Effect of Pharmacist-Led Interventions on Diabetes Distress Among People With Type 2 Diabetes.

PURPOSE: The purpose of this study was to determine the effectiveness of pharmacist-led interventions on diabetes distress and glucose management among people with type 2 diabetes (T2DM) in a community care clinic. METHODS: Adults with T2DM were recruited during routine visits at the pharmacist-run clinic. Participants completed a baseline A1C, demographic survey, Diabetes Distress Scale (DDS), and Patient Health Questionnaire-2 (PHQ-2). Depending on DDS subscale-specific responses, participants qualified for pharmacist-led educational interventions based on the ADCES7 Self-Care Behaviors™. After 6 months, participants completed another A1C, satisfaction survey, DDS, and PHQ-2. Data analysis included descriptive statistics and paired t tests. RESULTS: Among 53 participants at baseline, diabetes distress was present in 77.4%; emotional burden was most common in 64.2%, followed by regimen distress in 45.3%, interpersonal distress in 34.0%, and physician distress in 20.8%. After the intervention, significant reductions occurred in mean overall DDS score (2.0 to 1.7), emotional burden (2.4 to 1.8), regimen distress (2.3 to 1.7), A1C (7.0% to 6.5%; 53.0 to 47.5 mmol/mol), and PHQ-2 score (1.6 to 1.0). Participants were highly satisfied with the service, their knowledge, and self-management skills following completion of the study. CONCLUSIONS: Diabetes distress was present in most participants despite glucose management that was largely achieving treatment goals. Pharmacist-led educational interventions significantly reduced overall DDS score, emotional burden, regimen distress, A1C, and PHQ-2 score. The results of this study suggest that people with T2DM should receive routine screening for diabetes distress and that pharmacists can positively affect diabetes management and emotional well-being through tailored education.

Sharps Disposal Practices Among People With Diabetes in a Community Care Clinic.

Objectives: The primary objective of this study was to determine sharps disposal practices among people with diabetes in a community care clinic. Secondary objectives were to identify patterns of sharps use and barriers to proper use. Methods: Surveys were distributed to patients at a community care clinic in person and via mail. Survey questions focused on how sharps are used and disposed of, the frequency of sharps changes, sharps disposal training, sharps identification, and confidence in sharps disposal. Participant demographics and diabetes profiles were also collected. Findings: Among 89 respondents, mean age was 60 years (range 29-93 years), 61.8% were Caucasian, 88.8% had type 2 diabetes, and 60.7% had had a diabetes diagnosis for ≤10 years, with diverse diabetes management methods; 57.3% did not receive or were unsure of sharps training, 25.8% discarded used sharps without a designated sharps container, and 37.1% properly disposed of sharps containers at sharps disposal facilities. Barriers to proper sharps practices included perceived safety of reusing sharps and waste with single use, cost, and the hassle of disposal. Those with prior sharps training were more likely to properly use and discard sharps; however, gaps in knowledge were still evident in this population. Conclusion: Results indicate gaps in proper sharps use and disposal knowledge among people with diabetes. Responses revealed sharps practices that are inconsistent with current federal and state regulations and are potentially dangerous for those handling improperly discarded sharps. Targeted sharps usage and disposal education resources are needed for individuals with and without prior sharps training.

Clinical, Virologic and Immunologic Correlates of Breast Milk Acquired Cytomegalovirus (CMV) Infections in Very Low Birth Weight (VLBW) Infants in a Newborn Intensive Care Unit (NICU) Setting.

Cytomegalovirus (CMV) infections acquired by very-low-birthweight (VLBW) infants are incompletely characterized. To examine CMV transmission in VLBW infants, we evaluated maternal DNAlactia, infant DNAemia, and presence of clinical disease in a blinded study in VLBW infants in our newborn intensive care unit (NICU). To examine these issues, 200 VLBW infants were enrolled in a surveillance study, with weekly breast milk and infant whole blood samples collected, as available. Virologic (breast milk and infant whole blood real time PCR) and immunologic (IgG, IgM, and IgG avidity) correlates were evaluated. A chart review examined whether infants had symptoms compatible with CMV disease. DNAlactia was identified in 65/150 (43%) of lactating mothers. Nine CMV infections were identified in 9/75 CMV-exposed infants (12% of exposed infants). A higher median breast milk viral load (DNAlactia) correlated with an increased likelihood of DNAemia (p = 0.05). Despite potential symptoms compatible with CMV infection, clinicians had not considered the diagnosis of CMV in 6/9 cases (66%). All of these infants had chronic lung disease at discharge. There was no correlation between IgG antibody titer or IgG avidity index and the likelihood of transmission or CMV disease. In conclusion, in VLBW infants receiving milk from seropositive mothers, CMV infections are commonly acquired, and are frequently unrecognized. Future studies are needed to determine whether routine surveillance for CMV of either breast milk or infant plasma is beneficial in preventing or recognizing infection.

Puberty is a Critical Period for Vomeronasal Organ Mediation of Socio-sexual Behavior in Mice.

Genetic disruption of the vomeronasal organ (VNO), an organ responsible for pheromone processing, drastically alters socio-sexual behavior in mice. However, it is not known whether the VNO has a role during the pubertal organizational period when sex-typical socio-sexual behaviors emerge, or if disruption of the organ in adulthood is sufficient to alter socio-sexual behavior. To bypass the lifelong VNO disruption of genetic knockout models, we surgically ablated the VNO of male and female mice either during the peripubertal period [postnatal day (PND) 28-30] or adulthood (PND 58-60), with sham controls at both ages. We ruled out anosmia via the buried food test and assessed sexual odor preferences by simultaneously exposing mice to same- and opposite-sex soiled-bedding. We then measured territorial aggression with the resident-intruder paradigm and assessed sexual behavior in response to an encounter with an estrus-induced female. Neural activity approximated by FOS-immunoreactivity along the VNO-accessory olfactory pathway was measured in response to opposite-sex odors. We found that peripubertal VNO ablation decreased sexual odor preferences and neural activity in response to opposite-sex odors, and drastically reduced territorial aggression in male mice. Conversely, adult VNO ablation resulted in subtle differences in sexual odor preferences compared with sham controls. Regardless of the VNO condition, mice displayed sex-typical copulatory behaviors. Together, these results suggest that puberty is a critical period in development whereby the VNO contributes to the sexual differentiation of behavior and neural response to conspecific odors.

Impact of an ambulatory care pharmacist in an occupational health clinic.

OBJECTIVES: To describe and evaluate a novel practice setting for a pharmacist within an occupational health clinic. SETTING: Ambulatory care facility. PRACTICE DESCRIPTION: Implementation and evaluation of a new practice site embedding a clinical pharmacist into the workplace to provide ambulatory care services, such as comprehensive medication management, disease state management, and immunizations to a broad diversity of patients. PRACTICE INNOVATION: A clinical pharmacist provides pharmacy services as part of a collaborative occupational health clinic at a large, self-insured company. The pharmacy services are open to employees and family members with any chronic disease states, elevated biometric results, or medication questions, with the goal of improving patient care on a consistent basis. During visits, the pharmacist works to identify and resolve drug-related problems by educating the patient or reaching out to the patient's health care provider and to develop strategies with the patient to achieve desired health care outcomes. The pharmacist assists with patient outreach events and immunizations during the flu clinic. EVALUATION: Identification of drug-related problems, resolution status, patient satisfaction via survey results, immunizations provided. RESULTS: In 4.3 years of operation, the pharmacist conducted 604 visits with 172 patients. During these visits, the pharmacist identified 611 drug-related problems, of which 49.4% have been confirmed as resolved. All patients who completed the patient satisfaction survey said that they would recommend the pharmacy services to others. For the past 3 years, the pharmacist and pharmacy students immunized approximately 1000 patients each year during the company flu clinic. CONCLUSION: An occupational health clinic is a unique and convenient location for a pharmacist to provide ambulatory care services to employees and family members, as long as methods to identify patients and appropriate sources of referral exist. The pharmacist was able to help patients resolve approximately 50% of identified drug-related problems, and patients were highly satisfied with services provided.

Specialization within pharmacy education: A survey of curricular track or concentration offerings.

INTRODUCTION: The purpose of this national survey was to determine what constitutes a curricular track or concentration within colleges and schools of pharmacy. Additionally, for programs not currently offering curricular tracks or concentrations, this survey sought to identify barriers to implementation. METHODS: A survey instrument was developed and piloted. It was distributed electronically via SurveyMonkey to members of the American Association of Colleges of Pharmacy (AACP) Curriculum Special Interest Group (SIG) contact list, along with academic affairs contacts for the balance of programs not included on the SIG contact list, as obtained via a targeted website search. RESULTS: Sixty-five of 134 programs responded to the survey (48.5%). Sixteen programs currently offer 38 curricular tracks or concentrations. On average, tracks or concentrations contained 10.6 didactic credits, with 4.6 elective and six required didactic credits; 0.7 introductory pharmacy practice experience (IPPE) credits; and 5.3 advanced pharmacy practice experience (APPE) credits, with 2.8 elective and 2.5 required APPE credits. Most tracks did not require a summative project (n = 13), while some required completion of a project individualized by interest/needs (n = 7). Forty-nine programs do not currently offer curricular tracks, most frequently due to logistics of faculty, oversight, or the curriculum structure. Of these programs not currently offering curricular tracks or concentrations, 38.8% are currently considering implementation. CONCLUSION: Existing tracks or concentrations are highly variable in their composition. Many colleges and schools of pharmacy are considering implementation of curricular tracks or concentrations; this report provides guidance for appropriate rigor and development considerations.

Visual hallucinations associated with gabapentin use.

PURPOSE: A case of probable gabapentin-induced visual hallucinations in a patient with no psychiatric history is reported. SUMMARY: A 65-year-old white woman with no history of psychiatric conditions arrived at the pharmacy clinic with specific complaints of daytime sleepiness, fatigue, and visual hallucinations that started after coronary artery bypass graft surgery three years prior. After the surgery she began experiencing neuropathic pain in her chest, which was treated with gabapentin. Approximately one month later, she developed visual hallucinations that continued to occur at least two or three times per month. When first seen in the pharmacy clinic, the patient was taking gabapentin 300 mg orally four times daily plus 600 mg at bedtime, for a total daily dose of 1800 mg. Although gabapentin appears to have been prescribed as 600 mg three times daily, she had been taking it in five divided doses. One month later, she reported that she had self-reduced the gabapentin dosage to 300 mg once daily, after which she noticed improvement in her daytime sleepiness and fatigue and experienced one hallucination approximately one week after the dosage reduction. One month later, she completely discontinued gabapentin use, after which she experienced no further hallucinations. Assessment with the Naranjo et al. adverse drug reaction scale indicated a probable relationship between the patient's visual hallucinations and gabapentin use. CONCLUSION: A 65-year-old woman with no psychiatric history developed visual hallucinations while taking gabapentin five times daily. Her hallucinations resolved after discontinuation of gabapentin and have remained absent after 1 year of follow-up.