Includes bibliographical references.

Investigation Into the Pharmacist’s Role in Breastfeeding Support in the “Roma B” Local Health Authority in Rome -- Factors Associated With an Interest in Practice-Based Research Among Pharmacists in Nigeria -- Comparative Stability of Oral Vitamin K Liquids Stored in Refrigerated Amber Plastic Syringes -- Delafloxacin for the Treatment of Acute Bacterial Skin and Skin Structure Infections -- Andexanet Alfa: A Recombinant Modified Human Factor Xa Protein for Drug Reversal of Rivaroxaban and Apixaban -- Evidence-Based Review of Smartphone Versus Paper Asthma Action Plans on Asthma Control.

[Article Title: Investigation Into the Pharmacist’s Role in Breastfeeding Support in the “Roma B” Local Health Authority in Rome / Romana Prosperi Porta, Maria Antonietta D’Errico, Elise M. Chapin, Isabella Sciarretta and Paolo Delaini, p. 91-97]

Abstract:

Background: Breastfeeding is the biological norm for feeding infants and a public health strategy with such a significant impact on the health of the population in the short, medium, and long terms that it should be considered a priority. A pharmacy can be a place for breastfeeding support, since it is open 24 hours a day and is easily accessible.

Objective: The main objective of our fact-finding investigation into the breastfeeding support role of pharmacists in the “Roma B” Local Health Authority was to understand how often pharmacists came into contact with nursing mothers, and if pharmacists felt the need to have a greater knowledge of issues regarding breastfeeding.

Methods: This survey was done by administering 144 questionnaires (to 1 pharmacist per pharmacy) with items about the support and the protection of breastfeeding and lactation, the perceived need for specific training courses, and openness to establishing virtuous network mechanisms with stakeholders who work in breastfeeding in that geographical area.

Results: Our survey shows that mothers come to pharmacies for advice about various health problems. Although pharmacists had little knowledge about breastfeeding, they were interested in participating in a training course. Ninety percent of them declared their interest in collaborating with local breastfeeding stakeholders.

Conclusions: The role of the pharmacist in the protection, promotion, and support of breastfeeding has become increasingly important, along with the awareness of being competent and ethical on issues about breastfeeding.

https://doi.org/10.1177/8755122518823022

[Article Title: Factors Associated With an Interest in Practice-Based Research Among Pharmacists in Nigeria / Zayyanu Shitu, AI Jatau, Mohammed Mustapha, Kabiru Abubakar Gulma, Baraka Ado and Abubakar Sha’aban, p. 98-104]

Abstract:

Background: Practice-based research (PBR) is employed in the pharmacy profession to improve the quality and efficiency of health care delivery. Although widely practiced in developed countries, it is rarely used in developing countries, including Nigeria.

Objectives: To determine the factors associated with Nigerian pharmacists’ interest in PBR.

Methods: This is a cross-sectional study utilizing an online survey. Pharmacists currently practicing in Nigeria were invited to participate. A hyperlink to the online questionnaire was shared with members of relevant professional bodies via Facebook, WhatsApp, and Twitter. Reminders were sent to facilitate a high response rate. Factors associated with pharmacists’ interest in PBR were determined using multiple logistic regression.

Results: Two hundred and three completed responses were received from the survey. The majority, 94.6% (192), expressed an interest in PBR and believed that it would enhance their pharmacy practice and role in patient care. The multivariable analysis showed that pharmacists’ interest in publishing their research findings in peer-reviewed journals (odds ratio = 0.004, 95% confidence interval = 0.00-0.05, P < .001) and their knowledge of the professional relevance of research pertaining to their area of practice within the health care system (odds ratio = 0.02, 95% confidence interval = 0.00-0.47, P = .015) were found to be independent predictors of pharmacists’ interest in PBR.

Conclusion: There is an interest in PBR among practicing pharmacists in Nigeria. The provision of evidence-based pharmaceutical services in Nigeria will be enhanced by interventions that encourage the conduct of research and publication of research findings, and by improving knowledge of the professional relevance of PBR in pharmacy practice areas.

https://doi.org/10.1177/8755122519831384

[Article Title: Comparative Stability of Oral Vitamin K Liquids Stored in Refrigerated Amber Plastic Syringes / Sarah Lawson, Paul Lewis, Gina Peacock and Stacy Brown, p. 105-109]

Abstract:

Background: Compounded vitamin K oral liquids may be useful in some patient populations, or when an appropriate solid dosage form is not available. While vitamin K oral liquid is typically prepared with sterile water for injection (SWFI), other compounding agents may be more palatable.

Objective: To evaluate stability of compounded vitamin K liquids in SWFI, Ora-Sweet, simple syrup, cherry syrup, and SyrPalta stored in amber plastic oral syringes.

Methods: Five types of compounded vitamin K liquids were prepared in triplicate—Ora-Sweet, simple syrup, cherry syrup, SyrPalta, and SWFI without flavoring; aliquoted into amber plastic oral syringes; and stored in a laboratory refrigerator (4.9°C to 5.4°C). On study days, 3 syringes from each batch were removed, diluted to assay concentration, and compared with a freshly prepared US Pharmacopeia reference solution. The samples and reference were analyzed using a previously validated high-performance liquid chromatography–ultraviolet method. Product stability was defined as 90% to 110% labeled amount. Results were further compared using a 2-way ANOVA (analysis of variance; P = .05) with post hoc Tukey’s correction for multiple comparisons.

Results: Vitamin K in SWFI, SyrPalta, and cherry syrup was stable for 21 days, 7 days, and 24 hours, respectively, under refrigeration in amber plastic oral syringes. Vitamin K in Ora-Sweet and simple syrup demonstrated high within-day variability and low potency. Statistically significant differences were detected between the SWFI formulation and all other vehicles. Conclusion: Vitamin K in SWFI is appropriate for longer-term storage of unit-dosed vitamin K; however, SyrPalta and cherry syrup may be used for short-term storage or immediate administration of vitamin K.

https://doi.org/10.1177/8755122519838848

[Article Title: Delafloxacin for the Treatment of Acute Bacterial Skin and Skin Structure Infections / Young Ran Lee, Caitlin Elizabeth Burton and Kolton Rucks Bevel, p. 110-118]

Abstract:

Objective: To review the microbiological activity, safety, and efficacy of the new fluoroquinolone delafloxacin for the treatment of acute bacterial skin and skin structure infections (ABSSSIs).

Data Sources: A PubMed search from 1945 to September 2018 was done using the terms delafloxacin, acute bacterial skin and skin structure infections, skin and soft tissue infections, and fluoroquinolone. Additional sources include the Food and Drug Administration website, ClinicalTrials.gov, and the Melinta Therapeutics website.

Study Selection and Data Extraction: The literature search was limited to those published in the English language and included in vitro and human studies that evaluated microbiological coverage, pharmacokinetics, pharmacodynamics, safety, and/or efficacy.

Data Synthesis: Delafloxacin is a new fluoroquinolone with a unique structure for its class that covers both methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas. This new antibiotic has demonstrated noninferiority to vancomycin plus aztreonam for the treatment of ABSSSIs in both an intravenous-only regimen and an intravenous to an oral regimen.

Relevance to Patient Care and Clinical Practice: ABSSSIs are infections that are most often caused by Staphylococcus and represent one of the most common types of hospital infections. MRSA represents about half of all staphylococcal skin infections, and along with gram-negative infections, increase the rates of patient morbidity and health care costs. Delafloxacin is an additional treatment option that covers both of these types of microorganisms.

Conclusions: Delafloxacin is a safe and effective treatment option for ABSSSIs, particularly in those with polymicrobial infections and those with MRSA.

https://doi.org/10.1177/8755122519834615

[Article Title: Andexanet Alfa: A Recombinant Modified Human Factor Xa Protein for Drug Reversal of Rivaroxaban and Apixaban / Irene Abuan, Kristine H. Wong, Benjamin Bolinske and Katherine S. Hale, p. 119-125]

Abstract:

Objective: To review the pharmacology, safety, and efficacy of andexanet alfa (andexanet), a recombinant modified human factor Xa protein for reversal of factor Xa inhibitors.

Data Sources: English-language articles were obtained from MEDLINE (1966 to February 2019) using the following key words: andexanet, andexanet alfa, AndexXa, factor Xa, antidote, and reversal. Citations from selected articles were used to identify additional sources.

Study Selection and Data Extraction: Available published articles reporting results of human studies of andexanet alfa were reviewed for inclusion. Prescribing information was used to obtain additional information regarding pharmacology, adverse events, contraindications, and precautions.

Data Synthesis: Andexanet is a recombinant modified human factor Xa protein indicated for reversal of rivaroxaban and apixaban in patients with life-threatening or uncontrolled bleeding. Onset of action is rapid and sustained throughout bolus and infusion administration. Medication effects subside 1 to 3 hours postadministration. Andexanet is administered as a bolus followed by a 120-minute continuous infusion. Anti-factor Xa activity was reduced by 95% and 92% in apixaban and rivaroxaban groups, respectively, on infusion completion. Thrombin regeneration occurred within 2 to 5 minutes in up to 96% of patients. Minor infusion reactions and gastrointestinal upset were reported most. A black box warning for thrombotic events, cardiac arrest, ischemia, and sudden death should be noted.

Conclusions: Andexanet is effective in reversing rivaroxaban and apixaban anticoagulation due to reduction of anti-factor Xa activity in healthy patients and those with acute major bleeds. Safety concerns, including thrombotic risks, exist and should be assessed against individual patient factors.

https://doi.org/10.1177/8755122519839437

[Article Title: Evidence-Based Review of Smartphone Versus Paper Asthma Action Plans on Asthma Control / Julie A. Murphy, Jennifer M. Heisser and McKenzie Montgomery, p. 126-134]

Abstract:

Objective: To summarize and evaluate existing literature regarding the impact of mobile asthma action plans (MAAPs) versus written asthma action plans (WAAPs) on degree of asthma control.

Data Sources: PubMed, EMBASE, Web of Science, and ClinicalTrials.gov were searched (2000-January 2019) using the term asthma action plan with each of the following: smartphone, computers, handheld, mobile applications, portable electronic application, portable software application, tablet, or technology.

Study Selection and Data Extraction: The search was limited to cohort and randomized controlled trials examining MAAP versus WAAP data. Data extracted included the following: study design, population, intervention, control, outcomes related to asthma control, and potential biases assessed using Cochrane Collaboration’s Risk of Bias Assessment Tool.

Data Synthesis: Four of the 41 studies identified were included, each of which were randomized control trials. One study showed significant improvement using a non–asthma-specific assessment tool, 1 study showed improvement only for patients with uncontrolled asthma at baseline, and 2 studies showed no difference in asthma control scores. Overall risk of bias across all studies was low to moderate.

Relevance to Patient Care and Clinical Practice: Health care providers should select an asthma action plan (AAP) format based on what the patient is most likely to understand and consistently use.

Conclusions: Because of conflicting published data regarding the use of MAAPs versus WAAPs and risk of bias, it is unclear at this time whether one format of AAP is superior to the other for either adolescents or adults.

https://doi.org/10.1177/8755122519830446