The implementation of an outpatient naloxone prescribing policy at a large academic medical center created a streamlined approach for the interprofessional healthcare team to use in providing naloxone education and improved naloxone access to patients at high risk for opioid overdose.
Hypothyroidism is a common endocrine disease, which, in addition to its classic signs and symptoms, can present with primary complaints of myopathy. Myopathy can cause skeletal muscle weakness, tenderness, and pain and is often associated with elevated creatine kinase levels. There are many neuromuscular causes of myopathy, including inflammatory and infectious myopathies, metabolic and hereditary myopathies, and those caused by drugs or toxins. Hypothyroid patients with musculoskeletal symptoms can have elevated serum creatine kinase levels, which clinically resemble polymyositis. However, hypothyroid myopathies can be distinguished from polymyositis by coexisting signs and symptoms of hypothyroidism such as delayed relaxation phase of the deep tendon reflexes and the absence of inflammatory changes on muscle biopsy. The treatment of hypothyroidism with thyroid hormone replacement will alleviate symptoms of myopathy as well as lower the characteristic hyperlipidemia associated with hypothyroidism. Hypercholesterolemia, which can arise from different etiologies, is frequently treated with a class of HMG-CoA reductase inhibitors called statins. One of the most significant risks associated with the use of statins is the development of myopathy, a risk that may be compounded by the coexistence of hypothyroidism. The underlying metabolic mechanisms that account for muscle disease in these 2 settings show some common etiologies. The overlap of symptoms associated with hypothyroidism and statin-induced myopathy should prompt the physician to screen all patients presenting with myopathic symptoms with or without elevated creatine kinase levels and all hyperlipidemic patients before initiating statin therapy for hypothyroidism using a measurement of thyroid-stimulating hormone. (The Endocrinologist 2006;16: 279 -285) Learning Objectives• Describe the characteristics of the myopathy sometimes associated with hypothyroidism as well as the relationship between the hypothyroid state and hyperlipidemia. • Identify the key features of statin-induced myopathy.• Outline the ways in which hypothyroidism, statin treatment, and myopathy relate to one another, and the clinical implications of these associations.
Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Our organization implemented a health-system pharmacy/community pharmacy transitions of care (TOC) program, developing a scalable model to improve care transitions from the health system to the community setting for shared patients. Summary In this report, we describe our organization’s experiences in taking a purposeful approach to building and pilot testing a partnership between our department of pharmacy and 14 community pharmacies within a larger statewide network to improve TOC across care settings. We have been successful in partnering with our electronic health record (EHR) vendor to enhance access capabilities to allow for documentation by community pharmacists (external to the organization) to be included in the patient record as a note. The goal of the partnership with community pharmacies is to elevate TOC for patients, identify and resolve medication therapy problems that may occur post discharge and lead to poor outcomes, and improve continuity of care across practice settings. Conclusion Our department of pharmacy has led a successful initiative to promote collaboration with local external community pharmacies. This program has led to innovative advancements in EHR capabilities, promoting transparency in the documentation of pharmacy services and making this documentation visible to all care team members.
Background of Study: Associations between measures of body composition and vertical jump height have previously been established using a range of instrumentation and prediction equations. Limited data has presented using gold standard measurements for both variables Objective: This investigation sought to examination the relationship between total body and lower extremity measures of body composition and vertical jump performance using gold standard measurements within an athletic population. Methods: Using a cross-sectional, correlational research design fourteen collegiate female volleyball athletes completed body composition, three countermovement jumps (CMJ) and three squat jumps (SJ) analysis using DXA and force platforms. Results: High to very high positive relationships were seen between total body lean (p < 0.001) and fat mass (p < 0.05), lower extremity lean and fat mass (p < 0.01), and CMJ force and power. High negative relationships were present between total body fat percentage(p < 0.05), total fat mass (p < 0.01) and CMJ jump height. Relationships between all body composition variables and SJ performance tended to be weaker, with the exception of total body lean mass (p < 0.05), lower extremity lean mass, and power output (p < 0.01). Conclusions: These findings support much of the previous literature in that increases of mass have subsequent increases in force and power production; however caution should be taken will increases in mass coming from fat or lean tissue.
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