Impact of the COVID-19 Pandemic on US Pharmacy Academia Per Perspectives of Faculty and Administrators.

OBJECTIVE: The COVID-19 pandemic has markedly affected academic and administrative facets of pharmacy education. However, to date, no study has systematically summarized pandemic-related changes at pharmacy schools across the United States. This study aimed to evaluate US pharmacy school faculty and administrators' perspectives on the pandemic's impact on pharmacy academia. METHODS: A web-based survey was sent to US pharmacy school faculty and administrators in August 2020. The survey included questions assessing the pandemic's impact on the faculty's teaching, the school's financial status, administrative aspects, and mental well-being of faculty and administrators. Descriptive statistics and 1-sample Z tests were used for conducting statistical analyses. RESULTS: The survey was sent to 6177 individuals, of whom 1068 participated (17.3% response rate). In total, 931 respondents (759 faculty and 172 administrators) completed the entire survey. Both faculty and administrators experienced increased workload while their mental health and job satisfaction declined. Faculty's teaching satisfaction, research productivity, and service activity worsened. Administrators identified decreases in revenue sources and increases in expenses associated with the pandemic. Administrators also indicated the negative impact of the pandemic on an array of administrative and academic aspects within their pharmacy schools. The qualitative analysis identified several overlapping themes highlighting the negative effects of the pandemic on the faculty's teaching. CONCLUSION: Present findings indicate the negative effects of the COVID-19 pandemic on a variety of academic and administrative aspects at US pharmacy schools. These findings could provide useful information to stakeholders in pharmacy academia.

Variables affecting pharmacy students' pursuit and attainment of postgraduate residency and fellowship positions.

INTRODUCTION: Postgraduate pharmacy residency and fellowship positions have remained competitive. We evaluated factors predicting students' pursuit and attainment of postgraduate pharmacy training positions. METHODS: A web-based survey was administered to students from a three-year accelerated pharmacy program. The survey asked questions regarding the participants' demographics, cumulative academic pharmacy grade point average (GPA), school leadership positions in organizations or committees, and research activities. Students' resilience was measured by the Academic Pharmacy Resilience Scale questionnaire. Multiple logistic regression was used to determine variables that predicted the pursuit and attainment of residency positions. RESULTS: The survey response rate was 46.7%. Students with greater cumulative GPA (odds ratio [OR] 6.3; 95% CI, 2.25-17.68), research experience (OR 3.3; 95% CI, 1.29-8.45), resilience scores (OR 1.07; 95% CI, 1.03-1.12), and leadership in an organization (OR 3.27; 95% CI, 1.46-7.33) or school committee (OR 2.29; 95% CI, 1.04-5.07) were more likely to apply to a residency program. Students with greater cumulative GPA (OR 9.93; 95% CI, 1.33-74.23), self-rated performance score in the residency interview (OR 5.32; 95% CI, 2.47-11.44), and leadership experience on a school committee (OR 15.37; 95% CI, 3.94-59.93) were more likely to match with a residency program. The average scores on interview performance and networking were significantly higher in students who obtained a fellowship position compared to those who did not obtain that. CONCLUSIONS: This study identified several predictors for the pursuit and attainment of residency or fellowship positions, which could inform pharmacy educators, students, and program directors.

Effects of the hangover secret on mitigating hangover symptoms: A pilot study.

BACKGROUND: Due to the popularity of excessive alcohol consumption, there is an increasing need for hangover symptom remedies. Most commercially available hangover treatment products have not been tested for efficacy through clinical study. AIMS: The purpose of this pilot study was to characterize the activity of a commercially available hangover product, The Hangover Secret (THS). METHODS: This was a randomized, double-blinded, placebo-controlled, crossover pilot study. Healthy volunteers of 21- to 40-years-old were eligible for participation, and received either THS or placebo on two different occasions. Participants were given 43 mL of whiskey every twenty minutes for up to 3 hours to achieve a blood alcohol concentration (BrAC) ≥ 0.12%. Hangover severity was assessed using the Acute Hangover Scale (AHS) and Acute Hangover Severity Scale (AHSS) validated tools. RESULTS: Nine participants completed the study. AHS scores increased from baseline to 7 am by 4.11 ± 3.17 and 1.26 ± 2.29 for the placebo and active arms respectively (P = .16). AHS headache scores increased from baseline to 7 am by 2.44 ± 1.67 and 1.11 ± 1.17 for the placebo and active arms respectively (P = .06). AHSS scores increased from baseline to 7 am by 1.0 ± 1.05 and 0.41 ± 1.08, for the placebo and active arms respectively (P = .30). There was no significant difference between average BrAC at 7 am between the placebo and active arms. CONCLUSION: THS showed positive signals in the prevention of alcohol-induced hangover, especially headaches. The improvements with THS surpassed the minimum clinically important difference in overall AHS score and three individual AHS symptoms scores (hangover, headache, and thirsty). THS's reduction in AHS or AHSS scores did not reach statistical significance likely due to the small sample size. Larger studies with appropriate sample sizes are needed in light of these promising findings.

Electrocardiographic and blood pressure effects of energy drinks and Panax ginseng in healthy volunteers: A randomized clinical trial.

BACKGROUND: Energy drink usage has been linked to emergency room visits and deaths. The objective of the study is to assess the electrocardiographic and blood pressure effects of energy drinks, Panax ginseng and placebo in healthy individuals. METHODS: This was a randomized, double blinded, placebo controlled, crossover study. Young healthy volunteers with no comorbid conditions consumed 32oz of an energy drink, control drink with 800mg of Panax ginseng or matching placebo-control drink over 45min. Primary endpoints were QTc interval and systolic blood pressure. Secondary endpoints included QT interval, PR interval, QRS duration, heart rate, and diastolic blood pressure. All endpoints were assessed at baseline, 1, 2, 3.5, and 5.5h. RESULTS: A significant increase in QTc interval 2h post energy drink consumption was evident when compared to placebo (3.37±10.7ms and -3.19±11.8ms respectively; p=0.030). Similarly, systolic blood pressure 2h post energy drink consumption increased when compared to placebo (2.00±6.37mmHg and -2.67±5.83mmHg respectively; p=0.014). The PR interval significantly reduced over a 2h period post energy drink use in a clinically non-meaningful manner. Heart rate at 2h was not significantly higher in the energy drink group when compared to others. The QT interval, QRS interval and diastolic blood pressure were not impacted at any time point. CONCLUSIONS: Certain energy drinks consumed at a high volume significantly increase the QTc interval and systolic blood pressure by over 6ms and 4mmHg respectively. Panax ginseng does not have a significant impact on ECG or blood pressure parameters.

Impact of tofacitinib on patient outcomes in rheumatoid arthritis - review of clinical studies.

Rheumatoid arthritis is a chronic, progressive autoimmune disease associated with inflammation and destruction of joints and systemic effects, which result in significant impact on patient's quality of life and function. Tofacitinib was approved for the treatment of rheumatoid arthritis in the USA in 2012 and subsequently in other countries, but not by the European Medicines Agency. The goal of this review was to evaluate the impact of tofacitinib on patient-reported and patient-specific outcomes from prior clinical studies, focusing on quality of life, functionality, pain, global disease assessment, major adverse consequences, and withdrawals. A total of 13 reports representing 11 clinical studies on tofacitinib in rheumatoid arthritis were identified through PubMed and reference lists in meta-analyses and other reviews. Data on improvements in patient-driven composite tools to measure disease activity in rheumatoid arthritis, such as the Health Assessment Questionnaire, served as a major outcome evaluated in this review and were extracted from each study. Additional data extracted from those clinical studies included patient assessment of pain (using a 0-100 mm visual analog scale), patient global assessment of disease (using a 0-100 mm visual analog scale), patient withdrawals, withdrawals due to adverse effects or lack of effect, and risk of serious adverse effects, serious infections, and deaths. Tofacitinib 5 mg bid appears to have a favorable impact on patient outcomes related to efficacy and safety when compared with baseline values and with comparator disease-modifying antirheumatic drugs and placebo. Improvements were seen in the composite and individual measures of disease activity. Serious adverse effects, other adverse consequences, overall withdrawals, and withdrawals due to adverse effects and lack of efficacy are similar or more favorable for tofacitinib versus comparator disease-modifying antirheumatic drugs and placebo. At this point, tofacitinib appears to have an important role in the treatment of rheumatoid arthritis through improvement in these patient outcomes. However, it may require years of additional clinical studies and postmarketing surveillance to fully characterize the benefit-to-risk ratio of tofacitinib in a larger and diverse patient population.

Tofacitinib: The First Janus Kinase (JAK) inhibitor for the treatment of rheumatoid arthritis.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy and safety, dosage administration, and adverse effects of tofacitinib for rheumatoid arthritis (RA) treatment. DATA SOURCES: Primary sources of information were obtained from clinical studies, which were identified through PubMed (1966 to June 2013) and International Pharmaceutical Abstracts (1970 to March 2013) using terms: tofacitinib, tasocitinib, CP-690550, and CP-690,550. Information was used from tofacitinib package insert, guidelines, and published abstracts from the American College of Rheumatology (ACR) and the European League Against Rheumatism. STUDY SELECTION AND DATA EXTRACTION: Data search was limited to include publications in English language and from human subjects. DATA SYNTHESIS: Tofacitinib is the first oral Janus kinase inhibitor indicated for treatment of moderate to severe RA. Tofacitinib demonstrated efficacy and safety comparable to other disease-modifying antirheumatic drugs (DMARDs). Tofacitinib was efficacious in RA patients, indicated by achievements of ACR20, ACR50, and ACR70 criteria. Similar improvements were observed in patients who met remission criteria based on the Disease Activity Scores 28 criteria and quality of life as measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI). Tofacitinib was associated with infections and malignancies; and elevations in serum creatinine and lipids were observed. Drug interactions with inducers and inhibitors of the cytochrome P-450 3A4 and 2C9 isoenzymes were reported. CONCLUSIONS: Tofacitinib is an oral treatment option for RA patients who have inadequate response or intolerance to methotrexate. Postmarket surveillance will provide further insight to tofacitinib's role in RA therapy, especially in patients who may require different types of combination therapy with DMARDS.

Evaluation of pharmacy practice residents' research abstracts and publication rate.

OBJECTIVE: To determine the type, scope, and publication rate of pharmacy practice residency projects conducted in a subgroup of the United States. METHODS: Data were collected from the abstract book of the 28th Western States Conference for Pharmacy Residents, Fellows, and Preceptors (May 20-23, 2008). Data on project publication rate, institution affiliation, residency year, research practice setting, research therapeutic area, research hypothesis category, study design, statistical plan, and abstract reporting were extracted independently by two investigators. RESULTS: A total of 446 abstracts were presented at the annual residency meeting, 19 (4.3%) of which were published as full text in PubMed-indexed journals. The majority of the abstracts were presented by residents from California (52%). A total of 390 (87%) and 34 (8%) of the presentations were from postgraduate year (PGY)1 and PGY2 pharmacy residencies, respectively. PGY2 residents were more likely to report results at the time of abstract deadline compared with PGY1 residents (30.8% vs. 10.5%, P = 0.0185). Of the 19 publications found, about 3.6% (14 of 390) were from PGY1 residents compared with 14.7% (5 of 34) from PGY2 residents (P = 0.0126). A significantly higher percentage of abstracts that reported results in the study description resulted in publication compared with those that did not report results (10.2% vs. 3.5%; P = 0.0461). CONCLUSION: Although many residents in the western United States undertake residency projects, few projects result in journal publications. While PGY2 residents appear to be publishing at a higher rate than PGY1 residents, proper resource allocation and research training and collaboration by the residency director may improve overall research type, scope, and publication rate.

New oral anticoagulants for atrial fibrillation: a review of clinical trials.

BACKGROUND: Warfarin had been the only oral anticoagulant for stroke prevention in patients with atrial fibrillation (AF) for decades. Direct thrombin inhibitors and factor Xa inhibitors are new anticoagulants recently approved for prevention of stroke or systemic embolism in patients with AF. OBJECTIVE: The aim of this article was to provide a systematic review of recently published clinical data on the direct thrombin inhibitors and factor Xa inhibitors in the management of AF. METHODS: A search of the ClinicalTrials.gov registry was conducted using the subject terms dabigatran, rivaroxaban, and apixaban. Each search was limited to clinical trials that included patients with AF. Completed studies with warfarin as the main comparator were identified. From the yielded results, the national clinical trial identifier was inputted in PubMed (1966-November 2011) for a search of published literature. RESULTS: Three Phase III clinical trials reported the efficacy of each agent in patients who have AF and risk factors for stroke or embolic complications. The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) study reported dabigatran 150 mg was associated with a lower rate of stroke and systemic embolism, whereas dabigatran 110 mg was associated with a similar rate for such events when compared with warfarin (relative risk = 0.66; 95% confidence interval [CI], 0.53-0.82; P < 0.001; and relative risk = 0.91; 95% CI, 0.74-1.11; P = 0.34, respectively). From the intention-to-treat analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, rivaroxaban was reported to be noninferior to warfarin in reducing stroke or systemic embolism (2.1% vs 2.4% per year; hazard ratio = 0.88; 95% CI, 0.75-1.03; P < 0.001). The Apixaban for Reduction in Stroke and Other Thrombotic Events in Atrial Fibrillation (ARISTOTLE) trial reported that apixaban reduced stroke or systemic embolic events by 21% when compared with warfarin (1.27% vs 1.60% per year, respectively; hazard ratio = 0.79; 95% CI, 0.66-0.95; P < 0.001). All 3 agents were associated with similar bleeding when compared with warfarin. CONCLUSIONS: Published data suggest that all 3 agents are at least as efficacious as dose-adjusted warfarin, with similar major bleeding profiles. For patients who are unwilling to adhere to regular coagulation monitoring or whose therapeutic effect using warfarin is not optimal despite adequate monitoring and management, the inhibitors of direct thrombin or factor Xa may provide alternative choices in anticoagulation.

Aldosterone receptor antagonism in heart failure.

The renin-angiotensin-aldosterone system plays a major role in the pathophysiology of heart failure. Aldosterone is one of the central mediators involved in the cardiac remodeling process. Its classic effect in heart failure is attributed to mineralocorticoid receptor-mediated salt and fluid retention leading to increased afterload. New evidence demonstrates nonclassic effects of increased collagen synthesis and myocardial fibrosis resulting in left ventricular hypertrophy. Antagonism of aldosterone receptors with spironolactone benefits patients with severe heart failure, and eplerenone benefits those after myocardial infarction who have left ventricular dysfunction. Future research is directed at aldosterone antagonism in patients with mild-to-moderate heart failure, coronary artery disease treated with percutaneous coronary intervention, and nephropathy complicated by diabetes mellitus.

Impact of the clinical pharmacist on readmission in patients with acute coronary syndrome.

BACKGROUND: Previous studies have reported a positive impact of pharmacists on care of patients with chronic illnesses. The impact of the clinical pharmacist on hospital readmission in patients with acute coronary syndromes (ACS) has yet to be evaluated, as of this writing. OBJECTIVE: To evaluate the impact of the clinical pharmacist as a direct patient-care team member on cardiac-related readmission in patients admitted to the general cardiology unit with ACS. METHODS: A prospective, nonrandomized observational study compared patients who received standard practice care with patients admitted to a service with a clinical pharmacist to provide care at the bedside. Patients admitted to and discharged from the general cardiology unit for ACS were included. The primary endpoint of the study was cardiac-related readmission at 30 days following hospital discharge. Secondary endpoints included length of stay and medication utilization. Interventions provided by the clinical pharmacist in the study group were documented. RESULTS: Cardiac readmission at 30 days was similar between the groups (p = 0.59). In the subset of patients with unstable angina, readmission in the study group was significantly lower than in the control group (1.3% vs 9.1%; p = 0.04). Patients in both groups were similarly managed using drug therapy and invasive coronary interventions. The medical staff's rate of acceptance of recommendations provided by the pharmacist was 94.4%. The most common interventions were medication education and identification of indicated therapy. CONCLUSIONS: The addition of pharmacists did not decrease readmission in patients with ACS. The finding of significant reduction in readmission in the subset of patients with unstable angina should be considered "hypothesis generating" for future randomized studies to confirm the results.

Nesiritide for secondary pulmonary hypertension in patients with end-stage heart failure.

PURPOSE: The impact of adding nesiritide to standard therapy and positive inotropic agents in patients with end-stage heart failure and secondary pulmonary hypertension (PH) was studied. METHODS: Patients included in this retrospective study were 18 years of age or older, admitted to the hospital with PH secondary to end-stage heart failure (New York Heart Association functional class IV), had received a pulmonary artery catheter, had been treated with nesiritide because of inadequate hemodynamic response to previous therapy (pulmonary capillary wedge pressure [PCWP], >18 mm Hg), and had shown minimal symptomatic benefit from standard heart-failure therapy, continuous infusions of loop diuretics, and positive inotropic agents (milrinone or dobutamine or both). The primary endpoint was change in PCWP. Secondary endpoints included change in mean pulmonary artery pressure (MPAP), change in cardiac index (CI), change in mean arterial pressure (MAP), change in serum creatinine (SCr) concentration, and occurrence of symptomatic hypotension. RESULTS: The study included 33 patients. Mean PCWP was reduced by 31.1% with the addition of nesiritide to previous therapy (p < 0.0001). Significant improvements in other hemodynamic variables, including MPAP (15.6% reduction) and CI (13.0% increase), were also observed. MAP was reduced significantly (by 15.2%), but SCr concentration did not change. There were five episodes of symptomatic hypotension. All patients exhibited relief of dyspnea symptoms. CONCLUSION: The addition of nesiritide to standard therapy and positive inotropic agents improved hemodynamic measures and clinical symptoms in patients with end-stage heart failure and secondary pulmonary hypertension.