Bioidentical Oral 17ß-Estradiol and Progesterone for the Treatment of Moderate to Severe Vasomotor Symptoms of Menopause.

OBJECTIVE: To review the efficacy, safety, and available literature regarding the novel combination bioidentical product Bijuva, or 17ß-estradiol/progesterone (17ß-E/P), for the treatment of moderate to severe menopausal symptoms in cisgender females with an intact uterus. DATA SOURCES: Literature searches of both PubMed (1966 to October 2020) and Google Scholar were conducted using search terms including bioidentical, estradiol, progesterone, menopause, E2/P4, TX-001HR, and Bijuva. STUDY SELECTION AND DATA EXTRACTION: All articles with studies conducted in cisgender human females and in the English language were considered for review; 18 publications were included. DATA SYNTHESIS: In 1 phase 3 clinical study, 17ß-E/P was proven to be effective at reducing the frequency and severity of vasomotor symptoms (VMS) at 12 weeks compared with placebo, and no cases of endometrial hyperplasia were observed over the 52-week safety study period. Menopausal women with an intact uterus were included in the study population. RELEVANCE TO PATIENT CARE AND PRACTICE: Concerns over content and safety of compounded bioidentical hormones have been raised by several professional societies. As women experience VMS of menopause, a desire for a Food and Drug Administration-regulated bioidentical combination product for the treatment of moderate to severe menopausal symptoms may be desirable. Given as a once-daily oral capsule at the dose of 1 mg estradiol/100 mg progesterone, 17ß-E/P is approved for the treatment of VMS associated with menopause. CONCLUSIONS: 17ß-E/P is a novel bioidentical product that is the first of its kind in the treatment of moderate to severe menopausal symptoms.

Impact of health system protocol on patient qualification for influenza point-of-care testing.

BACKGROUND: Point-of-care testing (POCT) is a service that community pharmacies are implementing to increase patient access to care. Many pharmacies develop protocols with physicians to maximize patient qualification for POCT, while maintaining patient safety. OBJECTIVE: To determine the number of patients seen for influenza in the emergency department (ED) during the 2018-2019 season who would qualify for protocol-driven influenza testing. METHODS: This was a retrospective review of medical records. Patients seen in this 92 bed ED, level III trauma center between October 1, 2018 and May 1, 2019 were included if their age was older than 11 years or younger than 71 years with an influenza-related diagnosis. Patients were excluded if they were pregnant or breastfeeding, were allergic to oseltamivir, were recently diagnosed with pneumonia, or recently received a live influenza vaccine. Patient information collected included: sex, age, height, weight, pulse, blood pressure, respiratory rate, temperature, oxygen saturation, mental status, symptoms, time since onset of symptoms, immune system status, and history of respiratory illness or respiratory disease. These data points were used to determine eligibility for POCT based on a prespecified protocol that included criteria such as vital signs, symptom presentation, and other health conditions. The primary end point was the number of patients eligible for institutional protocol-driven POCT. RESULTS: There were 1955 ED visits with a primary diagnosis of influenza; 451 were eligible for study inclusion, and 49 (11%) qualified for POCT. The most common reason that patients did not qualify was temperature. If required temperature had been removed from the protocol, 155 patients (34%) would have qualified for POCT. CONCLUSION: On the basis of the institutional protocol, a small proportion of patients qualified for POCT. Without the protocol temperature requirement, the number of patients who qualified for POCT would have greatly increased. This study identified opportunities for improvement in the institutional protocol. Future research is needed to reassess the number of patients who qualify once revisions are made.

Relationship between medication synchronization and antiretroviral adherence.

OBJECTIVES: To compare antiretroviral adherence (measured as the proportion of days covered [PDC]) and change in viral load in insured, HIV-infected, adult outpatients enrolled and not enrolled in a medication synchronization program. METHODS: This was a multicenter, retrospective, pilot cohort study. Fifty-eight insured, HIV-infected, outpatients at least 18 years of age receiving antiretroviral therapy (ART) for at least 3 months as of August 2015 were included. PDC, viral load, PDC dichotomized into adherent or nonadherent, and viral load dichotomized into detectable or undetectable were collected for each patient. Study data were compared in those with (enrolled) and without (not enrolled or control) medication synchronization. The study end points were analyzed between the 2 groups retrospectively after 3 months. RESULTS: PDC in patients undergoing medication synchronization was significantly higher than in control patients: mean ± SD 96 ± 9% versus 71 ± 27%, respectively (P < 0.0001). The medication synchronization group was also more likely to be adherent to ART than the control group (odds ratio 10.67, 95% confidence interval 2.63-43.31). In the medication synchronization group, 75.9% of patients had an undetectable baseline viral load, and 83.3% had an undetectable viral load at study completion. In the control group, 62.1% and 64.7% had an undetectable viral load at baseline and completion, respectively. No statistically significant change in viral load was observed between groups (P = 0.34). CONCLUSION: In insured, HIV-infected, adult outpatients, implementation of a medication synchronization program was associated with improved ART adherence. Future studies are needed to better assess the impact of medication synchronization on clinical outcomes.

Mapping the association between mental health and people's perceived and actual ability to practice hygiene-related behaviours in humanitarian and pandemic crises: A scoping review.

Humanitarian crises such as disease outbreaks, conflict and displacement and natural disasters affect millions of people primarily in low- and middle-income countries. Here, they often reside in areas with poor environmental health conditions leading to an increased burden of infectious diseases such as gastrointestinal and respiratory infections. Water, sanitation, and hygiene behaviours are critical to prevent such infections and deaths. A scoping review was conducted to map out what is known about the association between three mental health disorders and people's perceived and actual ability to practice hygiene-related behaviours, particularly handwashing, in humanitarian and pandemic crises. Published and grey literature was identified through database searches, humanitarian-relevant portals, and consultations with key stakeholders in the humanitarian sector. 25 publications were included, 21 were peer-reviewed published articles and four were grey literature publications. Most of the studies were conducted in mainland China (n = 12) and most were conducted in an outbreak setting (n = 20). Six studies found a positive correlation between handwashing and anxiety where participants with higher rates of anxiety were more likely to practice handwashing with soap. Four studies found an inverse relationship where those with higher rates of anxiety were less likely to wash their hands with soap. The review found mixed results for the association between handwashing and depression, with four of the seven studies reporting those with higher rates of depression were less likely to wash their hands, while the remaining studies found that higher depression scores resulted in more handwashing. Mixed results were also found between post-traumatic stress disorder (PTSD) and handwashing. Two studies found that lower scores of PTSD were associated with better hygiene practices, including handwashing with soap. The contradictory patterns suggest that researchers and practitioners need to explore this association further, in a wider range of crises, and need to standardize tools to do so.

Comparison of Student Pharmacists' Knowledge Retention Utilizing Electronic Health Records Versus Simultaneously Completing Simulated Experiences.

Objective. The purpose of this study was to determine whether the addition of standardized patients or the addition of interprofessional student teams with standardized patients to the use of a simulated electronic health record improved student knowledge retention and perceptions.Methods. This was a prospective cohort study assessing three cohorts of first-year student pharmacists in pharmacy skills laboratory activities that occurred in 2018, 2019, and 2021. The primary objective of the study was to compare knowledge retention of the case material between groups at one month. Each year, an element of simulated experience was added onto the previous year's case. In 2018, students completed the case using only the electronic health record web application. In 2019, the previous year's experience was combined with an objective structured clinical examination (OSCE) with standardized patients. In 2021, the 2019 experience was supplemented with student physician assistants. Case scores and student perceptions were also compared between groups.Results. Of the 260 potential participants, 238 students were included in the primary analysis. Results showed that with the addition of interprofessional team-based care and standardized patients, significant improvement was demonstrated in knowledge retention assessments at one month. Mean knowledge retention assessment scores for the 2018, 2019, and 2021 groups were 63.8%, 71.7%, and 76.1%, respectively. Significant improvement was also found in student perceptions.Conclusion. Adding standardized patients and interprofessional team-based care to a pharmacy skills laboratory that uses a simulated electronic health record significantly improved student knowledge retention and perceptions.

Benefits of Utilizing Pharmacy Learners in an Inpatient Anticoagulation Education Service.

Objective. The 2019 Hospital National Patient Safety Goal 03.05.01 indicates education regarding anticoagulant therapy should be provided to patients and families. Previous studies assessing pharmacist and pharmacy student involvement in oral anticoagulation (OAC) education services have focused on patient-related outcomes, with limited emphasis on the additional benefit to the student. The purpose of this study was to assess the benefit of pharmacy student involvement in anticoagulation education services both clinically and through their perceptions of participating in the service. Methods. This study assessed students' knowledge and perceptions of providing OAC education before and after a 1-month learning experience, where students provided counseling 2-3 days per week. The primary endpoint was comparing each student's pre- and post-rotation OAC education knowledge assessments. Secondary endpoints included percentage change in knowledge between the prospective cohort and a historical comparator group, perceived benefit of student participation in the service, percentage of patients able to recall counseling, and number of interventions made related to OAC therapy. Results. A total of 35 pharmacy students were included in this prospective study with 277 patients receiving counseling from June 2020 through March 2021. A total of 32 pharmacy students had assessment data available for retrospective comparison. The mean pharmacy student score within the prospective cohort improved significantly (21.5%) between the pre-assessment and post-assessment. Change in pre- and post-rotation knowledge assessment was also significantly higher in the prospective cohort compared to the retrospective group. Additionally, students gained confidence in their counseling abilities and OAC knowledge through participation. Conclusion. Pharmacy student participation within anticoagulation education services significantly improved student knowledge and confidence in their counseling abilities. It also allowed for over 70% of patients to successfully recall pertinent information about their anticoagulants over a week later and improved patient care through dosing interventions.

Impact of social media use on reading levels in third-year student pharmacists.

INTRODUCTION: The majority of Americans report using social media, but there is limited research describing impact of social media on academic performance and reading. Our objectives were to describe the association between social media use and reading levels of third-year student pharmacists (P3), describe the association between reading level and pharmacy school admissions data, and assess texts used in the curriculum for readability. METHODS: This was a prospective, cohort study. Reading level was determined by a standardized test. Social media data were collected via questionnaire. Admissions data were obtained from the admissions office. Readability of texts was assessed using readability software. RESULTS: Eighty-nine student pharmacists completed the study. The average reading level was 16.4. Students reported using social media for an average of 126 min daily. Students reported using an average of four social media sites and spending 88 min weekly on extracurricular reading. Negligible linear correlations were found between reading level and time spent on social media (ρ = 0.063), number of sites used (ρ =0.062), and time spent on extracurricular reading (ρ= 0.130). A moderate correlation (ρ = 0.524) was found between reading level and Pharmacy College Admission Test (PCAT) score. The average readability of guidelines and textbook chapters were 18.1 ±â€¯1.0 and 20.4 ±â€¯0.3, respectively. CONCLUSIONS: In P3 students, reading level was not associated with social media use. However, PCAT scores were positively associated with reading level. Furthermore, the readability of assigned texts exceeded the average reading level of the students.