The impact of pharmacist interventions on the inappropriate use of acid-suppression therapy.

OBJECTIVE: The inappropriate use of acid-suppression therapy (AST) in non-intensive care unit patients contributes to inappropriate polypharmacy, drug interactions, community- and hospital-acquired pneumonia, and increased health care expenditures for institutions and individuals. The purpose of this study was to determine whether clinical pharmacist interventions significantly decreased the rate of inappropriately used AST. DESIGN: A single group, pre-test post-test. SETTING: The Geriatric Evaluation and Management unit in the St. Louis Veterans Affairs Medical Center. PATIENTS: All patients admitted between July 1, 2006, through April 30, 2007 (control group), and May 1, 2007, through February 28, 2008 (PharmD group), were evaluated. All patients with a minimum length of stay of seven days were eligible for inclusion. Data were obtained from the Computerized Patient Record System regarding the use of proton-pump inhibitors, histamine-2 receptor antagonists, sucralfate, and the indication for these therapies. INTERVENTIONS: A clinical pharmacist was present during the weekly interdisciplinary team rounds to make recommendations in the intervention group, compared with a nonpharmacist control group. OUTCOME MEASURES: The percent of patients on these therapies without an appropriate indication (International Classification of Diseases, 9th Revision) were identified from the chart review, and comparisons were made between the control and PharmD groups. RESULTS: A total of 142 and 151 patients were admitted during the control and PharmD arms, respectively. Of these patients, 117 in each group were eligible for inclusion in the analysis. The primary outcome, the number of patients receiving AST prior to discharge without an appropriate indication, occurred 46.2% (54/117) versus 23.9% (28/117) (P = 0.001) in the control and PharmD groups, respectively. CONCLUSIONS: This study examined the impact of pharmacists' active participation in interdisciplinary team rounds compared with a nonpharmacist control group. These results demonstrate pharmacist participation associated with potential cost savings and improved patient care.

Loss of appendicular muscle mass and loss of muscle strength in young postmenopausal women.

BACKGROUND: Different factors may predict loss of appendicular muscle mass (LossAMM) and loss of muscle strength (LossMS). We investigated the relationship between LossAMM or LossMS and baseline anthropometric measures, lifestyle habits, hormones, lipid profiles, and inflammatory markers in 49 healthy postmenopausal women (54.1 +/- 4.3 years) in a 24-36-month prospective study. METHODS: We measured parameters of lifestyle habits, anthropometry, lipid profiles, and blood levels of testosterone, estrone, estradiol, cortisol, dihydroepiandrostenedione, luteinizing hormone, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D, thyroxine, leptin, adiponectin, C-reactive protein (CRP), and interleukin-6 and interleukin-2 receptors. Percentage of loss per year of isometric knee extensor strength defined LossMS, and percentage of loss of AMM per year (dual x-ray absorptiometry) defined LossAMM. RESULTS: The means (standard deviation) for LossMS and LossAMM were 1.17%/y (2.03) and 0.60%/y (0.74) and did not correlate (r = -0.001; p =.99). LossMS correlated negatively with level of physical activity (r = -0.28), femoral BMD (r = -0.30), alcohol consumption (r = -0.30), and luteinizing hormone (r = -0.32) and positively with estrone (r = 0.29) and iPTH (r = 0.32) (each at p <.05). LossAMM correlated negatively with AMM (r = -0.41; p <.01). Stepwise regression analyses showed that LossMS was significantly predicted by baseline physical activity (beta = -0.39) with an explanation of variation of the model (R(2)) of 6%, body mass index (BMI) (-0.40; 3%), high-density lipoprotein cholesterol (-0.29; 3%), estrone (0.32; 6%), iPTH (0.27; 7%), and interleukin-2 receptor (0.32; 5%). LossAMM was predicted by baseline height (0.56; 47%), body mass index (1.04; 83%), AMM (-0.92; 76%), thyroxine (-0.33; 8%), estrone (-0.61; 30%), and dihydroepiandrostenedione (0.44; 28%). CONCLUSIONS: LossMS and LossAMM in young postmenopausal women were not correlated with one another, and were determined by different factors.

Leptin and adiponectin levels in middle-aged postmenopausal women: associations with lifestyle habits, hormones, and inflammatory markers--a cross-sectional study.

To investigate the relationships between blood levels of leptin or adiponectin and lifestyle habits, hormones, and inflammatory markers, we measured parameters of alcohol intake, smoking, physical activity, and blood levels of leptin, adiponectin, testosterone, estrone, estradiol, cortisol, dihydroepiandrostenedione, luteinizing hormone, thyroxin, C-reactive protein (CRP), and interleukin 6 and interleukin 2 receptor in 76 healthy middle-aged postmenopausal women. Anthropometric measures and body composition (evaluated by dual-energy x-ray absorptiometry) and lipid profiles were also assessed. By simple regression, leptin correlated positively with fat and lean masses, glucose, triglycerides, low-density lipoprotein cholesterol, and total cholesterol, and negatively with high-density lipoprotein cholesterol. Adioponectin correlated negatively with fat and lean masses and low-density lipoprotein cholesterol, and positively with high-density lipoprotein cholesterol. Leptin concentration was correlated inversely with adiponectin (r = -0.26, P < .05) and positively with CRP (r = 0.56, P < .01). Adiponectin concentration was negatively correlated with time since last alcoholic drink (r = -0.24, P < .05) and CRP (r = -0.27, P < .05) and positively with testosterone level (r = 0.23, P < .05). By multiple regression analysis, leptin concentration was predicted by age (P < .05), testosterone (P < .05), adiponectin (P < .05), CRP (P < .01), and interleukin 6 receptor (P < .01). Adiponectin concentration was predicted by the time since last alcoholic drink (P < .05), testosterone (P < .05), leptin (P < .05), and C-reactive protein (P = .05). Similar results were found when leptin or adiponectin concentration was adjusted for fat mass. These results suggested that levels of leptin and adiponectin in middle-aged postmenopausal women are partially determined by sexual hormones and inflammatory marker levels, and both predicted one another. Moreover, adiponectin level may be modulated by alcohol intake.

The effect of patient education on calcium intake in elderly men at risk for osteoporosis.

OBJECTIVE: To determine the effect patient education has on osteoporosis prevention and calcium intake has on elderly men who are at risk for developing osteoporosis. DESIGN: This was a prospective study in which subjects completed a Men's Osteoporosis Risk Questionnaire and watched a video on osteoporosis prevention. Subjects were then divided into groups based on osteoporosis status and contacted one month later to complete a telephone survey. SETTING: Geriatric ambulatory care clinic in the St. Louis Veteran's Affairs Medical Center. PARTICIPANTS: 35 men over the age of 65. INTERVENTION: Subjects watched a video on osteoporosis prevention. OUTCOMES: Primary outcome was change in calcium intake (total, dietary, and supplemental) in men at risk for osteoporosis. Secondary objectives were new diagnoses of osteoporosis; new fractures; effects on exercise, tobacco and alcohol use; and change from baseline calcium intake between at risk, diagnosed, and no risk for osteoporosis subjects. RESULTS: After watching the educational video, 67% of the subjects increased the amount of calcium ingested, and 10% of the subjects began calcium supplementation. CONCLUSIONS: There were significantly more subjects meeting the RDA of calcium after watching the educational video.