Collaborative practice between pharmacists and physicians is an important component of the evolving role of the pharmacist providing outpatient anticoagulation clinical services. Multiple issues should be addressed before the implementation of such services, including ensuring state laws and regulatory agencies' requirements are met. When a collaborative agreement is formed, the support of hospital services is vital to develop an outpatient anticoagulation clinic. The authors wish to offer this legal and regulatory process that evolved over a 5-year time period as an overview of potential areas to address when beginning a pharmacist-managed anticoagulation clinic. Our clinic example was between a community hospital and college of pharmacy faculty practitioners, but many of the principles can be extrapolated to other pharmacist practitioners not associated with a college of pharmacy. Throughout the article, we will briefly share the rationale and benefits of collaborative practice, with the main focus being the planning and implementation of an anticoagulation service and key hospital departments involved in that process.

No abstract

Healthy outcomes for both mother and child are expected and fortunately seen in most pregnancies. In some cases, serious or potentially serious problems arise during the pregnancy that mandate a need for both close monitoring and treatment interventions by health care providers. Gestational diabetes mellitus (GDM) is such a condition that may evolve during pregnancy. Women who experienced gestational diabetes during pregnancy are at increased risk of developing Type 2 diabetes as are their offspring. As defined, GDM is a type of diabetes restricted to pregnant women in whom the recognition of glucose intolerance first occurs during pregnancy.' Physicians and pharmacists who are trained in the management of diabetes can help guide the patient with GDM through the pregnancy and after delivery, monitor her and the infant. This article reviews the current concepts pertaining to the basic pathophysiology, detection, diagnosis, and management of gestational diabetes mellitus. ETIOLOGY AND OCCURRENCET HE OCCURRENCE OF gestational diabetes in pregnancy ranges from approximately 2% to 6% of all pregnancies making it a frequent complication seen in the health care setting. Diabetes can be classified by origin, it is either classified as pregestational (approximately 10% of cases) or gestational (approximately 90% of cases). Women who had diabetes prior to conception are tenned as having pregestational diabetes mellitus, whereas gestational diabetes mellitus is defined by any degree of glucose intolerance with onset or first recogni-