The Role of Pharmacists in Primary Care Settings

Introduction: The profession of pharmacy has evolved from a dispensing role to an interdisciplinary clinical role in patient care. One area of patient care expertise is Medication Therapy Management Services (MTM), which includes services such as pharmacotherapy, medication therapy reviews, disease management, immunizations and other clinical services. Various studies have shown that pharmacists conducting MTM improve patient outcomes in some clinical settings. Amidst the valuable services all healthcare professionals are providing, increasing medical costs and a lack of primary care physicians have become overwhelming, potentially leading to negative patient outcomes. Gaps in communication between hospital, primary care clinics and community pharmacies also contribute to negative patient outcomes. Pharmacists can help bridge the gap in miscommunication and help improve patient outcomes by working in primary care settings. Objective: To determine if the addition of pharmacists providing clinical services (i.e. MTM) in a primary care setting can support the prescribers’ patient care demands. Methods: The study is an observational, exploratory study. All Federally Qualified Health Centers (FQHCs) in Ohio will be invited to participate. FQHCs are identified from the HRSA Office of Pharmacy Affairs as Consolidated Health Center Programs. IRB approval will be acquired. A Qualtrics survey will be administered via email to the participants which will include a consent form, information about the study and a link to the survey. The survey will include demographic, open-ended and 5-point Likert-type scale (1=strongly agree, 5=strongly disagree) questions. Reliability and validity of the survey will be established by a thorough search of the literature and expert review. Results: Upon approval from the IRB, data will be collected from summer 2014 to summer 2015. Submitted surveys will be analyzed with the appropriate statistical tests in SPSS. Data will be presented in spring of 2016

The Pivotal Role of the Pharmacist in a Primary Care Office

Abstract The profession of pharmacy has evolved from a dispensing role to an interdisciplinary clinical role in patient care. One area of patient care expertise is Medication Therapy Management (MTM), which includes services such as pharmacotherapy, medication therapy reviews, disease management, immunizations and other clinical services. In various studies, pharmacists conducting MTM have shown improved patient outcomes in community pharmacy and hospital settings. Amidst the valuable services all healthcare professionals are providing, increasing medical costs and consequences have become overwhelming, leading to negative patient outcomes. A lack of primary care physicians (PCPs) may contribute to these distressing facts. Gaps in communication between hospital, PCPs and community pharmacies also contribute to negative patient outcomes. Pharmacists can bridge the gap in miscommunication and help improve patient outcomes. Thus far in practice, pharmacists have had a limited role in primary care settings. The objective of this study is to determine if the addition of pharmacists providing clinical services (i.e. MTM) in a primary care setting can support the prescribers’ patient care demands. For this observational, exploratory research, the primary care settings under study will be all Federally Qualified Health Centers (FQHCs) in Ohio. IRB approval will be acquired before contact is made with participants. The contact person from each FQHC has been identified from the HRSA Office of Pharmacy Affairs. A script will be used to gather email addresses for the manager, physician, nurse and pharmacist, if available, from the contact person. A Qualtrics survey will be administered to these participants via email. The purpose of this study is to establish components of patient care in a primary care office, specifically FQHCs, that other medical professionals identify as lacking, which pharmacists can provide. A consent form, information about the study and a link to the survey will be provided in an email. The survey will include demographic, open-ended and 5-point Likert-type scale (1=strongly agree, 5=strongly disagree) questions. Reliability and validity of the survey will be established by a thorough search of the literature and expert review. Submitted answers will be analyzed with the appropriate statistical tests

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Augmenting and Limiting Search Queries

Introduction Web queries tend to be significantly shorter and less complex than queries used in earlier types of information systems (Jansen &amp; Pooch, 2000; Lawrence &amp; Giles, 1999; Spink et al, 2001). Yet, there is general belief that enriched queries and query reformulation will lead to improved results (Belkin et al, 2001). In our research we are examining the sorts of tools that could assist with the creation of enriched queries and in turn improve the search process and the user&apos;s search experience. In the work reported here we assessed the use of two types of tools: one to assist the user in targeting and, thus, restricting the query, and a second one to assist in augmenting the query. We speculated that certain types of tools are more useful for certain types of information tasks. In particular we targeted the standard informational request in which a suitable response could be culled from many different Web pages, and secondly, the &apos;know-item&apos; task, in which a specific Websit

Leveraged Buyouts: A Survey of the Literature

This paper provides an exhaustive literature review of the motives for public-to-private LBO transactions. First, the paper develops the theoretical framework for the potential sources of value creation from going private: a distinction is made between the reduction in agency costs, stakeholder wealth transfers, tax benefits, transaction costs savings, takeover defense strategies, and corporate undervaluation. The paper then reviews and summarizes whether and how these theories have been empirically verified in the four different strands of literature in LBO research. These strands of literature are categorized by phase in the LBO transaction: Intent (of a buyout), Impact (of the LBO on the various stakeholders), Process (of restructuring after the leveraged buyout) and Duration (of retaining the private status). Then, the paper shows that in the first half of the 2000s, a public-to-private LBO wave re-emerged in the US, UK and Continental Europe, whose value vastly exceeded that of the 1980s US LBO wave. Finally, the paper provides suggestions for further research