Comparison of dosing errors between tenecteplase and alteplase for management of acute ischemic stroke.

BACKGROUND: Acute ischemic stroke (AIS) is a medical emergency leading to morbidity and mortality. Thrombolytic therapy is currently the mainstay for the management of AIS owing to its improvement in neurologic function at 3 months. OBJECTIVES: The objective of this study was to compare the frequency of dosing errors made with tenecteplase versus alteplase administration in management of AIS. The secondary objectives evaluated efficacy outcomes of intensive care unit length of stay (LOS), hospital LOS, and time from door to needle and safety outcomes of bleeding and all-cause mortality between groups. METHODS: This multicenter retrospective cohort study included patients with AIS treated with thrombolytics (tenecteplase or alteplase). The study evaluated patients at 9 different hospitals in a Texas Network between August 2018 and August 2020. RESULTS: There were 3808 patients evaluated for inclusion and 359 were included: 171 in the tenecteplase group and 188 in the alteplase group. There were no differences found in dosing errors between tenecteplase and alteplase (25.7% vs. 32.4%, P = 0.16). There was no difference in all-cause mortality (tenecteplase 1.8% vs. alteplase 5.3%, P = 0.09) or bleeding events (tenecteplase 8.8% vs. alteplase 7.4%, P = 0.64). Patients who received tenecteplase had improved door to needle time < 60 minutes (tenecteplase 60% vs. alteplase 49%, P = 0.04). CONCLUSION: There was no difference in dosing errors between tenecteplase and alteplase for the management of AIS. Tenecteplase was associated with shorter door to needle times, which may be caused by simpler administration times. Institutions could consider strategies to mitigate dosing errors for thrombolytic therapies.

GLP-1 Agonists in Type 1 Diabetes Mellitus.

OBJECTIVE: To review the use of GLP-1 agonists in patients with type 1 diabetes mellitus (T1DM). DATA SOURCES: A search using the MEDLINE database, EMBASE, and Cochrane Database was performed through March 2016 using the search terms glucagon-like peptide 1 (GLP-1) agonists, incretin, liraglutide, exenatide, albiglutide, dulaglutide, type 1 diabetes mellitus STUDY SELECTION AND DATA EXTRACTION: All English-language trials that examined glycemic end points using GLP-1 agonists in humans with T1DM were included. DATA SYNTHESIS: A total of 9 clinical trials examining the use of GLP-1 agonists in T1DM were identified. On average, hemoglobin A1C (A1C) was lower than baseline, with a maximal lowering of 0.6%. This effect was not significant when tested against a control group, with a relative decrease in A1C of 0.1% to 0.2%. In all trials examined, reported hypoglycemia was low, demonstrating no difference when compared with insulin monotherapy. Weight loss was seen in all trials, with a maximum weight loss of 6.4 kg over 24 weeks. Gastrointestinal adverse effects are potentially limiting, with a significant number of patients in trials reporting nausea. CONCLUSION: The use of GLP-1 agonists should be considered in T1DM patients who are overweight or obese and not at glycemic goals despite aggressive insulin therapy; however, tolerability of these agents is a potential concern. Liraglutide has the strongest evidence for use and would be the agent of choice for use in overweight or obese adult patients with uncontrolled T1DM.

Mentorship Landscape and Common Practices in an Academic Pharmacy Association.

OBJECTIVES: To explore the landscape of mentorship within professional associations in pharmacy academia, including reviewing available literature and describing currently available programs within the American Association of Colleges of Pharmacy, and recommend key considerations for the development of mentorship programs within professional associations. FINDINGS: A literature review of mentorship programs within professional associations for pharmacy academics was conducted, with a total of 5 articles identified and summarized. Additionally, a survey was conducted to determine the landscape of available mentorship programs within American Association of Colleges of Pharmacy affinity groups to capture unpublished experiences. Information regarding common characteristics and assessment methods was collected for groups that have mentorship programs, while needs and barriers were collected for those who did not. SUMMARY: Literature, while limited, supports positive perceptions of mentorship programs within professional associations. Based on the responses and working group experience, several recommendations are proposed for mentorship program development, including the need for clearly defined goals, relevant program outcomes, association support to reduce redundancies and promote participation, and, in some cases, implementation of an association-wide program to ensure access to mentorship.

A Systematic Review and Meta-Analysis of Metolazone Compared to Chlorothiazide for Treatment of Acute Decompensated Heart Failure.

Treatment of volume overload in the setting of acute decompensated heart failure (ADHF) is typically achieved through the use of loop diuretics. While they are highly effective, some patients may develop loop diuretic resistance. One strategy to overcome this scenario includes sequential nephron blockade with a thiazide-type diuretic; however, it is unknown which thiazide-type diuretic used in this setting is most effective. A systematic review and meta-analysis were performed to compare the efficacy and safety of chlorothiazide with metolazone as add-on therapy in the setting of loop diuretic resistance for the treatment of ADHF. Literature searches were conducted through PubMed, Google Scholar, and Science Direct from inception through February 2020 using the following search terms alone or in combination: metolazone, chlorothiazide, acute decompensated heart failure, loop diuretic, and urine output. All English-language prospective and retrospective trials and abstracts comparing metolazone to chlorothiazide for the treatment of ADHF were evaluated. Studies were included if they analyzed urine output for at least 24 hours in patients with ADHF. Meta-analysis was conducted to evaluate pooled effect size by using a random-effect model. Primary outcomes included net and total urine output. Secondary outcomes included commonly reported safety outcomes. Four studies comparing the use of metolazone to chlorothiazide as an adjunct to loop diuretics to treat ADHF were included in the evaluation. Metolazone was as effective as chlorothiazide to augment loop diuretic therapy in ADHF in most studies with no pooled difference in net or total urine output. However, there were notable differences in baseline loop diuretic dosing, ejection fraction, renal function, race, and endpoint timing across studies. Adverse effects were commonly observed and included electrolyte abnormalities, change in renal function, and hypotension but were comparable between groups. Metolazone is as effective as chlorothiazide as add-on to loop diuretics in treating ADHF without an increase in safety concerns.

High-dose Cholecalciferol Supplementation in Adults with Cystic Fibrosis.

INTRODUCTION: Despite the availability of consensus guidelines for the treatment of vitamin D deficiency, prospective trials are lacking to examine alternative dosing strategies for adult patients with cystic fibrosis (CF) who do not meet therapeutic goals with standard regimens. OBJECTIVES: The primary objective of this study was to determine the efficacy of high-dose cholecalciferol supplementation in increasing serum vitamin D (25-OHD) levels in adult patients with CF. METHODS: Patients were eligible for inclusion if they were 18 years or older, had baseline 25-OHD levels lower than 30 ng/ml, and were diagnosed with CF and pancreatic insufficiency. Patients were given a single dose of cholecalciferol 300,000 or 500,000 IU based on baseline 25-OHD levels. Response was defined by 25-OHD and ionized calcium levels at 3 months. At 6 months, responders received a second dose of the same strength, and nonresponders were given a weekly supplement of cholecalciferol 50,000 IU in addition to cholecalciferol 500,000 IU. A second 25-OHD level was obtained at 9 months. RESULTS: Of the 46 patients enrolled, 32 patients (70%) completed the study. Baseline levels of 25-OHD significantly increased over time in the per protocol population at 3 and 9 months. A total of 16 patients (50%) were considered nonresponders and required weekly supplementation. CONCLUSION: A protocol using high-dose cholecalciferol or high-dose plus weekly cholecalciferol is safe and effective in treating adult patients with CF and pancreatic insufficiency.

Hybrid Online Delivery of a Pharmacy Residency and Fellowship Elective Course.

OBJECTIVE: To describe and evaluate the transition of a pharmacy residency and fellowship (PRF) elective course to a hybrid online platform. INNOVATION: In 2016, the 1-credit hour PRF elective was transitioned from a live, synchronous course to a hybrid online platform. Over the course of the semester, students completed eight modules along with assignments that pertained to a different component of PRF. Course grades and evaluations, as well as PRF placement rates, were compared between 2015 (live, synchronous course) and 2016 (hybrid online course). There were no differences in overall course grades or student evaluations of individual relevant course objectives between the two course formats. However, more students rated the course as excellent during the 2015 live, synchronous course. Placement rates were similar between students who took the course in 2015 and 2016. CRITICAL ANALYSIS: Following the transition of a PRF elective to a hybrid online platform, course grades, evaluation of individual relevant course objectives, and PRF placement rates remained similar to previous years. Creative educational venues can help meet the student demand while simultaneously allowing faculty to manage their time. However, instructors should balance this with desire of students to have more face-to-face in class time.

Assessment of Learner Metacognition in a Professional Pharmacy Elective Course.

Objective. To investigate the effect of strategic feedback and metacognitive processes on learners' ability to predict performance and improve self-awareness. Methods. Strategic faculty and peer feedback, as well as self-assessments, were implemented in a professional pharmacy elective course throughout the semester, focused on three case-based oral presentations. After each presentation, students utilized an objective rubric to determine self-predicted and peer-predicted scores. Actual scores from faculty were compared to students' predicted scores. Results. Students' ability to predict presentation scores did not improve over time; however, students were able to accurately estimate performance in certain rubric sections on individual presentations (depth of problem, presentation). Students were generally overconfident in predicting their performance. When broken down into tertiles, top performing students were more accurate in their self-assessments compared to bottom performing students. Bottom performing students were highly overconfident in their assessment. Conclusion. Self-awareness is essential for professionals, though difficult to cultivate and improve in one semester. Incorporating longitudinal, continuous feedback and metacognitive skills may help learners become more aware of their own performance and devise a plan for enhancement.