Includes bibliographical references.

Amlodipine-Induced Pedal Edema and Its Relation to Other Variables in Patients at a Tertiary Level Hospital of Kathmandu, Nepal -- The Effect of Pharmacy-Led, Small-Group Academic Detailing on Prescribing Patterns in an Ambulatory Care Clinic -- Role of Approved Ohio High School Training Programs in the Demand for Pharmacy Technicians -- A Review of Emerging Technologies in Diabetes Management for Multiple-Dose Insulin-Injecting Patients With Type 2 Diabetes Who Self-monitor Blood Glucose -- Pharmacy Technicians and Improving Onychomycosis Treatment Outcomes.

[Article Title: Amlodipine-Induced Pedal Edema and Its Relation to Other Variables in Patients at a Tertiary Level Hospital of Kathmandu, Nepal / Sitaram Khadka, Rinku Joshi, Dhan Bahadur Shrestha, Drishti Shah, Niroj Bhandari, Magina Maharjan and Serene Sthapit, p. 51-55]

Abstract: Background: Vasodilatory edema is a frequently encountered side effect among hypertensive patients using antihypertensive drugs. This dose-dependent adverse effect is seen more commonly with amlodipine, so low-dose combination therapy is often used and preferred in practice. Pedal edema following use of amlodipine is scarcely studied in Nepalese population so far.

Objectives: To find out the prevalence of amlodipine-associated pedal edema and its relation with other variables among patients presenting to a tertiary care center of Kathmandu, Nepal.

Methods: A prospective cross-sectional study was conducted among hypertensive patients using amlodipine in combination with or without other antihypertensive medications under regular follow-up in an outpatient department of internal medicine of Shree Birendra Hospital, Kathmandu, Nepal, during the 7-month period from September 2017 to March 2018. The prevalence of pedal edema and its relation with amlodipine dose, duration, and other factors were studied using χ2 test and logistic regression using SPSS version 22.

Results: A total of 505 patients were observed during the study period, with the mean age of the population being 61.5 ± 13.4 years. Among the cases studied, edema was present in 79 (15.6%) cases. Use of amlodipine longer than 5 years was 21.65 (confidence interval [CI] = 9.575-48.970, P ˂ .001) times more likely to exhibit pedal edema; similarly, there was 2.149 (CI = 1.209-3.820, P = .009) times higher risk of having pedal edema in hypertensive individuals with other comorbidities. Increasing the dose of amlodipine has increased the likelihood of having pedal edema, but it is not statistically significant (odds ratio = 2.804, CI = 0.423-18.584, P = .285).

Conclusion and Relevance: Significant number of hypertensive patients using amlodipine developed pedal edema. Likelihood of vasodilatory edema increases with the presence of comorbidities, higher dose, along with longer duration of amlodipine use.

https://doi.org/10.1177/8755122518809005

[Article Title: The Effect of Pharmacy-Led, Small-Group Academic Detailing on Prescribing Patterns in an Ambulatory Care Clinic / Magdi H. Awad, Timothy R. Ulbrich, Kenneth M. Furdich, Stacy R. Schneider and M. David Gothard, p. 56-63]

Abstract:

Background: While academic detailing seems to be the most promising intervention to improve prescribing patterns, implementation could be challenging for small community practices.

Objective: A pharmacy-led, interactive, and tailored small-group academic detailing in a federally qualified health center is described. The primary objective of the study was to determine if the small-group academic detailing improved the prescribing patterns of the medical providers for select disease states: type 2 diabetes mellitus (T2DM), hyperlipidemia (HLD), and essential hypertension (HTN).

Methods: Prescribing patterns in a federally qualified health center were examined in relation to small-group academic detailing sessions from April 2010 to March 2015. The markers for improvement were the increase in utilizing metformin and statins in patients diagnosed with T2DM and HLD, respectively, and the reduction of β-blocker use in patients diagnosed with essential HTN. Changes in prescribing patterns were evaluated using Pearson’s χ2 and Fisher’s exact tests.

Results: The average number of active, adult patients with T2DM, HLD, and essential HTN was 839, 1768, and 2547, respectively. Utilization of metformin in T2DM increased from 5.5% at baseline to 37.7%, statin utilization in HLD increased from 77.1% to 86.9%, and β-blocker use in HTN decreased from 17.9% to 13.8% (P < .005).

Conclusions: A pharmacy-led, small-group academic detailing program improved and maintained appropriate prescribing patterns in an underserved community practice. This study serves as a successful pilot emphasizing the pharmacist’s role as an educator and a resource to medical providers regarding appropriate medication use.

https://doi.org/10.1177/8755122518818826

[Article Title: Role of Approved Ohio High School Training Programs in the Demand for Pharmacy Technicians / Rebecca L. Hunold and Mary F. Powers, p. 64-68]

Abstract:

Objective: To provide an overview of Ohio Administrative Code 4729 and to identify the potential role of newly approved Ohio high school training programs in preparation of registration-ready pharmacy technicians.

Data Sources: Relevant sections of the Ohio Administrative Code and the Ohio public high school pharmacy technician training program application were identified through the Ohio Board of Pharmacy website. Resources on employee training and pharmacy technician demand were used from the Bureau of Labor Statistics, Forbes magazine, Association for Talent Development, and ExploreGate. Information pertaining to the approved high school training programs was identified from the program-specific websites. Related materials were searched for via PubMed and Google Scholar from 2000 to present.

Study Selection and Data Extraction: Portions of the Ohio Administrative Code pertaining to pharmacy technician training and registration. Articles describing the cost of employer-based training and the growth of pharmacy technician demand.

Data Synthesis: Training and registration requirements for pharmacy technicians have increased over the past decade. In Ohio, pharmacy technicians must now complete an approved training program and become either a registered or certified technician with the Board of Pharmacy. Technicians may complete either a nationally recognized, employer-based, or public high school training program prior to becoming a registered or certified pharmacy technician. Ohio public high school training programs must be Board approved and must prepare students for national certification. After completing a high school training program, pharmacy technicians are adequately prepared to enter the workforce with minimal training burden to potential employers.

Conclusions: Newly approved Ohio high school training programs have the potential to fulfill the increased demand for pharmacy technicians at a decreased cost to both students and employers.

https://doi.org/10.1177/8755122518813706

[Article Title: A Review of Emerging Technologies in Diabetes Management for Multiple-Dose Insulin-Injecting Patients With Type 2 Diabetes Who Self-monitor Blood Glucose / Malgorzata Slugocki, Damian Bialonczykn and Ayşe Elif Özdener, p. 69-81]

Abstract:

Objective: The management of diabetes mellitus requires a precise interpretation of blood glucose (BG) data by patients and providers and is increasingly associated with a need for medical technologies that aid in achieving patient-specific outcomes while making the process convenient. This review aims to summarize the current landscape in diabetes management technology, focusing specifically on devices that assist with pattern management in patients with type 2 diabetes (T2DM) who are on multiple-dose insulin regimens.

Data Sources: The authors searched MEDLINE to identify articles from 2007 to 2018 that evaluated technologies for BG pattern management and diabetes monitoring. Additional references were generated through review of identified literature citations. Article selection was based on mutual agreement for inclusion.

Data Selection and Data Extraction: Relevant articles were defined as English-language articles, describing technologies that assist with diabetes management in insulin-injecting patients with T2DM. Articles that focused exclusively on type 1 diabetes were excluded.

Data Synthesis: The literature search yielded 334 articles, of which 21 were included for synthesis. The current BG monitoring practices emphasize the benefit of the structured self-monitoring of BG approach. Several randomized controlled trials conclude that the available technology aids in comprehensive data collection and facilitates communication between patients and providers. Digitally enabled “smart” devices are valuable tools that may help improve outcomes while providing a flexible, personalized approach.

Conclusions: Integration of digital technology with diabetes management allows for accurate collection and analysis of data. Emergence of digital tools promotes a comprehensive, precise, and objective approach to glucose monitoring and encourages patient-provider collaborations.

https://doi.org/10.1177/8755122518813889

[Article Title: Pharmacy Technicians and Improving Onychomycosis Treatment Outcomes / Sherrill J. Brown, p. 82-87]

Abstract:

Objective: To provide an overview of onychomycosis and current treatments and to identify opportunities for pharmacy technicians to improve treatment outcomes.

Data Sources: A MEDLINE/PubMed search (1966 to October 2018) was performed using search terms designed to identify English-language articles on onychomycosis diagnosis, treatment, and prevention, as well as articles on the impact of pharmacy technicians on onychomycosis outcomes and the use of pharmacy technicians to improve treatment adherence.

Study Selection and Data Extraction: Review articles and clinical studies describing onychomycosis, risk factors, treatment efficacy, and prevention of recurrent infections were included.

Data Synthesis: Although no articles on the impact of pharmacy technicians in the treatment of onychomycosis were found, the importance of treatment adherence on positive outcomes highlights a potential role of pharmacy technicians. Pharmacy technicians can identify patients with potential onychomycosis based on questions about over-the-counter products and refer patients to the pharmacist for counseling on treatment. Pharmacy technicians can also reinforce treatment adherence at refill visits.

Conclusions: Pharmacy technicians can have a positive impact on onychomycosis treatment outcomes by addressing barriers to successful treatment and promoting treatment adherence.

https://doi.org/10.1177/8755122518815057