the Planning & Design phase, concept development process. The second phase includes schematic design development process, space planning, elevations, conceptual sketches, material, and finishes. The final phase includes digital and manual sketching, rendering of plans and elevations, perspective drawings and overall professional presentation designing.https://source.sheridancollege.ca/swfaad_projects_interior_decorating_commercial/1006/thumbnail.jp

Two Dimensional Clustering of Gamma-Ray Bursts using durations and hardness

Gamma-Ray Bursts (GRBs) have been conventionally bifurcated into two distinct categories: ``short'' and ``long'' with durations less than and greater than two seconds respectively. However, there is a lot of literature (although with conflicting results) regarding the existence of a third intermediate class. To investigate this issue, we extend a recent study (arXiv:1612.08235) on classification of GRBs to two dimensions by incorporating the GRB hardness in addition to the observed durations. We carry out this unified analysis on GRB datasets from four detectors, viz. BATSE, RHESSI, Swift (observed and intrinsic frame), and Fermi-GBM. We consider the duration and hardness features in log-scale for each of these datasets and determine the best-fit parameters using Gaussian Mixture Model. This is followed by information theoretic criterion (AIC and BIC) to determine if a three-component fit is favored compared to a two-component one or vice-versa. For BATSE, we find that both AIC and BIC show preference for three components with decisive significance. For Fermi and RHESSI, both AIC and BIC show preference for two components, although the significance is marginal from AIC, but decisive using BIC. For Swift dataset in both the observed and rest frame, we find that three components are favored according to AIC with decisive significance, and two are preferred with BIC with marginal to strong significance.Comment: 13 pages, 10 figures. This is an extension of arXiv:1612.08235 to two-dimension

Clinical Pharmacy services and medication utilization in Hospice Care

Background: As discussed within the guidelines from the American Society of Health-System Pharmacists (ASHP), pharmacists are an integral part of the hospice multidisciplinary team involved in optimizing the treatments. Methadone, a long-active opioid, is particularly useful in this population but may be clinically underutilized. Additionally, the cost share of medication utilization in hospice and palliative care is shifting towards hospice providers. The assessment of medication utilization and methadone use in this setting can help develop overall cost/clinical optimization strategies. Thus, there is a need to understand the use and expenditure of various medications and pharmacists\u27 role in providing methadone use recommendations in hospice and palliative care settings that would facilitate the cost containment. Objectives: The purpose of the study was to (1) identify the prevalence and acceptance of clinical pharmacists’ methadone recommendation before and after admission to hospice/palliative care, and (2) identify the frequency, expenditure, and monthly mean cost of therapeutic medication classes belonging pain, pulmonary and anticoagulant medications categories. Methods: The study was conducted in two phases. The phase I was conducted in two parts of data collection at DeltaCareRx hospice and palliative care site. A systematic literature review formed the basis of clinical pharmacist\u27s role and significance in the multidisciplinary team of hospice and palliative care. The instruments for data collection were developed for the clinical pharmacists and student pharmacist researcher. Descriptive and inferential statistics of the collected data identified the prevalence of clinical pharmacist recommendations for methadone upon admission to hospice/palliative care and the acceptance of the pharmacists’ recommendations for methadone after admission to hospice/palliative care. Phase II studied medication utilization at the hospice/palliative sites served by the pharmacy benefit manager (PBM) DeltaCareRx. Pharmacy claims data for six months of the year 2019 was obtained from DeltaCareRx. The data included information on the utilization of individual medications and their associated therapeutic classes, patient characteristics, and dispensing cost charged to the patients. Claims data were analyzed to identify the frequency in use, total expenditure, and the monthly average cost of each therapeutic class and the pattern in the utilization of therapeutic class based on the sex of the patients. The consumption of individual medications was calculated using defined daily doses (DDD), a methodology that analyses medication consumption and enables comparison across different months in a standardized manner. Results: In total, the data collected on both instruments included 158 (99.3%) patients. The prevalence of pharmacist methadone recommendation was 37 (23.4%). The majority (26; 16.5%) of methadone recommendation were for switching to methadone as the maintenance treatment. Out of the 37 pharmacist recommendations, 5 (13.5%) were accepted by the physicians, and the physicians themselves implemented 3 (8.1%) recommendations. In phase II, the pharmacy claims data were obtained for six months (January, June, July, September, October, and November) of 2019. The data consisted of 487 unique therapeutic classes and 3,189 unique medications. Sympathomimetics, opioid agonists, and coumarin anticoagulants were the most frequently used therapeutic classes. The average cost per male/female patients was the highest ($64.82 and$67.70) for pulmonary medications. Medications such as albuterol, enoxaparin, and morphine had higher consumption levels. Conclusion: The study provided valuable insights regarding clinical pharmacists\u27 significant role in hospice and palliative care. A pharmacist\u27s role in providing recommendations on medication use to the patients can improve clinical/cost optimization in the setting. The data collection on pharmacists’ recommendations on methadone demonstrates minimum medication use in the hospice and palliative care setting. There should be an increase in the use of this cost-effective medicine for pain management among the patients. The pharmacy claims data analysis implements that the rise in use of cost-effective medications from the individual therapeutic classes will help in higher cost savings at DeltaCareRx’s client sites and reduce the provider’s overall cost burden

Comparison of dermatoglyphic patterns in oral leukoplakia and oral submucous fibrosis patients

Background: Genetics plays an important role in the detection of an Oral potentially malignant lesion. A major contributor to genetic study is Dermatoglyphics or the study of fingerprints and lines of palmer and plantar surfaces. Many researchers have used dermatoglyphics to connect genetics with oral lesions and malignancies. Thus, the current study has been conducted to find out an association between dermatoglyphic patterns and oral leukoplakia, oral submucous fibrosis and healthy subjects.Methods: The present study is conducted on subjects that have been already diagnosed with oral lesions. Fingerprint patterns (whorled, loop and arch) were evaluated by utilizing fingerprints.Results: The present study showed that the loop pattern was common in all three subjects. The frequency of whorled and arch pattern is decreased in oral leukoplakia and oral submucous fibrosis that healthy subjects. Arch pattern is comparatively decreased in subjects with oral leukoplakia than oral submucous fibrosis and there is a decrease in the frequency of whorled patterns in OSMF as compared to oral leukoplakia.Conclusions: Authors conclude that simply by observing the whorled and arch patterns in a subject, authors can hypothesize that risk of occurrence of oral leukoplakia and oral submucous Fibrosis and take preventive measures against the said lesions

PHYTOCHEMISTRY AND PHARMACOLOGY OF PTEROCARPUS SANTALINUS AND ITS ROLE IN DERMATOLOGY

The review provides an updated overview of the phytochemical and pharmacological studies on Pterocarpus santalinus. It briefs on the synergistic interactions of P. santalinus with other medicinal plants and its use in Ayurvedic formulations. Phytochemical analysis suggests the presence of triterpenoids, steroids, flavonoids, and phenolic acids. The phytoconstituents and related pharmacological activities of various parts of P. santalinus include antifungal, anticholinesterase, antidiabetic, antibacterial, antipyretic, anti-inflammatory, anticancer, and antiulcer. Literature survey highlights the dermatological applications of the phytoconstituents such as pterostilbene, savinin, and betulin as potential leads for anti-aging, ultraviolet rays (UV-B) protective, and wound healing effects. Undoubtedly, P. santalinus has wide therapeutic value. The dermatologically significant phytoconstituents, namely, pterostilbene, cedrol, savinin, lupeol, betulin, β-eudesmol, and α-bisabolol, if isolated and used in dermatological formulations, can show promising skin protective effect. The data were compiled using scientific databases, namely, Google Scholar and PubMed, the data made available specifically from 2010 to 2021

In silico identification and characterization of the SNPs in the human ASTL gene and their probable role in female infertility

Ovastacin (ASTL), a zinc metalloprotease, is released from a fertilized egg during exocytosis of cortical granules which occurs minutes after the sperm and egg fuse. ASTL cleaves ZP2, one of the four primary glycoproteins of human zona pellucida, and this cleavage prevents polyspermy, causes zona pellucida hardening, and also protects the pre-implantation embryo. Any perturbation in the activity of ASTL can thus disturb this process and may lead to infertility without changing the gross morphology of the oocyte. A small amount of ASTL is also released by unfertilized oocytes but its catalytic activity is absent as it is bound by its inhibitor, Fetuin-B (FETUB). Pre-mature release of ASTL when FETUB is absent also causes infertility. To identify and understand the structural and functional effects of deleterious SNPs of ASTL on its interaction with ZP2 and FETUB and hence on fertility, a total of 4,748 SNPs from the dbSNP database were evaluated using a variety of in silico tools. All of the 40 shortlisted nsSNPs were present in the catalytic domain of the protein. Comparison of the wild type with mutants using MutPred2 suggests an alteration in the catalytic activity/zinc binding site in many SNPs. Docking studies show the involvement of hydrophobic interactions and H bonding between ASTL and ZP2 and also between ASTL and FETUB. Four positions in ASTL involved in the hydrophobic interactions (P105 and D200 between ASTL and ZP2; D198 and L278 between ASTL and FETUB) and 5 in H bonding (E75 and R159 between ASTL and ZP2; and K93, R159, and C281 between ASTL and FETUB) have SNP’s associated with them validating their importance. Interestingly, a cluster of multiple SNPs was found in the motif 198DRD200, which is also a well-conserved region among several species. Statistical Coupling Analysis (SCA) suggested that the deleterious SNPs were present in the functionally important amino acid positions of ASTL and are evolutionarily coupled. Thus, these results attempt to identify the regions in ASTL, mutations in which can affect its binding with ZP2 or FETUB and cause female infertility

Examining virtual research recruitment and participant diversity in a multi-center birth cohort, Childhood Allergy and the NeOnatal Environment (CANOE)

Rationale: Recruitment for a NIH/ECHO-supported multi-center birth cohort, “Childhood Allergy and the NeOnatal Environment” (CANOE) stopped due to the COVID-19 pandemic. Redesign of study procedures emphasized virtual and socially distanced activities. We hypothesized that “virtual” recruitment methods (social media, websites, email) would surpass “traditional” methods (in-clinic, telephone, flyers/print materials) and increase enrollment of families from diverse backgrounds and communities. Methods: Pregnant women (n=439, target 500) were recruited from four academic medical centers in Detroit MI, Madison WI, Nashville TN, and St. Louis MO. We collected demographic and social information by questionnaires and examined race, ethnicity, age, parity, and employment status in relation to recruitment method using chi-square tests. Results: In-clinic and telephone recruitment comprised 55% of enrollment, followed by print materials (17%), and social media and email (15%). The cohort includes families self-identifying as Caucasian/White (63%), African American/Black (27%), Hispanic/Latino (3.3%), Asian (3.5%), and mixed races (1.2%). This reflects site demographics for White and Black patients, while other populations are not as well recruited into this cohort. Recruitment method success did not vary by race, ethnicity, maternal age, or employment status (p=ns for each comparison). Most (63%) multigravida mothers (9.1% of participants) were recruited in clinic, while primigravida participants were recruited more evenly via all methods. Conclusions: “Virtual” recruitment methods comprised a smaller proportion of cohort enrollment than hypothesized and study recruitment method did not vary by race/ethnicity; however, consideration of combined, varied, and novel recruitment methods may add to the development of best practices for more representative research study recruitment