Increased fracture rate in women with breast cancer: a review of the hidden risk

Women with breast cancer, particularly individuals diagnosed at a relatively early age, have an increased incidence of fractures. Fractures can have serious clinical consequences including the need for major surgery, increased morbidity and mortality, increased cost of disease management, and reduced quality of life for patients. The primary cause of the increased fracture risk appears to be an accelerated decrease in bone mineral density (BMD) resulting from the loss of estrogenic signaling that occurs with most treatments for breast cancer, including aromatase inhibitors. However, factors other than BMD levels alone may influence treatment decisions to reduce fracture risk in this setting. Our purpose is to review current evidence for BMD loss and fracture risk during treatment for breast cancer and discuss pharmacologic means to reduce this risk.Journal ArticleResearch Support, Non-U.S. Gov'tReviewSCOPUS: re.jinfo:eu-repo/semantics/publishe

Utilization and prescribing patterns of direct oral anticoagulants

Maegan M Whitworth,1 Krystal K Haase,1 David S Fike,1 Ravindra M Bharadwaj,2 Rodney B Young,3 Eric J MacLaughlin1,4 1Department of Pharmacy Practice, Texas Tech University Health Sciences Center (TTUHSC) School of Pharmacy, 2Department of Internal Medicine, 3Department of Family and Community Medicine, 4Departments of Family Medicine and Internal Medicine, TTUHSC School of Medicine, Amarillo, TX, USA Background: Scant literature exists evaluating utilization patterns for direct oral anticoagulants (DOACs). Objectives: The primary objective was to assess DOAC prescribing in patients with venous thromboembolism (VTE) and nonvalvular atrial fibrillation (NVAF) in outpatient clinics. Secondary objectives were to compare utilization between family medicine (FM) and internal medicine (IM) clinics, characterize potentially inappropriate use, and identify factors associated with adverse events (AEs). Methods: This was a retrospective cohort study of adults with NVAF or VTE who received a DOAC at FM or IM clinics between 10/19/2010 and 10/23/2014. Descriptive statistics were utilized for the primary aim. Fisher’s exact test was used to evaluate differences in prescribing using an adapted medication appropriateness index. Logistic regression evaluated factors associated with inappropriate use and AEs. Results: One-hundred twenty patients were evaluated. At least 1 inappropriate criterion was met in 72 patients (60.0%). The most frequent inappropriate criteria were dosage (33.0%), duration of therapy (18.4%), and correct administration (18.0%). Apixaban was dosed inappropriately most frequently. There was no difference in dosing appropriateness between FM and IM clinics. The odds of inappropriate choice were lower with apixaban compared to other DOACs (odds ratio [OR]=0.088; 95% confidence interval [CI] 0.008–0.964; p=0.047). Twenty-seven patients (22.5%) experienced an AE while on a DOAC, and the odds of bleeding doubled with each inappropriate criterion met (OR=1.949; 95% CI 1.190–3.190; p=0.008). Conclusion: Potentially inappropriate prescribing of DOACs is frequent with the most common errors being dosing, administration, and duration of therapy. These results underscore the importance of prescriber education regarding the appropriate use and management of DOACs. Keywords: rivaroxaban, dabigatran, apixaban, atrial fibrillation, venous thromboembolism, medication errors&nbsp

A Participation Requirement to Engage Students in a Pharmacokinetics Course Synchronously Taught at a Local and Distant Campus

Objective To design, implement, and evaluate a strategy to actively engage doctor of pharmacy (PharmD) students at local and distant sites in a pharmacokinetics course. Design A Web-based system was designed that allowed second-year pharmacy students to choose whether to participate in a instructor-led class discussion session by registering prior to or during the first 10 minutes of each class. The instructor then used the program to randomly select students to respond to questions based on the assigned reading. Five percent of the overall course grade was based on class participation. Assessment For each class session, an average of 85% of students at both the local and distant campuses registered for participation in class discussion and approximately 5% were called on to respond to questions. Student responses to course survey questions regarding the participation strategy were overwhelmingly positive, with 75%-90% agreeing that the strategy more actively engaged them in classroom activities, resulting in improved learning. Student performance in all assessment categories was almost identical at the local and distant sites. Conclusions Implementation of a participation strategy in a large course synchronously taught on 2 campuses is feasible and results in successful engagement of most students at both sites

Establishing and Maintaining a Satellite Campus Connected by Synchronous Video Conferencing

Pharmacy education has experienced substantial growth in the number of new schools and existing schools establishing satellite campuses. Several models have previously been used to connect primary and satellite campuses. We describe the Auburn University Harrison School of Pharmacy's (AUHSOP's) experiences using synchronous video conferencing between the Auburn University campus in Auburn and a satellite campus in Mobile, Alabama. We focus on the technology considerations related to planning, construction, implementation, and continued use of the various resources that support our program. Students’ perceptions of their experiences related to technology also are described