Quality Improvement Project of Pharmacist-Assisted Medication Reconciliation and Regimen Review Following Veteran Discharge to Hospice

The Joint Commission NPSG （National Patient Safety Goals） requires that medication reconciliation be performed upon any transition of care （NPSG 03.06.01）. The hospice clinical pharmacist, in delivering pharmaceutical care, performs medication regimen reviews to identify medication-related problems. This project aims to improve the medication reconciliation process upon transition from inpatient units to non-VA （Veterans Affairs） hospice care by identifying and resolving medication discrepancies and medication-related problems. Patients discharged from inpatient to non-VA hospice care from October 2013-March 2014 were included. Medication reconciliation was performed by the pharmacist via telephone with the patient/caretaker and the hospice agency within two weeks of discharge. The patient＇s primary care provider was contacted via telephone when changes were recommended, and upon agreement, medication lists were updated electronically. A total of 18 patients were included. The results found that following medication reconciliation and regimen review, the mean number per patient of VA medications discontinued and non-VA medication documented was 5.7 and 10.8 respectively. The mean number per patient of medication discrepancies and medication-related problems was 14.4 and 8.6 respectively. This quality improvement project demonstrates the vulnerability of patients to medication discrepancies and medication-related problems and highlights the role of pharmacists in resolving these issues during this transition of care.

National patent Chinese herbal compound for parkinson's disease based on data mining and network pharmacology analysis

Objective:To analyze the dosing pattern and mechanism of herbal compound patents for the treatment of Parkinson's disease using data mining and network pharmacology methods,and to provide ideas for the clinical use of Parkinson's disease and new drug development.Methods:The Chinese herbal medicine compound prescriptions for Parkinson's disease built up to May 31,2022 by searching the official website of patent publication notice.An Excel table was built,and after term normalization of the included compound prescriptions,Excel and IBM SPSS Modeler 18.0 were used for data mining such as frequency statistics.We also applied network pharmacology methods to study HF drugs,using TCMSP and TCM database@Taiwan to obtain drug components and using TCMSP platform and Swiss ADME screening,collecting targets through UniProt and Swiss Target Prediction platform;obtaining PD disease from databases such as GeneCards The targets were obtained from GeneCards and other databases,drug-disease target intersections were obtained,and"drug-disease-target"networks were created using Cytoscape 3.8 software,and GO and KEGG enrichment analyses were performed using the Metascapep platform.Results:A total of 113 patented Chinese medicine recipes were included,involving 394 drugs,among which Tianma,Angelica and Bai Shao were the most commonly used drugs.A total of 442 drug targets,4884 disease targets and 324 drug-disease common targets were obtained.Conclusion:The study found that the medicinal properties of the patented compound Chinese medicine for Parkinson's disease are mainly warm and cold,the taste of the medicine is mainly sweet and bitter,the normalizing meridian is mainly liver,heart and spleen meridians,and the treatment method is mainly to strengthen the liver and kidney,nourish the qi and blood,and extinguish the wind and dredge the luo.The core ingredients include 4-ethoxymethylphenyl-4'-hydroxyl,palmitic acid,lignan,etc.;the main action targets are PTGS2,PTGS1,SCN5A,etc.;involved in PI3K-Akt,cAMP and other signaling pathways.The development of relevant compound can be based on clinical symptoms,appropriate tailoring,and flexible use of such drugs,in order to obtain the best therapeutic effect.

NLRP3 inhibitor dopamine receptors agonist as a potential therapeutic strategy for treatment of overactive immune responses in COVID-19

Patients infected with coronavirus disease 2019(COVID-19)have high serum levels of proinflammatory cytokines.The"cytokine storm"has become one of the major causes of death for critically ill patients infected by COVID-19.Glucocorticoids,plasma from convalescent patients,blood purification,and tocilizumab are currently recommended for use when the body’s inflammatory response is overactivated.However,there are limitations in terms of medicinal effects,equipment reserves,and treatment expense.These challenges prompted us to assess classical agents with good safety and mature production technology.A recent study showed that nucleotide-binding oligomerization domain(NOD)-,leucine-rich repeat(LRR)-,and pyrin domain-containing protein 3(NLRP3)inflammasomes drive COVID-19 pathology.We speculate that suppression of NLRP3 inflammasome-derived cytokine production may be beneficial in COVID-19-infected patients.Dopamine receptors are present in almost all immune cells and can modulate their activation,proliferation,and cytokine production of immune cells.Previous studies have shown that dopamine receptor agonists can control systemic inflammation through inhibition of the NLRP3 inflammasome.This suggests that dopamine receptor agonists may be a new strategy for the treatment of overactive immune responses in COVID-19 patients.This is worthy of further investigation in clinical practice.