Non-adherence to antihypertensive medications is related to pill burden in apparent treatment resistant hypertensive individuals

Objective: Non-adherence to medication is present in ≥50% of patients with apparent treatment resistant hypertension. We examined the factors associated with non-adherence as detected by an LC-MS/MS based urine antihypertensive drug assay. Methods: All urine antihypertensive test results, carried out for uncontrolled hypertension (BP persistently >140/90 mmHg) between January 2015 and December 2016 at a single toxicology laboratory were analysed. Drugs detected were compared to the antihypertensive drugs prescribed. Patients were classified as adherent (all drugs detected), partially non-adherent (≥1 prescribed drugs detected) or completely non-adherent (no drugs detected). Demographic and clinical parameters were compared between the adherent and non-adherent groups. Binary logistic regression analysis was performed to determine association between non-adherence and demographic and clinical factors. Results: Data on 300 patients from 9 hypertension centres across the UK were analysed. The median age was 59 years, 47% female, 71% Caucasian , median clinic BP was 176/95 mmHg and the median number of antihypertensive drugs prescribed was four. One hundred and sixty-six (55%) were non-adherent to prescribed medication with 20% of these being completely non-adherent. Non-adherence to antihypertensive medication was independently associated with younger age, female gender, number of antihypertensive drugs prescribed, total number of all medications prescribed (total pill burden) and prescription of a calcium channel blocker. Conclusion: This LC-MS/MS urine analysis-based study suggests the majority of patients with apparent treatment resistant hypertension are non-adherent to prescribed treatment. Factors that are associated with non-adherence, particularly pill burden, should be taken into account while treating these patients

Preparation bootcamp for pharmacy residency application and interviews

Description: A six-hour Residency Bootcamp, offered to interested students, provided review and individualised feedback on student Curriculum Vitae, letters of intent, topic presentations, case-based critical thinking skills, and interview skills. Questionnaire data were used to evaluate student perceptions. School-reported match results were used to determine the residency match rates of participants of the Bootcamp. Evaluation: A total of 24 students participated in the Bootcamp. When asked how valuable the Residency Bootcamp was for residency preparation on a scale of 1-10 (1 = not valuable and 10 = extremely valuable), students reported an average of 9.28 for the Bootcamp. A total of 23 students participated in the match and 21 students secured match for residency (91.3%). Conclusion: A six-hour Residency Bootcamp was perceived as valuable to students in preparing for residency applications and training. Participants in the Bootcamp had a high match rate

Ethics and oncofertility: A call for religious sensitivity

For patients of reproductive age, treating cancer may come at the price of infertility. Literature regarding fertility preservation recommendations in this population has increased significantly, but this literature too often overlooks or insufficiently considers the relevance of religious preferences. Similarly, practice guidelines donot address the role of religion in the oncofertility discussion. The acceptance of oncofertility practices varies significantly among Christianity, Judaism, and Islam. A patient\u27s faith-based spirituality or secular morality may enhance his or her interpretation of the meaning of illness and should be incorporated into the informed-consent process. In this article, we describe the role of religious sensitivity in oncofertility care and argue for its importance in such care. We briefly summarize the views and moral reasoning about oncofertility in a few religions commonly encountered in many patient populations today.Werecommend that clinicians discuss fertility options early in the decision process and, when relevant, incorporate the patient\u27s moral and religious preferences into the treatment plan.Weencourage providers to be prepared to offer resources to patientswhodesire moral and spiritual guidance about fertility preservation options. Hospital chaplains should be able to provide such resources

Ethics and Oncofertility: A Call for Religious Sensitivity

For patients of reproductive age, treating cancer may come at the price of infertility. Literature regarding fertility preservation recommendations in this population has increased significantly, but this literature too often overlooks or insufficiently considers the relevance of religious preferences. Similarly, practice guidelines do not address the role of religion in the oncofertility discussion. The acceptance of oncofertility practices varies significantly among Christianity, Judaism, and Islam. A patient’s faith-based spirituality or secular morality may enhance his or her interpretation of the meaning of illness and should be incorporated into the informed-consent process. In this article, we describe the role of religious sensitivity in oncofertility care and argue for its importance in such care. We briefly summarize the views and moral reasoning about oncofertility in a few religions commonly encountered in many patient populations today. We recommend that clinicians discuss fertility options early in the decision process and, when relevant, incorporate the patient’s moral and religious preferences into the treatment plan. We encourage providers to be prepared to offer resources to patients who desire moral and spiritual guidance about fertility preservation options. Hospital chaplains should be able to provide such resources. </jats:p

Development of a capstone course to improve student confidence and pharmacotherapy knowledge prior to advanced pharmacy practice experiences

Objective: To describe a capstone course designed to improve student confidence with clinical skills, improve confidence with providing medication therapy, and evaluate student knowledge. Design: A 2-week capstone course was incorporated into the third-year pharmacotherapy course in a Doctor of Pharmacy program. Students evaluated complex patient cases and developed pharmacotherapy care plans. Pre- and post-capstone course survey results were used to assess change in student confidence using clinical skills and providing medication therapy, and quiz and exam results were used to assess student knowledge. Results: Student confidence significantly improved from baseline for clinical skills (p \u3c 0.02 across all clinical skills domains) and providing medication therapy (p \u3c 0.01 across all disease states). Students reported the largest improvement in confidence for the clinical skill of creating a Subjective/Objective/Assessment/Plan (SOAP) note on a patient with multiple disease states (p \u3c 0.001). Students reported the highest confidence increase for acute kidney injury (p \u3c 0.001). The average written exam score was 87.2% (standard deviation ± 8.0) and the average verbal exam score was 79.1% (standard deviation ± 15.7). Conclusion: A 2-week capstone course can be valuable to improve confidence and assess student knowledge prior to advanced pharmacy practice experiences (APPEs)