Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention

As medication therapy management (MTM) continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need.   Type: Idea Pape

Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention

As medication therapy management (MTM) continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need.   Type: Idea Pape

Evidence for a black hole spin--orbit misalignment in the X-ray binary Cyg X-1

Recently, the accretion geometry of the black-hole X-ray binary Cyg X-1 was probed with the X-ray polarization. The position angle of the X-ray emitting flow was found to be aligned with the position angle of the radio jet in the plane of the sky. At the same time, the observed high polarization degree could be obtained only for a high inclination of the X-ray emitting flow, indicating a misalignment between the binary axis and the black hole spin. The jet, in turn, is believed to be directed by the spin axis, hence similar misalignment is expected between the jet and binary axes. We test this hypothesis using very long (up to about 26 years) multi-band radio observations. We find the misalignment of $20^\circ$--$30^\circ$. However, on the contrary to the earlier expectations, the jet and binary viewing angles are found to be similar, while the misalignment is seen between position angles of the jet and the binary axis on the plane of the sky. Furthermore, the presence of the misalignment questions our understanding of the evolution of this binary system.Comment: ApJL, in pres

Analysis of a First Professional Year Student Wellness Program

Objective: To identify wellness-related needs and assess the impact of wellness-related offerings among first professional year pharmacy students. Innovation: A survey tool was developed and offered to P1 students at the beginning and end of their fall and spring semesters. Additional biometric data was also collected to help identify wellness needs. Data from the first academic year (AY1) was used to develop targeted wellness interventions offered to P1 students during the subsequent academic year (AY2). Assessment strategies from AY1 were repeated with minor modifications in AY2 to identify changes in baseline needs and changes in markers across the academic year. Critical Analysis: AY1 survey response rates varied from 20.1% to 47.4% across the semester. Frequent dissatisfaction was reported with diet, weight, and exercise. AY2 survey response rates varied from 15.8% to 58.3% across the semester. The AY2 cohort demonstrated similar dissatisfaction data; however, also demonstrated lower baseline stress scores as compared to the AY1 cohort, higher baseline BMI, and higher systolic and diastolic blood pressure. Individual interventions offered to AY2 students were attended by as many as 16.5% of the academic cohort. Nutrition classes exhibited stronger attendance than fitness classes. Next Steps: The process used in this study was easily implemented and provided understanding of wellness gaps, which helped to identify interventions that were implemented and assessed. The process also demonstrated that wellness needs can vary from one population to another, reinforcing the value of periodic assessment to identify changing needs.   Type: Not

Assessment of a pharmacist-led comprehensive medication management and wellness program

Background: Pharmacists are currently providing comprehensive medication management in the outpatient setting. However, there is little documented evidence demonstrating pharmacists are generating further improved health outcomes utilizing non-pharmacologic support, such as fitness and nutrition counseling. The objective of this study is to determine if a pharmacist-led wellness program with medication management and lifestyle modifications through fitness and nutrition coaching can lead to improved biometric markers. Methods: The wellness program targeted corporate employees and was offered in a corporate headquarters' setting with an on-site workout facility. The program was expected to recruit approximately 15 patients into the wellness program consisting of two treatment arms. The standard group featured nutrition-based classes, medication therapy management and fitness education. The intervention group performed the standard group's activities plus direct, supervised fitness training once weekly. Measured biometric markers were assessed at baseline, 3.5 months, and 7 months and included body mass index (BMI), waist circumference (WC), fasting blood glucose (FBG), systolic and diastolic blood pressure (SBP and DBP), and full lipid panel (TC, TG, HDL, and LDL). Results: Seventeen patients were enrolled in the study. The standard group (n = 11) and intervention group (n = 6) had relatively similar biometric markers at baseline. Seven total patients completed the study (4 from standard group, 3 from intervention group). The majority of biometric markers improved in both groups, and BP and LDL control was maintained for all who completed the study. Conclusion: These data suggest that a licensed pharmacist with certified personal trainer credentials may be capable of maintaining biometric markers at healthy levels and improving where necessary in an employee wellness program through one-on-one medication, fitness and nutrition support. Additional, large-scale research is needed to verify the clinical outcomes and feasibility in a larger group setting.   Type: Clinical Experienc

Mentoring Residency Candidates: Avoiding Misinformation and Employing Best Practices

Type: Commentar

Global biogeographic patterns of avian morphological diversity

Understanding the biogeographical patterns, and evolutionary and environmental drivers, underpinning morphological diversity are key for determining its origins and conservation. Using a comprehensive set of continuous morphological traits extracted from museum collections of 8353 bird species, including geometric morphometric beak shape data, we find that avian morphological diversity is unevenly distributed globally, even after controlling for species richness, with exceptionally dense packing of species in hyper-diverse tropical hotspots. At the regional level, these areas also have high morphological variance, with species exhibiting high phenotypic diversity. Evolutionary history likely plays a key role in shaping these patterns, with evolutionarily old species contributing to niche expansion, and young species contributing to niche packing. Taken together, these results imply that the tropics are both ‘cradles’ and ‘museums’ of phenotypic diversity

Exogenous sex steroid hormones and asthma in females:protocol for a population-based retrospective cohort study using a UK primary care database

This work was supported by Asthma UK, grant number: AUK-IG-2016-346. BIN, INS, CRS and AS were in addition support by the Farr Institute and Asthma UK Centre for Applied Research. BIN acknowledges the support of Knut and Alice Wallenberg Foundation and the Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden.Peer reviewedPublisher PD

Development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population

Objective: To describe successes and barriers with the development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population. Setting: A single supermarket chain pharmacy Practice description: Community pharmacists provide dispensing and non-dispensing pharmacy services including medication therapy management, biometric wellness screenings, and immunizations. Practice innovation: Developed and implemented a community pharmacy medication therapy management-based transition of care program for patients with managed Medicaid Main outcome measures: Feasibility of developing and implementing a transition of care service in a community pharmacy Results: During the first six months, a total of 17 patients were seen as part of the program. Study pharmacists identified successes and potential strategies for overcoming barriers. Conclusion: Developing and implementing a community pharmacy transition of care program for patients with managed Medicaid was logistically feasible.   Type: Original Researc