Pharmacy student training in United States hospices.

Hospice is a quickly growing field in health care in the United States. As the pharmacist's role in providing patient care to persons at the end of life increases, considerations should be given for training pharmacy students in this area. The objectives of this study were to examine the frequency of pharmacy student education and training among United States hospice organizations as well as to describe factors of hospice organizations that are associated with pharmacy student training. This is the first study of which we are aware to address the availability of experiential rotations for pharmacy students in hospice programs. A one-page questionnaire was mailed to 3,762 hospice organizations with addresses obtained from the National Hospice and Palliative Care Organization (NHPCO). Following two mailings, eight weeks apart, 907 responses were obtained. Ninety-four (10 percent) hospices trained pharmacy students, 246 (27 percent) trained medical students, 357 (39 percent) trained social work students, and 623 (69 percent) trained nursing students. These results indicate that the experiential training needs of United States pharmacy students are being addressed. However, further study is warranted to describe the various experiences of pharmacy students within the hospice setting.

Parkinson's disease revisited.

Parkinson's disease (PD) is a neurodegenerative disorder that affects an estimated 1 million persons in the United States each year. Although PD has been studied for almost 50 years, several shortcomings in management still exist. Symptom management, addressing movement disorders, psychological aspects, sexual dysfunction, and gastrointestinal concerns may all affect the person with PD.

The influence of ethnicity on use of herbal remedies in elderly Hispanics and non-Hispanic whites.

OBJECTIVE: To compare the use of herbal remedies between elderly, self-identified Hispanics and non-Hispanic whites (NHW). DESIGN: Cross-sectional, interviewer-administered survey. PATIENTS/SETTING: 186 patients, 65 years and older, at a university-based, ambulatory, senior health center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Differences in herbal use patterns between Hispanic and NHW participants. Main outcome measures were participants' use of herbal remedies, types of remedies used, medical reason for use, age, sex, Hispanic or NHW ethnicity, income, and education. RESULTS: Overall, 61% of patients had used an herbal remedy at some time in their lives. A larger proportion of Hispanic subjects used herbal remedies than did NHW subjects (77% versus 47%, respectively). Hispanic subjects preferred to use the raw herb in a tea, whereas NHW subjects preferred processed herbs in a capsule or tablet form. Significantly more Hispanic subjects grew or gathered their own herbs and received their information about herbs from a family member than did NHW subjects. Few subjects in either ethnic group received their information about herbal remedies from an allopathic provider. For both groups, the herbs most often used were yerba buena, manzanilla, poleo, osha, and alhucema. The top perceived medical problems that herbs were used for were health care maintenance, dyspepsia, upper respiratory infection, skin problems, and anxiety/nerves/insomnia. CONCLUSION: Ethnicity was related to the frequency of herbal use, the choice and preferred form of herb, and the source of knowledge of herbal remedies. Hispanic culture may account for the observed differences.

Minocycline-associated tooth staining.

OBJECTIVE: To describe a case of tooth discoloration in an adult after minocycline treatment for arthritis. CASE SUMMARY: A 68-year-old white women presented with blue-black staining of her lower anterior teeth after 4 months of minocycline therapy for arthritis. Her other medications are not known to cause discoloration of teeth. While the patient continued taking minocycline, her dentist was not able to remove the discoloration. Within 1 month after discontinuation of the minocycline, the dentist was able to remove the discoloration entirely. DISCUSSION: Minocycline, a synthetic derivative of tetracycline, has been shown to cause abnormal pigmentation of the skin, thyroid gland, nails, bone, sclera, and conjunctiva in adults. It also has been shown to cause tooth discoloration in a few patients. This case is unusual in that the tooth discoloration disappeared after discontinuing minocycline therapy. CONCLUSIONS: This complication of minocycline is more commonly thought of in the pediatric population. However, clinicians need to be aware of this adverse drug reaction, as this agent may be used increasingly in the treatment of adults with arthritis.

Evaluation of drug information in an Internet newsgroup.

OBJECTIVE: To determine the accuracy and potential harmfulness of the drug information in a newsgroup on the Internet, sci.med.pharmacy. DESIGN: In this cross-sectional study, two independent reviewers analyzed the nonsubjective drug information in this newsgroup. Drug information was classified as correct, incorrect or could not verify. Information was determined to have no harm, minor harm, moderate harm, or severe harm. RESULTS: About one-half of the drug information was found to be correct in this newsgroup. Although 68% of the drug information was found to result in no harm, 19.4% was classified as harmful. CONCLUSIONS: If drug information on the Internet contains inaccuracies, its ready accessibility may pose a public health problem. With the number of Internet users growing, health professionals need to be aware of the potential for dissemination of misinformation, and need to become familiar with the Internet and the various health information resources available to the public.

Nilutamide: an antiandrogen for the treatment of prostate cancer.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and adverse effects of nilutamide and to compare this agent with the currently marketed nonsteroidal antiandrogens (i.e., bicalutamide, flutamide) by critically analyzing the published literature. DATA SOURCES: MEDLINE (1980-1995) and CANCERLIT (1991-1995) were searched for English-language publications using the terms nilutamide, bicalutamide, and flutamide alone, and either nilutamide or androgen antagonists in combination with prostatic neoplasms. STUDY SELECTION AND DATA EXTRACTION: All articles with subject matter on nilutamide, bicalutamide, and flutamide were considered for inclusion. For studies published in more than one journal, the first publication was used unless a subsequent publication included additional or follow-up data, in which case the latter publication was cited instead. DATA SYNTHESIS: Nilutamide was effective in combination with orchiectomy in improving responses in patients with advanced prostate cancer. However, patient survival was not improved in these trials, and improvements in bone pain did not usually result in improved performance status in these patients. The few trials of nilutamide monotherapy or nilutamide in combination with a luteinizing hormone-releasing hormone analog are too small to draw meaningful conclusions regarding its efficacy or its role in the treatment of advanced prostate cancer. No comparative trials of nilutamide with other antiandrogens and no analysis of the impact of nilutamide on patient quality of life are currently available. Nilutamide appears to produce a higher frequency of adverse effects than the other currently marketed nonsteroidal antiandrogens, bicalutamide and flutamide. CONCLUSIONS: Nilutamide does not appear to represent a major advance in the treatment of advanced prostate cancer and appears to be somewhat inferior to both flutamide and bicalutamide with regard to adverse effects. Nilutamide should not be considered the antiandrogen of choice in the treatment of advanced prostate cancer.

Effect of acute glycerol administration with or without a mixed meal in humans.

We explored the effects of oral glycerol administration (20 g) alone or in combination with a mixed meal on postprandial lipids, free fatty acids, high-density lipoprotein cholesterol and retinyl palmitate. We also tested the meal alone as a control. The metabolic behavior of 13C-labelled glycerol, mainly its incorporation into triglycerides and glucose, was also investigated. The tests were performed on 13 healthy subjects aged 20-56 years (mean 32.1 +/- 10.8). Glycerol administration alone induced a decrease in plasma free fatty acid levels. When glycerol was given with the meal, it was absorbed faster and postprandial triglyceride levels were higher compared to the meal alone (p < 0.05). An earlier and higher peak of retinyl palmitate was also observed when comparing the glycerol and mixed meal test to the mixed meal alone. No significant effect was observed on total, high-density and low-density lipoprotein cholesterol. These results suggest that the glycerol-induced increase in postprandial triglyceride levels is probably due to an increase in chylomicron synthesis and perhaps to the stimulation of intestinal glycerol kinase activity. 13C-labelled glycerol administration showed a more important glycerol incorporation in lipoproteins with a density range of < 1.006 during the test with glycerol alone as compared to the test with glycerol and a mixed meal, suggesting that the rate of glycerol incorporation into lipoproteins depends on the availability of other substrates.

Alterations in lipoprotein density classes in infantile visceral leishmaniasis: presence of apolipoprotein SAA.

This study describes the alterations in the plasma lipoproteins from nine young Tunisian children with active visceral Leishmaniasis. The plasma lipid profile from affected patients was characterized by a marked hypertriglyceridaemia associated with reduced levels of total and high density lipoprotein (HDL)-cholesterol and a significant increase in the plasma ratio of unesterified to total cholesterol. Quantitative determination of plasma apolipoproteins revealed significantly decreased levels of all measured apolipoproteins, especially of apolipoproteins A-I and A-II, with the exception of apolipoprotein E, the levels of which were markedly increased. Moreover, at least two isoforms of the apolipoprotein serum amyloid A (SAA), an acute phase protein, were detected in all patients' plasma using two-dimensional electrophoresis. Immunochemical evidence was presented that apolipoproteins E and SAA, although both primarily associated with apolipoprotein A- (A-I and A-II) as well as with apolipoprotein B-containing lipoproteins, could occur as LP-E and LP-SAA subspecies, devoid of apolipoproteins A and B. However, it should be pointed out that LP-SAA particles were found in HDL2 from only two patients whereas the abnormal LP-E particles were detected in LDL and HDL2 from all investigated patients. The polydispersity and heterogeneity of patients' HDL3 were assessed by electron microscopy. It was further suggested that the profound changes in the lipoprotein metabolism of these young patients may be due to the increased hepatic synthesis of apolipoprotein SAA and/or to their altered immune function during active visceral Leishmaniasis.

Evaluation of pharmacists' compliance with the Poison Prevention Packaging Act.

Sixty pharmacies in Memphis, Tennessee were given two prescriptions at seven-day intervals to determine whether the medicine would be dispensed in child-resistant containers (CRCs) as required by federal law. One prescription included the statement "dispense in child-resistant container." Without such a statement, 77 per cent of the pharmacies dispensed the drug in a CRC; the prescription with the reminder elicited a compliance rate of 75 per cent. Factors such as cost of the prescription and time required to fill the prescription had no discernible effect on local pharmacy practice to dispense the prescription in a CRC.