An Examination of the Prescription Renewal Process and Implications for Primary Care Physicians and Community Pharmacists.

In physician practices and pharmacies, staff members work to process prescription renewals so that patients receive a steady supply of medications. These functions are essential to ensure patients have continuous access to medications and remain adherent to prescribed therapies. Despite the incorporation of e-prescribing software programs to ease management of these processes, barriers to effective management of the prescription renewal process exist. Mismanagement of pharmacy adherence programs can ultimately lead to patients receiving inappropriate medications and excessive use of staff resources. The objective of this article is to examine the prescription renewal process in both the primary care setting and the pharmacy and report challenges associated with the process. A literature review was conducted to find studies that describe pharmacists' and physicians' handlings of prescription renewals, use of e-prescribing software, and benefits and barriers to using these technologies. Although studies report e-prescribing software improves efficiency in the prescription renewal process, there is a need to reduce technological problems that create challenges in use. It is recommended that staff within physician practices and pharmacies standardize prescription renewal processes and educate patients about the prescription renewal process.

Impact of a Hands-on Knee Exam Workshop on Medical Student Clinical Examination Scores.

INTRODUCTION: The goal of this research project was to retrospectively evaluate the effect of a voluntary hands-on musculoskeletal knee exam workshop, presented to medical students in the family medicine rotation at the University of Toledo, on the outcomes of a required objective structured clinical examination (OSCE). METHODS: We analyzed student OSCE scores for both knee and back exams before (July 2011 to June 2012) and after (August 2013 to June 2015) the workshop was offered. The analysis was based on those who attended the voluntary knee exam workshop and those who did not. We compared scores between the two groups of students using two-tailed t testing and χ 2 testing, and assessed the correlation of attending the workshop to passing the knee OSCE. RESULTS: One hundred eighty-seven students attended the workshop and 279 did not. During the period when the workshop was offered, the overall mean score on the knee OSCE was 59.5% for the 187 who attended the workshop and 35.9% for the 116 who did not, which was significantly different (P<.001). A χ2 test with α=0.05 showed that attending the workshop correlated with completing at least 70% of maneuvers acceptably during the knee OSCE (P<.001). CONCLUSIONS: Our study yielded positive outcomes on OSCE scores, comparable to other studies that investigated the effect of similar teaching techniques. Comparison of the scores of those who attended the knee workshop on the simpler back exam OSCE, in which no workshop was offered, demonstrated the efficacy of the workshop.

Risks of alcoholic energy drinks for youth.

Ingesting alcohol and energy drinks together is associated with a decreased awareness of the physical and mental impairment caused by the alcohol without reducing the actual impairment. This is of particular concern for youth who have a baseline of less mature judgment. Adding energy drinks to alcohol tends to increase the rate of absorption through its carbonation and dilution of the alcohol, and keep a person awake longer allowing ingestion of a greater volume of alcohol. At low blood alcohol levels, caffeine appears to decrease some of the impairment from the alcohol, but at higher blood alcohol levels, caffeine does not appear to have a modifying effect on either the physical or mental impairment induced by the alcohol. Obtaining this combination is made easier and more affordable for under aged persons by manufacturers of premixed alcoholic energy drink combination beverages. Awareness by medical and educational personnel and parents of this activity and its potential for harm is unknown.

Discussing spirituality with patients: a rational and ethical approach.

BACKGROUND: This study was undertaken to determine when patients feel that physician inquiry about spirituality or religious beliefs is appropriate, reasons why they want their physicians to know about their spiritual beliefs, and what they want physicians to do with this information. METHODS: Trained research assistants administered a questionnaire to a convenience sample of consenting patients and accompanying adults in the waiting rooms of 4 family practice residency training sites and 1 private group practice in northeastern Ohio. Demographic information, the SF-12 Health Survey, and participant ratings of appropriate situations, reasons, and expectations for physician discussions of spirituality or religious beliefs were obtained. RESULTS: Of 1,413 adults who were asked to respond, 921 completed questionnaires, and 492 refused (response rate = 65%). Eighty-three percent of respondents wanted physicians to ask about spiritual beliefs in at least some circumstances. The most acceptable scenarios for spiritual discussion were life-threatening illnesses (77%), serious medical conditions (74%) and loss of loved ones (70%). Among those who wanted to discuss spirituality, the most important reason for discussion was desire for physician-patient understanding (87%). Patients believed that information concerning their spiritual beliefs would affect physicians' ability to encourage realistic hope (67%), give medical advice (66%), and change medical treatment (62%). CONCLUSIONS: This study helps clarify the nature of patient preferences for spiritual discussion with physicians.

Age effects on body fluid distribution during exercise in the heat.

BACKGROUND: The purpose was to study the effects of age on body fluid distribution during exercise and exercise combined with heat stress. METHODS: Ten young (Y; 23.2 +/-0.7 yr) and eight older (O; 65.3 +/- 1.0 yr) men performed two 80-min intermittent exercise bouts on a cycle ergometer at 50% VO2peak, one in a thermoneutral (N), 22 degrees C environment, the other in a hot (H), 40 degrees C environment. For each condition, changes in serum protein, albumin, and electrolytes (Cl-, Na+, K+); total body water (TBW); plasma volume (PV); and interstitial (ISF), extracellular (ECF), and intracellular (ICF) fluids were determined. RESULTS: During exercise, [Cl-] responses increased more in O than Y (p < or = 0.05) while albumin (g) increased in Y and decreased in O (p < or = 0.05). There were no age-related differences in total protein changes nor any of the other blood parameters. PV decreased similarly for all subjects in both conditions with larger decreases in the H environment (241.8 +/- 40.3 vs. 478.3 +/- 46.0 mL). Loss of TBW was exacerbated in the H condition and significantly different (p < 0.05) between the groups (N: Y = -1.03 +/- 0.076 L, O = -0.88 +/- 0.12 L; H: Y = -1.65 +/- 0.12 L, O = -1.85 +/- 0.14 L). The O group lost more ICF (p < 0.05) (N: Y = -510.4 +/- 86.8 mL, O = -631.7 +/- 115.1 mL; H: Y = -529.3 +/- 118.0 mL, O = -928.6 +/- 118.9 mL) and less ISF (p < 0.05) (N: Y = -295.5 +/- 101.1 mL, O = 15.8 +/- 77.6 mL; H: Y = -684.6 +/- 134.5 mL, O = -397.9 +/- 165.5 mL) in both conditions. CONCLUSIONS: There was an interactive effect between age and heat stress in TBW loss. In addition, older individuals lost more ICF and less ISF than younger individuals during prolonged exercise. These findings suggest that the utilization of ICF, rather than ISF, to preserve PV during cycling exercise at or near 50% VO2max may be an age-related compensation.