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Biomedical subjects

Tami L Remington

Publications and source records attributed to Tami L Remington.

9 recordsLinked to original sources
PubMed2006

Evaluation of evidence for interprofessional education.

Based on recommendations from numerous organizations, educators in healthcare disciplines are implementing interprofessional training programs. Our objective was to summarize relevant literature in a way that would be most useful to clinician educators. Studies involving educational interventions in health professions to enhance learner-based outcomes relevant to the provision of interprofessional care were identified. We sought prospective, controlled trials in which at least 2 health care disciplines were represented, and 1 of which was medicine. Thirteen reports met the criteria for inclusion. Interventions varied widely in design and intensity, but generally included both didactic and clinical components and lasted several weeks or longer. Most studies used pretest/posttest controls and observed positive effects on learners' attitudes and knowledge. Combined clinical and didactic experiences may produce short-term improvements in learners' knowledge and attitudes about interprofessional care. Future research should employ control groups and validated, behaviorally oriented outcome measures whenever possible.

Controlled Clinical Trials as Topic↗
PubMed2006

Effects of a geriatrics interdisciplinary experience on learners' knowledge and attitudes.

This study examines the impact of an interdisciplinary training program on knowledge and attitudes of learners from four health care programs: medicine, pharmacy, social work, and nursing. Sixty-two learners participated in a 4-day educational program (one day each week for 4 weeks) focusing on interdisciplinary geriatric care. After completing the program, learner scores improved on a knowledge test and two attitudinal subscales, and they reported a positive training experience. A short-term interdisciplinary educational intervention can have an impact on learners' knowledge of and attitudes toward older adults, and improve their understanding and confidence in participating in an interdisciplinary collaborative care team.

Education, Professional↗
PubMed2006

Teaching interdisciplinary geriatrics ambulatory care: a case study.

Interdisciplinary health care training is advocated by numerous government and philanthropic organizations. Educators in the health professions are increasingly offering training in interdisciplinary health care in a variety of contexts, including ambulatory settings. This paper describes a three-year program to teach skills in interdisciplinary care to learners from internal medicine, social work, pharmacy, and nursing in a geriatrics clinic at a major academic institution in the United States. Framed in a critical review of existing evidence for the effectiveness of interdisciplinary training and health care and expert recommendations, specific recommendations are made to educators interested in interdisciplinary training in ambulatory settings.

Ambulatory Care↗
PubMed2005

Tiotropium: a bronchodilator for chronic obstructive pulmonary disease.

OBJECTIVE: To review the scientific literature evaluating the efficacy and tolerability of tiotropium bromide, a new bronchodilator indicated for treatment of chronic obstructive pulmonary disease (COPD). DATA SOURCES: Articles were identified through searches of MEDLINE (1966-January 2005) using the key words tiotropium, BA 679 BR, chronic obstructive pulmonary disease, and anticholinergic agents. Additional citations were identified from bibliographies of publications cited. STUDY SELECTION AND DATA EXTRACTION: Experimental and observational studies of tiotropium bromide were selected. Trials of the efficacy of the drug in humans were the focus of the review. DATA SYNTHESIS: Tiotropium bromide is an effective bronchodilator for patients with COPD. It produces clinically important improvements in lung function, symptoms of dyspnea, quality of life, and exacerbation rates compared with placebo. In comparative studies, tiotropium does not appear to be more efficacious than salmeterol or ipratropium. CONCLUSIONS: Tiotropium is an effective inhaled anticholinergic agent that is recommended among preferred long-acting bronchodilators for the chronic management of moderate to very severe COPD. Although similar to ipratropium in efficacy and tolerability, it has the advantage of once-daily dosing.

Albuterol↗
PubMed2005

Long-acting beta-agonists: anti-inflammatory properties and synergy with corticosteroids in asthma.

PURPOSE OF REVIEW: Contemporary asthma management calls for combination inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) for patients with moderate to severe persistent asthma. This combination has consistently shown superior clinical efficacy compared with monotherapy with higher doses of ICS. It is unclear whether ICS and LABA act additively because of their complementary mechanisms of action, or whether they act synergistically based on possible favorable interactions between them. The purpose of this review is to summarize research findings on the anti-inflammatory activity of LABA published since October 2002 and to speculate on how these findings will affect future asthma management recommendations. RECENT FINDINGS: Combination ICS plus LABA consistently demonstrates superiority over ICS monotherapy in clinical outcomes such as pulmonary function, symptoms, and exacerbation rates, and is consistent with definitive data published before the review period. However, investigations into possible effects of LABA on inflammatory mediators are preliminary. Positive effects of LABA on some serum and bronchial inflammatory measures have been observed, but the clinical importance of these findings has not been established. SUMMARY: Current asthma treatment recommendations are based on clinical trials demonstrating improved clinical outcomes of combination ICS plus LABA over ICS alone. Whether LABA possesses clinically important benefits beyond bronchodilation remains to be established. Distinguishing anti-inflammatory activity of LABA will help define optimal long-term treatment regimens for asthma that not only improve pulmonary function, symptoms, and exacerbation rates but also protect against airway remodeling.

Adrenergic beta-Agonists↗
PubMed2003

Drug-induced esophageal injuries and dysphagia.

OBJECTIVE: To review and analyze medical literature documenting drug-induced esophageal injury and dysphagia and to formulate strategies to enhance pharmacists' prevention, detection, and treatment of these iatrogenic complications. DATA SOURCES: A MEDLINE search (1966-April 2002) was conducted to identify primary and secondary literature using variable combinations of the following search terms: pill-induced, drug-induced, or iatrogenic with esophageal injury, esophageal damage, or dysphagia. Bibliographies were also reviewed to identify additional relevant references. STUDY SELECTION AND DATA EXTRACTION: All case reports, reviews, and clinical studies relating to drug-induced esophageal injury or swallowing dysfunction were evaluated. DATA SYNTHESIS: Drug-induced esophageal injury may be under-recognized. Several drugs have been associated with physical or chemically mediated injuries. Risk factors for injury have been identified and preventive and treatment strategies have been successful in limiting esophageal injury. Drug-induced dysphagia can have serious complications and is most often associated with typical neuroleptics such as haloperidol. CONCLUSIONS: Pharmacists can play a pivotal role in proactively identifying situations where there is a higher likelihood of drug-induced esophageal injury or dysphagia. They can recommend preventive strategies to promote safe medication use, help identify iatrogenic complications when they occur, and assist in formulation of appropriate treatment strategies.

Deglutition Disorders↗
PubMed2003

Collaborative drug therapy management by pharmacists--2003.

Since publication of the initial ACCP position statement on CDTM by pharmacists in 1997, the public, government, and much of the health care community at large have come to better appreciate the growing complexity of providing effective and safe drug therapy in today's health care environment. Increased interest in the issues of cost and quality of drug use is evident in the increasing coverage of the issue in the lay press and professional literature. This represents real progress, as well as real opportunity, for pharmacists. It also heightens the potential for a better understanding of the vital role that pharmacists can play in addressing these concerns. The percentage of patients who take several drugs for chronic diseases will continue to increase. Based on current trends, the number of patients who lack adequate access to care, or who receive either suboptimal, inappropriate, or unnecessarily expensive drug therapy for their acute and chronic diseases, will increase. Even as financial and human resources are increasingly strained within the current health care system, costs will continue to rise unless changes are made. Fortunately, qualified pharmacists are prepared, capable, and willing to help address a significant portion of these challenges. The public, many health care providers, some legislators, and a few insurers now recognize that pharmacists, because of their education and training in drug therapy, are well positioned both to accept additional responsibility for patient care and to provide services that make a real difference in health care quality and outcomes. The health care programs administered by the U.S. Public Health Service, the armed forces, and the Veterans Health Administration, as well as 38 states, now support pharmacist participation in CDTM. Pharmacists, working in an interdisciplinary structure with physicians and other health care providers, have demonstrated that they can improve the effectiveness, efficiency, and safety of drug therapy by providing CDTM. It is time to incorporate this valuable professional skill of the contemporary pharmacist as a core component of the delivery of health care services.

Drug Therapy↗
PubMed2002

Combined budesonide/formoterol turbuhaler treatment of asthma.

OBJECTIVE: To provide product information; review and analyze the clinical literature studying combination therapy, budesonide, and formoterol in asthmatics; and to define the role for this therapy in asthma treatment. DATA SOURCES: A MEDLINE search (1990-September 2001) was conducted to identify the primary literature. Bibliographies were reviewed for further relevant citations. STUDY SELECTION/DATA EXTRACTION: All randomized, blinded, controlled studies at least 3 months in duration exploring the efficacy of the combination of budesonide and formoterol (in 1 or separate formulations) compared with other treatments were selected to be included in the review of clinical studies. DATA SYNTHESIS: The combination of budesonide and formoterol was more effective than increasing the dose of budesonide in patients with moderate or severe persistent asthma and in patients with mild asthma not previously controlled with inhaled corticosteroids. Milder corticosteroid-naïve asthmatics did not derive benefit compared with inhaled corticosteroids alone. CONCLUSIONS: Combination therapy in 1 device is a preferred treatment option in patients with moderate to severe persistent asthma and in those with milder asthma not controlled with inhaled corticosteroids. Advantages of this product include rapid onset of action, long duration of action, and a wide dosing range to assist with titration. Further research is required to evaluate this therapy in asthmatic children <5 years old and in patients with oral corticosteroid-dependent asthma. Investigations into the effect of this combination product on other disease outcomes, such as quality of life and productivity, will further define the role for this drug therapy.

Administration, Inhalation↗