Acetaminophen (APAP) is widely used as an over-the-counter fever reducer and pain reliever. However, the current therapeutic use of APAP is not optimal. The inter-patient variability in both efficacy and toxicity limits the use of this drug. This is particularly an issue in pediatric populations, where tools for predicting drug efficacy and developmental toxicity are not well established. Variability in toxicity between age groups may be accounted for by differences in metabolism, transport, and the genetics behind those differences. While pharmacogenomics has been revolutionizing the paradigm of pharmacotherapy for many drugs, its application in pediatric populations faces significant challenges given the dynamic ontogenic changes in cellular and systems physiology. In this review we focused on the ontogenesis of the regulatory pathways involved in the disposition of APAP and on the variability between pediatric, adolescent, and adult patients. We also summarize important polymorphisms of the pharmacogenes associated with APAP metabolism. Pharmacogenetic studies in pediatric APAP treatment are also reviewed. We conclude that while a consensus in pharmacogenetic management of APAP in pediatric populations has not been achieved, a systems biology based strategy for comprehensively understanding the ontogenic regulatory pathway as well as the interaction between age and genetic variations are particularly necessary in order to address this question.
Introduction A postgraduate year 1 (PGY1) pharmacy residency is designed to build upon the Doctor of Pharmacy education. The American Society of Health‐System Pharmacists (ASHP) accreditation standards, along with the competency areas, goals, and objectives (CAGOs), list four required competency areas for the design of pharmacy residency programs. The fourth required competency area goals and objectives (CAGO R4) focuses on the development of residents' skills related to teaching, education, and dissemination of knowledge. A characterization of current programs' approaches to satisfying this CAGO might stimulate improvements and spread innovation. Objectives To better characterize how PGY1 pharmacy residency programs incorporate teaching experiences in the training of residents. Methods The authors developed a survey to address the goals and objectives under CAGO R4. The survey was distributed to residency program directors (RPDs) of ASHP‐accredited PGY1 pharmacy residency programs and responses were voluntary. All data were analyzed descriptively to determine frequency (n) and percent (%). Results 21.9% of RPDs surveyed completed the survey, with a wide variation in program demographics. The most common presentations were to pharmacy staff/students (65.6%) and consisted of poster presentations (81.8%) or platform presentations (74.9%). The most common writing experiences included chart notes (94.6%) and drug monographs (88.7%). In regard to precepting, the majority (82.8%) of programs require their residents to co‐precept one to two pharmacy students per residency year. Finally, approximately half of the respondents required their residents to complete a teaching certificate program, with an additional 62.6% of these programs offering pedagogical readings. Conclusion Despite offering a number of experiences aimed at achieving the goals and objectives of CAGO R4, considerable variation exists in the design of the experiences offered and how programs assess the residents' learning experiences.
The role of health-system pharmacists continues to expand, and this area of pharmacy practice increasingly requires augmented baseline training. It is unclear how Post Graduate Year 1 (PGY-1) pharmacy residencies may be changing to meet these needs.The objectives of our survey were to describe PGY-1 pharmacy residency program design among academic medical centers, characterize program changes enacted over 5-year period, and describe career paths among PGY-1 pharmacy residency graduates. A 32-item questionnaire was developed independently, which was reviewed and validated by 4 residency program directors. The survey was uploaded to an online survey tool and sent electronically to residency program directors of 109 Vizient academic medical centers with PGY-1 pharmacy residency programs. Residency program directors were identified from a list of Vizient-participating hospitals. The survey was re-sent at 2-week intervals on 4 occasions to improve response rates. SPSS version 23.0 was used to analyze the data. Overall, 49 (45%) of hospitals responded to the survey. Survey responses showed statistically significant increases over the 5-year survey period in the following areas: the number of PGY-1 resident positions offered ( = .001), percent of time spent on teaching experiences ( = .001), and percentage of PGY-1 residents pursuing PGY-2 or fellowship training ( = .026). We found that PGY-1 pharmacy residency programs at Vizient academic medical centers have undergone limited changes over the 5-year survey period and substantial variation exists between program designs. The most common change to program design was an increase in the percentage of time residents spend on teaching experiences. There was an increase in residents pursuing PGY-2 or fellowship training, which may suggest a shift toward increased specialization in clinical pharmacy practice or may reflect changes in the availability of job opportunities.
Background: Patients with higher clinical pharmacy priority (CP2) scores are more likely to receive a medication recommendation from a pharmacist to resolve an identified medication related problem (MRP) in a family medicine clinic.Objective: The objective of this study was to compare a modified CP2 score to the original CP2 score in an adult medicine residency clinic and assess whether a modified CP2 score more appropriately captured patients in need of recommendations from a clinical pharmacist.Methods: A convenience sample of patients scheduled for visits in an adult medicine clinic had a comprehensive medication review (CMR) performed. All patients had the original CP2 score and modified CP2 score calculated retrospectively. Both versions of the CP2 scores were compared using Pearson correlation. The relationship between a recommendation from a pharmacist and each CP2 score was evaluated using Pearson correlation and t test.Results: In total, 148 patients who received a CMR by a clinical pharmacist were included in the retrospective chart review. Overall, there was a strong positive correlation between the CP2 score and the modified CP2 score (correlation coefficient (r) 0.968, P < 0.001); thus, as the CP2 scores increase, the modified CP2 score increases.Patients with higher CP2 and modified CP2 scores were more likely to receive a recommendation from a pharmacist (P < 0.001 and P < 0.001, respectively). There was a moderate correlation between both scores and number of recommendations made (CP2: r = 0.436 [P < 0.001], modified CP2: r = 0.456 [P < 0.001]) which did not differ significantly. Conclusions:The CP2 score and the modified CP2 score were both associated with pharmacist recommendations in an adult medicine clinic. Refinement of the CP2 score did not better capture patients in an adult medicine residency clinic with a recommendation from a clinical pharmacist. K E Y W O R D Shealth care systems, health services research, medication therapy management, pharmacists, pharmacy service, hospital
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