The Effects of Adding Semaglutide to High Daily Dose Insulin Regimens in Patients With Type 2 Diabetes.

BACKGROUND: Escalating doses of insulin required with progression of type 2 diabetes may lead to weight gain. Weight loss associated with semaglutide may be beneficial. However, data on the use of semaglutide in patients requiring high daily doses of insulin are currently lacking. OBJECTIVE: The purpose of this project was to evaluate the impact of semaglutide on total daily dose (TDD) of insulin when initiated in patients with type 2 diabetes mellitus (T2DM) on high daily doses of insulin. Secondary objectives assessed included changes in weight, body mass index (BMI), blood pressure, heart rate, and diabetes and blood pressure medications. METHODS: This IRB exempt retrospective medical record review included patients with T2DM prescribed semaglutide and at least 100 units TDD of insulin between January 1, 2019, and December 31, 2019. RESULTS: Of the 72 patients included, the TDD of insulin decreased from baseline to 6 months (183 ± 98 units and 143 ± 99 units, P < 0.001). Average A1c and body weight also decreased from baseline to 6 months (8.9% ± 1.3% and 7.6% ± 1.5%, P < 0.001 and 123.9 ± 23.5 kg and 118.9 ± 22.9 kg, P < 0.001, respectively). Limitations included a homogenous patient population and inability to control confounding factors. CONCLUSION AND RELEVANCE: Improvement in glycemic control occurred despite reductions in TDD of insulin. Improvements in A1c and body weight were clinically significant. This analysis adds to existing literature supporting the use of GLP-1 RAs in patients on high daily doses of insulin.

Erratum to "Perceptions of psychosocial and interpersonal factors affecting self-management behaviors among African Americans with diabetes" [Exploratory Research in Clinical and Social Pharmacy 3C (2021) 100057].

[This corrects the article DOI: 10.1016/j.rcsop.2021.100057.].

Impact of a novel project management course sequence on innovative thinking in pharmacy students.

BACKGROUND: As healthcare continues to become more complex, pharmacist innovators have worked to advance the profession and expand the role of the pharmacist on the healthcare team. Accreditation standards for schools of pharmacy recognize the importance of developing future pharmacist innovators capable of making positive change in the profession, but there are limited resources available on how to best instill innovative thinking in student pharmacists. EDUCATIONAL ACTIVITY: A two-semester elective course sequence was created for third-year doctor of pharmacy students requiring completion of a longitudinal quality improvement project at a partnering health system. Students collaborated with key stakeholders to design a project plan and charter, identify deliverables, and deliver project results. Innovative thinking was assessed using a mixed methods approach including questionnaires with forced choice and open response items, focus group data, and semi-structured interviews. Each questionnaire item mapped specifically to an element of a validated model for employee innovation. From the beginning to the end of the course sequence, there were significant improvements in student-perceived project management self-efficacy and innovative thinking. CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY: Student learning outcomes and the course structure mapped closely with a validated model of innovative behavior, demonstrating the effectiveness of utilizing project management to instill innovative thinking in student pharmacists. These findings support the concept that innovative thinking can be taught in pharmacy didactic curricula by situating students in the environment of real-world pharmacy practice.

Perceptions of psychosocial and interpersonal factors affecting self-management behaviors among African Americans with diabetes.

Background: African Americans are more likely to be diagnosed with diabetes and have diabetes complications as compared to non-Hispanic Whites, but have lesser medication adherence and poorer self-management behaviors. Interventions to improve self-management behaviors may not be successful if psychosocial and interpersonal factors of African Americans are not addressed. Objective: The study objective was to qualitatively explore perceptions of African Americans with type 2 diabetes (T2DM) regarding self-management behaviors and understand the effect of psychosocial and interpersonal factors on behavior change. Methods: Adults with T2DM who self-identified as African American/Black were selected from a cohort participating in a mixed-methods study in a midwestern state. The data collection and analysis were guided by the Integrated Theory of Behavior Change. Ten semi-structured, 60-min, theory-based interviews were conducted and content analysis was utilized to identify themes. Themes were then categorized based on theoretical domains. Results: The sample was mostly female, an average of 52 years old, and had a high school education or more. Four themes were identified. Two themes were categorized as psychosocial factors: 1) attitude and beliefs regarding diabetes and 2) sociocultural influences on self-management, while two were interpersonal factors: 3) role of family and social support and 4) relationships with healthcare professionals. Themes connected back to the theory and directly affected self-management behaviors. Conclusion: Future research should focus on incorporating these themes when designing interventions that improve T2DM self-management behaviors and outcomes in African Americans. Health care professionals should emphasize individualized and culturally appropriate T2DM education and counseling.

Continued Dosing of Oritavancin for Complicated Gram-Positive Infections.

Several retrospective and cohort analyses have suggested that continued dosing of oritavancin is both safe and efficacious for complicated Gram-positive infections, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci.

Characteristics of Individuals Who Chose to Participate in a Preceptor Continuing Professional Development Program.

An online program for pharmacy preceptors to improve their clinical teaching using continuing professional development (CPD) was launched in 2017. While 491 preceptors participated in the CPD program, only 35% of potential participants completed this voluntary program. A secondary data analysis was undertaken to determine the characteristics of preceptors who completed the program and identify ways to target program advertising for those who did not complete it. Residency-trained preceptors were more likely to complete the CPD program compared with those without residency training (45% and 37%, respectively; p = 0.011). This may be due to the inclusion of CPD in residency accreditation standards. To improve completion of the CPD program by preceptors without residencies, a brief introduction to CPD, a statement of benefits, and use of a personalized plan should be included in advertisements. Preceptors teaching more experiential students were more likely to complete the CPD program (p < 0.001 for introductory and advanced experiences). To encourage preceptors with less students to participate, the CPD program should be advertised year-round to allow preceptors to complete the training when it is most relevant to their precepting schedule. Future directions include the monitoring of changes in CPD program participation rates following changes in advertisements and exploring other motivations for program completion such as collaborations with employers.

Medication Adherence Changes in Blacks with Diabetes: A Mixed Methods Study.

Objectives: In this study, we conducted a longitudinal evaluation of changes in medication adherence and the role of psychosocial and interpersonal factors in these changes among Blacks with type 2 diabetes mellitus (T2DM), and determined barriers and facilitators of T2DM medication adherence. Methods: We used an explanatory sequential mixed methods design for a sample of 287 black adult patients with T2DM in Wisconsin. Two surveys quantitatively evaluated changes in medication adherence, psychosocial factors, and interpersonal factors over time. We conducted 10 semi-structured qualitative interviews to explore participants' perceptions of these changes. Data integration of the quantitative and qualitative findings elucidated barriers and facilitators of medication adherence. Results: Increased adherence was significantly correlated with less concerns about medicines (r = -0.31), higher self-efficacy (r = 0.47), lesser depressive symptoms (r = -0.26), and lesser negative illness perceptions (r = -0.26) at both baseline and follow-up. Patient perceptions of adherence changes included adherence motivators, social support, and complex medication regimens. Integration showed that barriers and facilitators both existed in individuals who had an increase or a decrease in adherence over time. Conclusions: Specific beliefs of Blacks towards T2DM medications must be addressed to improve their adherence. Interventions must be tailored using interpersonal factors.

µ-1,4-Bis(pyridin-4-ylmeth-yl)piperazine-κN:N'-bis-[aqua-bis-(3-bromo-5-carb-oxy-benzoato-κO)copper(II)].

In the title compound, [Cu(2)(C(8)H(4)BrO(4))(4)(C(16)H(20)N(4))(H(2)O)(2)], slightly distorted square-planar-coordinated Cu(II) ions are bound by one aqua ligand and two monodentate 3-bromo-5-carb-oxy-benzoate anions, and linked into a centrosymmetric dinuclear mol-ecule by a bridging 1,4-bis-(pyridin-4-ylmeth-yl)piperazine (4-bpmp) ligand. In the crystal, mol-ecules are connected into a supra-molecular two-dimensional network parallel to (131) via O-H⋯O hydrogen bonds involving the aqua ligands and 3-bromo-5-carb-oxy-benzoate carboxyl-ate groups.