Having an article published is a great honor; it is an acknowledgement that your ideas and proposals are justified enough to share with others on a broad scale. It is an opportunity to contribute to and hopefully positively influence the provision of patient care. As I reflect on the publication process, I wish to strongly encourage others to explore their responsibility to their chosen profession through the publication of evidenced based articles.
This is the pre-peer reviewed version our article published this month: Fudin J, Fontenelle DV, Payne A. Rifampin Reduces Oral Morphine Absorption; A Case of Transdermal Buprenorphine Selection Based on Morphine Pharmacokinetics. The Journal of Pain & Palliative Care Pharmacotherapy. Vol 26, Number 4 Dec. 2012, which has been published in final form at HERE. In this article which I co-authored with Dr. Jeffrey Fudin and Dr. Annette Payne, we present an infectious disease case complicated by chronic pain, intravenous drug use and the evident interaction between oral morphine and oral rifampin. You may qualify for a copy of the published version by request via e-mail to jeff@paindr.com.
Via pharmacokinetic monitoring of serum morphine, we observed abnormally low levels of serum morphine relative to the orally administered dose. With compliance verified and a positive patient response to pain management despite this discrepancy we had 2 options: 1) be content with the fact that the patient was responding to treatment and ignore the divergent response or 2) try to identify the origin and mechanism of the interaction and share it with our colleagues. Needless to say, we chose the latter.
We discovered that it was an interaction that many had observed in their years of practice but there was surprisingly very limited data published on the interaction. Using a combination of previously published yet relevant articles and our own pharmacokinetic data, we were able to propose an evidenced based mechanism for the interaction between oral morphine and oral rifampin; something which had yet to be done. The observation, documentation and analysis of this interaction further allowed us to incorporate the use of the buprenorphine transdermal patch for chronic pain based on serum morphine values versus the use of conventional oral dosage to guide the initiation of therapy. This case is a great example of the inherent evolutionary nature of science and understanding; that we will continue to build upon established work. The systematic publication of articles therefore creates a continuum of thought; being a part of that process is rewarding beyond description.
In addition to the professional responsibility of sharing with colleagues through publication, there is personal development that accompanies the process. As the paper came together, I had the opportunity to present our proposed mechanism for the interaction as well as become very familiar with the stringent regulations for content and presentation of articles for journal publication. Exposure to this process is particularly important for any student who is considering a residency, fellowship or other forms of post graduate training. Most programs anticipate the completion of projects with data and articles suitable for publication. It is empowering to have that prior experience and confidence. It allows you the comfort to further challenge yourself because you are no longer overwhelmed and intimidated by the mechanics of the process but rather you are now able to devote more time to analysis and interpretation. This was particularly important for me because programs and employers are seeking candidates who are innovative and dedicated to improving the quality and efficacy of care that they provide. The nature of the publication process and its inherent goal of introducing new ideas should help to develop skills that are valued in a post graduate candidate.
Numerous revisions and meticulous attention to detail are inherent norms of the process; it is undoubtedly going to be hard work. My last piece of advice is therefore to seek out opportunities for publication in areas of interest to you and others. You will commit a lot of time to gathering all the necessary information, preparing a logical proposal and then organizing it into a publishable format. Surrounding yourself with a great mentor in a field that you genuinely find interesting and rewarding will help to ease the path to your first publication.
Dania Fontenelle
Pharm.D. Candidate 2013
Albany College of Pharmacy & Health Sciences
All very good points Dania,
Extensive exposure to the process allows for pharmacists to more quickly distinguish which samples of primary literature hold potential value in clinical practice. In hospital systems, many MD’s practicing in internal medicine know to make reference to the most recent guidelines. When choosing a medication, dose, or monitoring time frame it is typically fair to trust these guidelines which have been thoroughly reviewed by experienced professionals.
When a patient presents complications that place his or her condition outside of the templates put forth by treatment guidelines, practitioners are forced to either compromise and use their non-evidence based clinical judgment or delve into a sea of primary literature.
Assessing the value of primary literature to help make recommendations in complex cases is a great skill that pharmacists can used to claim turf in the medical arena.