Self-Care in the Twenty First Century: A Vital Role for the Pharmacist

© 2016, The Author(s). In order for the global healthcare system to remain sustainable, healthcare spending needs to be reduced, and self-treating certain conditions under the guidance of a pharmacist provides a means of accomplishing this goal. This article was developed to describe global healthcare trends affecting self-care with a specific focus on the role of the pharmacist in facilitating over-the-counter (OTC) medication management. Potential healthcare-related economic benefits associated with the self-care model are outlined. The importance of the collaboration between healthcare providers (HCPs), including specialists, primary care providers, and pharmacists, is also discussed. The evolving role of the pharmacist is examined and recommendations are provided for ways to successfully engage with other HCPs and consumers to optimize the pharmacist’s unique qualifications and accessibility in the community. Using the management of frequent heartburn with an OTC proton-pump inhibitor as a model, the critical role of the pharmacist in patient self-treatment of certain symptoms will be discussed based on the World Gastroenterology Organization’s recently published guidelines for the community-based management of common gastrointestinal symptoms. As the global healthcare system continues to evolve, self-care is expected to have an increasing role in treating certain minor ailments, and pharmacists are at the forefront of these changes. Pharmacists can guide individuals in making healthy lifestyle choices, recommend appropriate OTC medications, and educate consumers about when they should consult a physician. Funding: Pfizer Inc

Both Phenolic and Acyl Glucuronidation Pathways of Diflunisal Are Impaired in Liver-cirrhosis

The pharmacokinetics of diflunisal, a salicylate derivative that undergoes phenolic and acyl glucuronidation as well as sulphate conjugation, has been studied after a single oral dose (250 mg) in patients with cirrhosis (n = 5) and in healthy controls (n = 5). The plasma clearance of total (bound + unbound) diflunisal was 10.2 ml.min-1 in the control subjects and it was not affected by cirrhosis (10.9 ml.min-1).The plasma protein binding of diflunisal was significantly reduced in cirrhosis; the percentage of unbound diflunisal in plasma was 0.089 in the controls and 0.147 in the patients with cirrhosis. Plasma clearance of unbound diflunisal was significantly impaired in cirrhosis: 11.51.min-1 in control subjects vs 7.41.min-1 in cirrhotics. In cirrhotic patients, the unbound partial clearances to the phenolic and acyl glucuronides were both significantly reduced, by approximately 38%. The unbound partial clearance to the sulphate conjugate was not significantly affected by cirrhosis. The results show that both the phenolic and acyl glucuronidation pathways of diflunisal are equally susceptible to the effects of liver cirrhosis

Burden of nonsteroidal anti-inflammatory and antiplatelet drug use in Asia: a multidisciplinary working party report

BACKGROUND & AIMS: We established a working group to examine the burden of atherothrombotic and musculoskeletal diseases in Asia and made recommendations for safer prescribing of nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin. METHODS: By using a modified Delphi process, consensus was reached among 12 multidisciplinary experts from Asia. Statements were developed by the steering committee after a literature review, modified, and then approved through 3 rounds of anonymous voting by using a 6-point scale from A+ (strongly agree) to D+ (strongly disagree). Agreement (A+/A) by >/= 80 of panelists was defined a priori as consensus. RESULTS: We identified unique aspects of atherothrombotic and musculoskeletal diseases in Asia. Asia has a lower prevalence of degenerative arthritis and coronary artery disease than Western countries. The age-adjusted mortality of coronary artery disease is lower in Asia; cerebrovascular accident has higher mortality than coronary artery disease. Ischemia has replaced hemorrhage as the predominant pattern of cerebrovascular accident. Low-dose aspirin use is less prevalent in Asia than in Western countries. Traditional Chinese medicine and mucoprotective agents are commonly used in Asia, but their efficacy is not established. For Asian populations, little is known about complications of the lower gastrointestinal tract from use of NSAIDs and underutilization of gastroprotective agents. Our recommendations for preventing ulcer bleeding among users of these drugs who are at high risk for these complications were largely derived from Asian studies and are similar to Western guidelines. CONCLUSIONS: By using an evidence-based, multidisciplinary approach, we have identified unique aspects of musculoskeletal and atherothrombotic diseases and strategies for preventing NSAID-related and low-dose aspirin-related gastrointestinal toxicity in Asia

Peginterferon alpha-2a (40 kDa): an advance in the treatment of hepatitis B e antigen-positive chronic hepatitis B

SUMMARY. Current therapies for chronic hepatitis B (CHB) have a number of limitations, and better treatment options are needed. Peginterferon a-2a (40 kDa) is superior to conventional interferon a-2a in the treatment of chronic hepatitis C. This is the first report on peginterferon a-2a (40 kDa) in the treatment of CHB. In this phase II study, 194 patients with CHB not previously treated with conventional interferon- a were randomized to receive weekly subcutaneous doses of peginterferon a-2a (40 kDa) 90, 180 or 270 lg, or conventional interferon a-2a 4.5 MIU three times weekly. Twenty-four weeks of therapy were followed by 24 weeks of treatment-free follow-up. All subjects were assessed for loss of hepatitis B e antigen (HBeAg), presence of hepatitis B antibody (anti-HBe), suppression of hepatitis B virus (HBV) DNA, and normalization of serum alanine transaminase (ALT) after follow-up. At the end of follow-up, HBeAg was cleared in 37, 35 and 29% of patients receiving peginterferon a-2a (40 kDa) 90, 180 and 270 lg, respectively, compared with 25% of patients on conventional interferon a-2a. The combined response (HBeAg loss, HBV DNA suppression, and ALT normalization) of all peginterferon a-2a (40 kDa) doses combined was twice that achieved with conventional interferon a-2a (24% vs 12%; P ¼ 0.036). All treatment groups were similar with respect to frequency and severity of adverse events. These results indicate that peginterferon a-2a (40 kDa) is superior in efficacy to conventional interferon a-2a in chronic hepatitis B based on clearance of HBeAg, suppression of HBV DNA, and normalization of ALT

OLGA Gastrits staging in young adults and country-specific Gastric Cancer Risk

Geographical differences have been shown in the clinical outcomes of Helicobacter pylori-associated gastritis phenotypes and in gastric cancer risk. This study tested whether the Operative Link on Gastritis Assessment (OLGA) staging correlated with gastric cancer risk in populations from 3 continents. Mapped gastric biopsies were obtained from 316 dyspeptic adults aged less than 41 years from 8 geographic areas that differed in gastric cancer risk. Gastric atrophy was assessed according to internationally validated criteria. Gastritis stage was established according to the OLGA staging system. The most prevalent gastritis stages were 0 to II, which included all subjects entered from Chile, Germany, India, Italy, and Thailand. Gastritis Stages III and IV were limited to the Chinese and Korean populations. Indians had a high prevalence of H pylori infection without high-stage gastritis. In populations at different cancer risk, the gastritis OLGA stage mirrored the gastric cancer incidence. Gastritis staging identifies a subgroup of higher-risk patients