Sandra Leal

In this commentary, the authors describe existing barriers to vaccination access linked to the restriction of pharmacists’ prescribing authority, rationalize the need for more innovative care models to enhance the role of the pharmacist, and outline the framework required for health care redesign to enable nonphysicians to close gaps in preventive care. Regulatory and legal issues challenge care redesign at scale. To illustrate this scalability issue and its downstream impact on public health… Show more

In this commentary, the authors describe existing barriers to vaccination access linked to the restriction of pharmacists’ prescribing authority, rationalize the need for more innovative care models to enhance the role of the pharmacist, and outline the framework required for health care redesign to enable nonphysicians to close gaps in preventive care. Regulatory and legal issues challenge care redesign at scale. To illustrate this scalability issue and its downstream impact on public health, real-world data from a large national pharmacy chain in the United States, CVS Pharmacy, were leveraged to examine the influence of state-by-state immunization policies on respiratory syncytial virus vaccination administration during the national rollout for adults. As a result of these policies, preventive care (e.g., vaccination administration) was limited in a vulnerable population. Show less

The history of American pharmacy contributions to pandemic responses can be described for five pandemics: 1918 (influenza A/H1N1 virus), 1957–1958 (H2N2 virus), 1968 (H3N2 virus), 2009 (H1N1pdm09 virus), and 2019–2023 (syndrome coronavirus-2 virus). Using historical surveillance data and published literature, this article provides opportunities to reflect on how the pharmacy profession played a role in preparedness and response.

Featured Presidential Address:

I look forward to more of you taking the baton because together, we will continue to be the collective voice for our patients, profession, and changes needed to improve care throughout our communities and the well-being of our team members. APhA continues to amplify your voice. @BeTheVoiceRx.

Featured Presidential Address:

Together, we can be the collective voice for our patients, profession, and changes needed to improve care throughout our communities. I look forward to supporting you in this endeavor. APhA is ready to amplify your voice. Join me @BeTheVoiceRx.

Physicians, pharmacists, and other health professionals play an important role in addressing social determinants of health and health disparities. Pharmacists have been addressing social determinants of health for years in all populations that experience health disparities by working as vital members of their communities and interacting on a regular basis with patients. The case presented in this article highlights social determinants’ roles in health outcomes and how pharmacists contribute to… Show more

Physicians, pharmacists, and other health professionals play an important role in addressing social determinants of health and health disparities. Pharmacists have been addressing social determinants of health for years in all populations that experience health disparities by working as vital members of their communities and interacting on a regular basis with patients. The case presented in this article highlights social determinants’ roles in health outcomes and how pharmacists contribute to improving them. In collaboration, pharmacists and physicians can help reduce costs and optimize health outcomes. Show less

The American Diabetes Association (ADA) Standards of
Medical Care in Diabetes is updated and published annually
in a supplement to the January issue of Diabetes Care. The
Standards are developed by the ADA’s multidisciplinary Professional Practice Committee, which comprises physicians, pharmacists, diabetes educators, and other expert diabetes healthcare professionals. The Standards include the most current evidence-based recommendations for diagnosing and treating adults and children… Show more

The American Diabetes Association (ADA) Standards of
Medical Care in Diabetes is updated and published annually
in a supplement to the January issue of Diabetes Care. The
Standards are developed by the ADA’s multidisciplinary Professional Practice Committee, which comprises physicians, pharmacists, diabetes educators, and other expert diabetes healthcare professionals. The Standards include the most current evidence-based recommendations for diagnosing and treating adults and children with all forms of diabetes. Show less

1.1 Background
Racism is a root cause of social determinants of health.
Structural racism has been perpetuated through laws and policies, implicitly and explicitly, and continues to manifest in racial inequities across all parts of society, including education, health care, and social and political systems.

1.2 Findings
In order to practice patient‐centered care, pharmacists must acknowledge and work to mitigate the negative impacts of social determinants of… Show more

1.1 Background
Racism is a root cause of social determinants of health.
Structural racism has been perpetuated through laws and policies, implicitly and explicitly, and continues to manifest in racial inequities across all parts of society, including education, health care, and social and political systems.

1.2 Findings
In order to practice patient‐centered care, pharmacists must acknowledge and work to mitigate the negative impacts of social determinants of health.
Pharmacists across all sectors must take a look inward at their own biases and socialization to then work outward to dismantle structural racism in order to pave way for reform and racial equity. Show less

Systemic racism is a public health emergency and disproportionately impacts communities of color, specifically black Americans. Pharmacists took an oath to protect the welfare of humanity and protect our patients. As such, in order to practice truly patient-centered care, pharmacists must recognize racism as a root cause of social determinants of health and use their privilege to educate themselves and their colleagues around dismantling structural racism.

Systemic racism is a public health emergency and disproportionately impacts communities of color, specifically black Americans. Pharmacists took an oath to protect the welfare of humanity and protect our patients. As such, to practice truly patient-centered care, pharmacists must recognize racism as a root cause of social determinants of health and use their privilege to educate themselves and their colleagues around dismantling structural racism.

ABSTRACT
BACKGROUND: Three pharmacist-specific Current Procedural Terminology (CPT) codes exist to facilitate medication therapy management (MTM) reimbursement (codes 99605, 99606, and 99607). However, no studies have used CPT codes in administrative claims databases to identify
subjects who have received MTM services.
OBJECTIVE: To assess the prevalence of MTM services provided, using CPT codes identified in an administrative dataset.
METHODS: A retrospective cohort study was… Show more

ABSTRACT
BACKGROUND: Three pharmacist-specific Current Procedural Terminology (CPT) codes exist to facilitate medication therapy management (MTM) reimbursement (codes 99605, 99606, and 99607). However, no studies have used CPT codes in administrative claims databases to identify
subjects who have received MTM services.
OBJECTIVE: To assess the prevalence of MTM services provided, using CPT codes identified in an administrative dataset.
METHODS: A retrospective cohort study was conducted using a subset of Medicare Part D individuals from the IBM MarketScan Medicare Supplemental Research Databases (2009-2015). Researchers identified beneficiaries who received MTM services using CPT codes 99605, 99606, and 99607.
RESULTS: Of the 16,483,709 individuals in the dataset, only 3,291 had CPT codes indicating that they received MTM services, representing an overall prevalence of 0.020%.
CONCLUSIONS: The use of CPT codes as an indicator of MTM service provision resulted in far lower MTM utilization rates than in published literature. Reliance on CPT codes to identify MTM services in administrative claims is not recommended, given that it limited the researchers’ ability to properly identify patient receipt of such services. More accurate methodologies are warranted for identifying MTM use and its effects on patient outcomes.

J Manag Care Spec Pharm. 2020;26(10):1297-300 Show less

Abstract
Pharmacy residents must complete research as part of their program; however, challenges exist in providing experiences that result in successful research dissemination outcomes. A university-based research team, integrated into an ambulatory care pharmacy residency program aimed to improve presentation and publication rates of pharmacy resident research projects. Data on the number of postgraduate year-2 (PGY2) residents and their productivity were collected and summarized to assess… Show more

Abstract
Pharmacy residents must complete research as part of their program; however, challenges exist in providing experiences that result in successful research dissemination outcomes. A university-based research team, integrated into an ambulatory care pharmacy residency program aimed to improve presentation and publication rates of pharmacy resident research projects. Data on the number of postgraduate year-2 (PGY2) residents and their productivity were collected and summarized to assess progress. A total of 13 residents completed their residency over seven years. Each resident produced one regional presentation, and one national presentation beginning in year four. To date, three peer-reviewed papers have been published, with another one in-press. Responses from residents found lack of guidance, lack of data availability for projects and feedback fatigue were barriers to a positive research experience. To address these problems, a university-based research team was integrated to provide research mentor guided support, ensure study feasibility, and provide structured feedback. This program evaluation highlighted the integration of a PGY2 ambulatory care pharmacy residency with a designated, interprofessional university-based research team. Future work is warranted to reduce research-related barriers and formally evaluate resident post-program knowledge, skills, and subsequent dissemination rates.
Keywords: residency; research; post-graduate year-2; ambulatory care Show less

Research has shown that getting to glycemic targets early on leads to better outcomes in people with type 2 diabetes; yet, there has been no improvement in the attainment of A1C targets in the past decade. One reason is therapeutic inertia: the lack of timely adjustment to the treatment regimen when a person’s therapeutic targets are not met. This article describes the scope and priorities of the American Diabetes Association’s 3-year Overcoming Therapeutic Inertia Initiative. Its planned… Show more

Research has shown that getting to glycemic targets early on leads to better outcomes in people with type 2 diabetes; yet, there has been no improvement in the attainment of A1C targets in the past decade. One reason is therapeutic inertia: the lack of timely adjustment to the treatment regimen when a person’s therapeutic targets are not met. This article describes the scope and priorities of the American Diabetes Association’s 3-year Overcoming Therapeutic Inertia Initiative. Its planned activities include publishing a systematic review and meta-analysis of approaches to reducing therapeutic inertia; developing a registry of effective strategies; launching clinician awareness and education campaigns; leveraging electronic health record and clinical decision-support tools; influencing payer policies; and potentially executing pragmatic research to test promising interventions. Show less

This paper is intended to provide insight into the current landscape of pharmacist prescriptive authority in the United States through 2019 in order to provide historical context and identify opportunities for state policy considerations. This was done through a review of published literature, national professional association resources, individual state pharmacy practice acts, and state legislation and regulations.

This is an abridged version of the current Standards containing the evidence-based recommendations most pertinent to primary care. The recommendations, tables, and figures included here retain the same numbering used in the complete 2020 Standards and so are not numbered sequentially in this abridged version. All of the recommendations included here are substantively the same as in the complete Standards. The abridged version does not include references. The complete 2020 Standards of Care… Show more

This is an abridged version of the current Standards containing the evidence-based recommendations most pertinent to primary care. The recommendations, tables, and figures included here retain the same numbering used in the complete 2020 Standards and so are not numbered sequentially in this abridged version. All of the recommendations included here are substantively the same as in the complete Standards. The abridged version does not include references. The complete 2020 Standards of Care, including all supporting references, is available at professional.diabetes.org/standards. Show less

Objective: To identify gaps in care based on a telepharmacist’s recommendations and determine whether these recommendations aligned with Health Effectiveness Data Information Set (HEDIS) performance measures.

To reduce readmission rates and avoid financial penalties from the Centers for Medicare and Medicaid Services, hospitals are seeking to implement innovative transitions of care (TOC) programs. This retrospective study evaluated the Discharge Companion Program (DCP), a pharmacist- and nurse-coordinated interprofessional, collaborative TOC program. Adult patients (18 years and older) from a single hospital, discharged with at least one qualifying diagnosis, were eligible for this service. The… Show more

To reduce readmission rates and avoid financial penalties from the Centers for Medicare and Medicaid Services, hospitals are seeking to implement innovative transitions of care (TOC) programs. This retrospective study evaluated the Discharge Companion Program (DCP), a pharmacist- and nurse-coordinated interprofessional, collaborative TOC program. Adult patients (18 years and older) from a single hospital, discharged with at least one qualifying diagnosis, were eligible for this service. The hospital transitional care coordinator nurse referred qualified patients to the DCP nurse coordinator, who scheduled telephonic medication therapy management (MTM) reviews with the DCP pharmacist at one- and three-weeks postdischarge. Hospital records and DCP documentation were reviewed to describe respective interventions and assess the impact on 30-day readmissions. A total of 456 patients were referred to the DCP between 31 August, 2015 and 7 September, 2016. Of the 340 patients who participated (DCP group), 44 (13%) compared to 17% (n = 20) of the usual care, were readmitted within 30-days postdischarge. The DCP pharmacists conducted 1242 clinical interventions with participants, demonstrating the benefits of an interprofessional TOC model involving multiple, pharmacist-delivered MTM intervention touchpoints within 30 days post-hospital discharge. Show less

The ACCP Ambulatory Care Survival Guide, Fourth Edition is a comprehensive resource that offers practical assistance to both new and seasoned clinicians. As in previous editions, all content in this Survival Guide has been contributed by members of the ACCP Ambulatory Care Practice and Research Network, ensuring its applicability and relevance.

The ACCP Ambulatory Care Survival Guide, Fourth Edition is a comprehensive resource that offers practical assistance to both new and seasoned clinicians. As in previous editions, all content in this Survival Guide has been contributed by members of the ACCP Ambulatory Care Practice and Research Network, ensuring its applicability and relevance.

The Preceptor's Handbook for Pharmacists, 4th edition is the updated and expanded authoritative resource for both new and experienced pharmacy preceptors to create a lifelong impact on young pharmacists.

Abstract
The pharmacy profession has advanced remarkably, however pharmacists have yet to obtain provider status at the federal level. Establishing pharmacists as providers is imperative in light of the growing shortage of primary care providers and need to provide care for medically underserved populations. Academic reform, professional development and legislation have all contributed to the furtherment of provider status. Yet, the cornerstone to obtaining this status lies in imminent… Show more

Abstract
The pharmacy profession has advanced remarkably, however pharmacists have yet to obtain provider status at the federal level. Establishing pharmacists as providers is imperative in light of the growing shortage of primary care providers and need to provide care for medically underserved populations. Academic reform, professional development and legislation have all contributed to the furtherment of provider status. Yet, the cornerstone to obtaining this status lies in imminent changes at the healthcare and interprofessional collegial levels in conjunction with professional perseverance and legislative action. These actions will help ensure pharmacists as integral partners on collaborative health care teams in clinical service provision for managing patients’ chronic conditions and medications, to ultimately, improve access to quality care and patient health outcomes. Show less

The American Diabetes Association (ADA) annually updates its Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes.

Methods:
For the 2018 standards, the ADA Professional Practice Committee searched MEDLINE through November 2017 to add, clarify, or revise recommendations on the basis of new evidence. The committee rated the… Show more

The American Diabetes Association (ADA) annually updates its Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes.

Methods:
For the 2018 standards, the ADA Professional Practice Committee searched MEDLINE through November 2017 to add, clarify, or revise recommendations on the basis of new evidence. The committee rated the recommendations as A, B, or C depending on the quality of evidence or E for expert consensus or clinical experience. The standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions.

Recommendations:
This synopsis focuses on guidance relating to cardiovascular disease and risk management in nonpregnant adults with diabetes. Recommendations address diagnosis and treatment of cardiovascular risk factors (hypertension and dyslipidemia), aspirin use, screening for and treatment of coronary heart disease, and lifestyle interventions. Show less

PURPOSE:
Documentation of Stage 1 and Stage 2 Meaningful Use (MU) criteria for patients with type 2 diabetes mellitus between clinical pharmacists and other healthcare providers was compared.

METHODS:
Patients seen at 8 clinics in a federally qualified health center who had type 2 diabetes mellitus and were seen by clinical pharmacists or other healthcare providers were randomly selected for inclusion in this retrospective study. Approximately half of the encounters were evaluated… Show more

PURPOSE:
Documentation of Stage 1 and Stage 2 Meaningful Use (MU) criteria for patients with type 2 diabetes mellitus between clinical pharmacists and other healthcare providers was compared.

METHODS:
Patients seen at 8 clinics in a federally qualified health center who had type 2 diabetes mellitus and were seen by clinical pharmacists or other healthcare providers were randomly selected for inclusion in this retrospective study. Approximately half of the encounters were evaluated for Stage 1 MU compliance (encounters from October through December 2014), and half were evaluated for Stage 2 MU compliance (encounters from January through March 2015). Categorical and descriptive variables were analyzed by calculating frequencies and percentages. Chi-square tests were used to compare groups with an a priori level of significance set at 0.05.

RESULTS:
A total of 790 patients were seen by 46 providers, 8 (18%) of whom were clinical pharmacists. The study also included 24 medical doctors, 8 family nurse practitioners, 1 physician assistant, and 5 doctors of osteopathic medicine. Other healthcare providers more consistently documented 5 Stage 1 MU criteria than did clinical pharmacists. Clinical pharmacists more consistently documented 2 core objectives than did other healthcare providers. Otherwise, no significant differences in documentation were detected.

CONCLUSION:
Other healthcare providers more consistently documented 5 Stage 1 MU criteria than did clinical pharmacists. Clinical pharmacists more consistently documented 2 core objectives than did other healthcare providers. Show less

IN BRIEF “Quality Improvement Success Stories” are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., (ACP) and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors… Show more

IN BRIEF “Quality Improvement Success Stories” are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., (ACP) and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a pilot project aimed at improving overall quality of care and reducing readmissions for patients discharged from a community hospital in Arizona. Show less

The American Diabetes Association (ADA) first released its practice guidelines for health professionals in 1989. The Standards of Medical Care in Diabetes have since provided an extensive set of evidence-based recommendations that are updated annually for the diagnosis and management of patients with diabetes. The 2017 Standards of Care cover all aspects of patient care (1); this guideline synopsis focuses on monitoring and pharmacologic approaches for patients with type 1 diabetes.

The American Diabetes Association (ADA) first released its Standards of Medical Care in Diabetes for health professionals in 1989. These practice guidelines provide an extensive set of evidence-based recommendations that are updated annually for the diagnosis and management of patients with diabetes. The 2017 Standards cover all aspects of patient care (1); this guideline synopsis focuses on pharmacologic approaches for patients with type 2 diabetes.

Three hundred patient records were reviewed. Clinical pharmacists completed 1608 interventions, with a mean of 5.4 interventions per patient. A total of 272 referrals were made, 120 (45%) of which were completed within one month of the visit. Of the 183 laboratory tests ordered for diabetes and lipid screening, 152 (83%) were completed within one month of the AWV (p < 0.001). Of the 370 vaccinations offered during the visits, 182 (49%) were administered (p < 0.001). Twenty-four medication… Show more

Three hundred patient records were reviewed. Clinical pharmacists completed 1608 interventions, with a mean of 5.4 interventions per patient. A total of 272 referrals were made, 120 (45%) of which were completed within one month of the visit. Of the 183 laboratory tests ordered for diabetes and lipid screening, 152 (83%) were completed within one month of the AWV (p < 0.001). Of the 370 vaccinations offered during the visits, 182 (49%) were administered (p < 0.001). Twenty-four medication and dosage changes were made by clinical pharmacists during AWVs, and the total revenue for the AWVs conducted by pharmacists and services completed during the visits exceeded $22,000. Show less

As pharmacists continue to work toward full integration among care teams, they must endeavor to understand their organization’s quality priorities, step up improvement efforts, keep abreast of changing requirements, and foster collaboration.

Purpose: Diet and eating habits are of key importance in patients with type 2 diabetes mellitus (T2DM). The purpose of this comparative study was to analyze fat- and fiber-related behavior (FFB) in patients with T2DM from distinct cultural areas.

This article discusses the impact of the Hospital Readmissions Reduction Program on hospitals and strategies used by pharmacy departments to decrease hospital readmission rates.

In Patients and Health Care Teams Forging Effective Partnerships, the authors provide insight into how, by including patients and families as active participants in the health care team, the broad systemic movement toward team-based care can be enhanced. The discussion paper, published by the Institute of Medicine (IOM), builds upon previous work regarding the core principles of team-based care in order to help achieve three aims of better health, better care, and lower costs. The authors are… Show more

In Patients and Health Care Teams Forging Effective Partnerships, the authors provide insight into how, by including patients and families as active participants in the health care team, the broad systemic movement toward team-based care can be enhanced. The discussion paper, published by the Institute of Medicine (IOM), builds upon previous work regarding the core principles of team-based care in order to help achieve three aims of better health, better care, and lower costs. The authors are participants in the Best Practices Innovation Collaborative of the IOM Roundtable on Value & Science-Driven Health Care. In their paper, the authors undertook both a detailed review of the literature and one-on-one interviews with patients and clinicians to suggest how to create health care teams that involve patients and meet their needs. Show less

Despite the integration of clinical pharmacists in many areas of clinical practice, there are currently not enough clinical pharmacists to provide on-site consultation to each satellite clinic. To address this gap, you have to develop a service that allows providers to immediate have access to pharmacy consult services by creating an internal email group that improve and increase access to all clinical pharmacists for specific drug related question or consults.

Objective: To compare a pharmacist's interventions before and after patient diagnosis is added by prescribers to their electronic prescription orders.

Provides an overview of ACA, key provision and how pharmacists expertise can be used in ACA

Clinical pharmacists have proven that they can improve patient outcomes, despite the increasing complexity and specialization within the healthcare system. It is critical for all physicians to have timely access to clinical pharmacists. The integration of technology in daily healthcare workflow has created an opportunity for clinical pharmacists..

The purpose of this study was to assess physician understanding and adoption of the updated consensus into current practice, and to determine changes in insulin use rates and A1C values after an academic detailing intervention. The intervention was done by PharmD/CDEs (Doctor of Pharmacy/Certified Diabetes Educators) within the El Rio Community Health Centers in Arizona. Ten primary care providers from the family medicine and internal medicine clinics were included for a baseline knowledge… Show more

The purpose of this study was to assess physician understanding and adoption of the updated consensus into current practice, and to determine changes in insulin use rates and A1C values after an academic detailing intervention. The intervention was done by PharmD/CDEs (Doctor of Pharmacy/Certified Diabetes Educators) within the El Rio Community Health Centers in Arizona. Ten primary care providers from the family medicine and internal medicine clinics were included for a baseline knowledge assessment in Feb 2009 on the appropriate initiation and management of insulin therapy based on the ADA Self-Assessment Program. A re-assessment was conducted in September 2009 after implementation of the intervention. The intervention was conducted over 6 months and included three main components: group education, print and video resources, and monthly contacts through one on one consultation and email reminders. Medical records for all patients with diabetes as a primary or secondary diagnosis treated by the ten physicians were reviewed in the six months before (Aug 2008-Jan 2009) and six months after the intervention (Feb 2009-Aug 2000) to detect changes in insulin use rates and A1C values. On the knowledge assessment physicians scored 63.9% at baseline and 80.6% at re-measurement which represents a 20.7% improvement. A total of 131 medical records were abstracted. Insulin use rate increased from 25% to 39% (p=0.069). Average A1C values were 8.1% at baseline and 7.8% at re-measurement (p=0.207). Proportion of diabetics with A1C > 8.5% changed from 36% to 24.6% (p=0.144). These findings suggest that a multi-pronged academic detailing intervention delivered by PharmD/CDEs increased physician knowledge on appropriate insulin initiation and management, and improved insulin use rates and A1C values which would have likely reached statistical significance on a larger group. Show less

This activity provides an overview of issues surrounding diabetes management and outcomes in ethnic minorities in the US, with a goal to improve physicians awareness of these issues and how best to overcome them. Interactive cases are used to illustrate effective strategies for providing optimal treatment for multicultural patients with diabetes.

Abstract
The purpose of this study was to evaluate the ability of a pharmacist-based disease-state management service to improve the care of indigent, predominately Spanish-speaking patients with diabetes mellitus and common comorbid conditions at high risk for the development of chronic kidney disease (CKD). Patients at high risk for developing CKD who have diabetes at a community health center were placed in a pharmacist-based disease state management service for CKD risk reduction. A… Show more

Abstract
The purpose of this study was to evaluate the ability of a pharmacist-based disease-state management service to improve the care of indigent, predominately Spanish-speaking patients with diabetes mellitus and common comorbid conditions at high risk for the development of chronic kidney disease (CKD). Patients at high risk for developing CKD who have diabetes at a community health center were placed in a pharmacist-based disease state management service for CKD risk reduction. A residency-trained, bilingual, certified diabetes educator, with a PharmD served as the patient's provider using diagnostic, educational, and therapeutic management services under a medical staff approved collaborative practice agreement. Outcomes were assessed by using national standards of care for disease control and prevention screening. The impact on CKD was shown with a mean A1C decrease of 2% and improvement in the proportion of patients at target goals for blood pressure, A1C, and cholesterol levels and receiving aspirin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. A pharmacist-based disease-state management service for CKD risk reduction, care of diabetes, and frequently associated comorbid conditions improved compliance with national standards for diabetes care in a high-risk population. Show less

Objective:
The objective of this article was to discuss the role of rapid-acting insulin analogues and inhaled insulin inthe treatment of patients with type 2 DM.

A pharmacist-managed service for the care of diabetes and frequently associated
comorbid conditions was effective in significantly lowering A1C, blood pressure, and LDL cholesterol levels and had near perfect compliance with national standards for diabetes care. This was accomplished in a federally qualified health center treating primarily indigent and transient Hispanic and NativeAmerican populations. This study demonstrates the positive effect of clinically trained pharmacists in managing… Show more

A pharmacist-managed service for the care of diabetes and frequently associated
comorbid conditions was effective in significantly lowering A1C, blood pressure, and LDL cholesterol levels and had near perfect compliance with national standards for diabetes care. This was accomplished in a federally qualified health center treating primarily indigent and transient Hispanic and NativeAmerican populations. This study demonstrates the positive effect of clinically trained pharmacists in managing patients with diabetes and common comorbid conditions. Show less

ABSTRACT Opportunities abound for pharmacists to expand their practices by providing clinical services or assuring access to affordable pharmaceuticals to the medically underserved. The PSSC is a recently established resource at APhA that provides the pharmacy community and HRSA grantees with information and technical assistance on HRSA programs and projects. By participating in HRSA demonstration projections, pharmacists can implement much greatly needed patient care services to reduce… Show more

ABSTRACT Opportunities abound for pharmacists to expand their practices by providing clinical services or assuring access to affordable pharmaceuticals to the medically underserved. The PSSC is a recently established resource at APhA that provides the pharmacy community and HRSA grantees with information and technical assistance on HRSA programs and projects. By participating in HRSA demonstration projections, pharmacists can implement much greatly needed patient care services to reduce disparities in health care. Becoming a 340B-contracted pharmacy can help pharmacists build prescription volume, expand their clinical services, and better serve the health care needs of their communities. Show less

Abstract

DNA topoisomerase IIα (topo IIα) is an essential proliferation-dependent nuclear enzyme which has been exploited as an anti-tumor drug target. Since the proliferative status of human leukemia cells is associated with expression of the c-myb proto-oncogene, c-Myb was investigated as a trans-activator of the topo IIα gene. Using topo IIα promoter-luciferase reporter plasmids, c-myb expression caused trans-activation of the topo IIα promoter a maximum of ∼4.5-fold over basal levels… Show more

Abstract

DNA topoisomerase IIα (topo IIα) is an essential proliferation-dependent nuclear enzyme which has been exploited as an anti-tumor drug target. Since the proliferative status of human leukemia cells is associated with expression of the c-myb proto-oncogene, c-Myb was investigated as a trans-activator of the topo IIα gene. Using topo IIα promoter-luciferase reporter plasmids, c-myb expression caused trans-activation of the topo IIα promoter a maximum of ∼4.5-fold over basal levels in HL-60 human promyelocytic leukemia cells. Trans-activation was submaximal with higher levels of c-myb expression plasmid but a Myb protein lacking its negative regulatory domain resulted in ∼19-fold trans-activation. Mutagenesis and 5′-deletion studies revealed that Myb trans-activation was mediated via a Myb-binding site at positions −16 to −11 and that this region governed the bulk of basal topo IIα promoter activity in human leukemia cells. Trans-activation of topo IIα by c-Myb was lymphoid- or myeloid-dependent. However, B-Myb, a more widely-expressed Myb family member, caused topo IIα trans-activation in both HL-60 cells and HeLa epithelial cervical carcinoma cells. These data provide evidence for a new Myb-responsive gene which is directly linked to and required for cellular proliferation. Show less