An evaluation of pharmacogenomic information provided by five common drug information resources.

INTRODUCTION: This study evaluated whether pharmacogenomic information contained in the Food and Drug Administration (FDA)-approved package inserts of sixty-five drugs was present in five drug information resources. METHODS: The study searched for biomarkers from the FDA package inserts in 5 drug information sources: American Hospital Formulary Service Drug Information (AHFS), Facts & Comparisons 4.0 (Facts), ePocrates Online Free (ePocrates Free), Lexicomp Online (Lexicomp), and Micromedex 2.0. Each resource had the opportunity to present biomarker information for 65 drugs, a total of 325 opportunities. A binary system was used to indicate presence or absence of the biomarker information. A sub-analysis was performed on the 13 most frequently prescribed drugs in the United States. RESULTS: Package insert biomarker information was available, on average, for 81.5% of the 65 FDA-listed drugs in 2011. Percent availability for the individual resources was: Lexicomp, 95.3%; Micromedex 2.0, 92.3%; Facts, 76.9%; AHFS, 75.3%; and ePocrates Free, 67.7%. The sub-analysis of the 13 top drugs showed Lexicomp and Micromedex 2.0 had the most mentions, 92.3%; ePocrates Free had the least, 53.8%. CONCLUSION: The strongest resource for pharmacogenomic information was Lexicomp. The gap between Lexicomp and ePocrates Free is concerning. Clinicians would miss pharmacogenomic information 6.6 times more often in ePocrates Free than in Lexicomp. IMPLICATIONS: Health sciences librarians should be aware of the variation in biomarker availability when recommending drug resources for licensing and use. Librarians can also use this study to encourage publishers to include pharmacogenomics information from the package insert as a minimum standard.

Twenty-six years of psychosocial interventions to reduce suicide risk in adolescents: Systematic review and meta-analysis.

BACKGROUND: During adolescence, suicide risk increases; effective treatments are needed to reduce risk. METHODS: Databases were searched (1995-2020) for randomized controlled trials (RCTs) concerning psychosocial treatments for suicide prevention in adolescents (10-18 yrs). Data were extracted from the timepoint closest to 6 months. Cohen's ds were estimated for reducing suicidal ideation (SI), self-harming behaviors (SHB) excluding strictly non-suicidal self-injury, and suicide attempts (SA) and analyzed using generalized least square regression. Meta-analytic innovations included within-person correlations to reflect trait suicidality; annualization to control for exposure; estimated lifetime risk based on ages; and modeling inclusion/exclusion criteria. Alternate approaches included relative risk and comparison of intervention and control treatments to baseline. RESULTS: Of 30 RCTs, 6 assessing SHB (4 measuring SA), and 7 assessing SI demonstrated treatment effectiveness. Overall, interventions decreased SI (n = 25) with low effect size (d = 0.08, p = 0.01), non-significant after controlling for publication bias (d = 0.05, p = 0.1); interventions were non-significant for SHB (n = 25, d = 0.001, p = 0.97) or SA (n = 18, d = 0.03, p = 0.52). To prevent one SHB, the number needed to treat (NNT) was 45[26,156]; for SA, NNT=42[24,149]. Non-superiority may relate to effectiveness of control treatments. Thus, experimental and control treatments also were compared to baseline: both reduced SI (p < 0.0001), and effectiveness improved for SHB (NNT=12) and SA (NNT=11). LIMITATIONS: Study heterogeneity and inconsistent statistical reporting limited meta-analysis. CONCLUSIONS: Psychosocial interventions for suicide risk in adolescents showed little effectiveness compared with control treatments; suicide outcomes improved in both groups compared to baseline. Different approaches may be needed, including precision medicine methodologies and standardized statistical reporting criteria.

Medication management in North Carolina elementary schools: Are pharmacists involved?

OBJECTIVE: To determine the extent of pharmacist use in medication management, roles of school nurses, and use of other health care providers at elementary schools in North Carolina. METHODS: Prospective survey of 153 (130 public and 23 private) elementary schools in four counties of North Carolina. A 21-question survey was e-mailed to the head administrator of each school (e.g., principal, headmaster) containing a Qualtrics survey link. Questions were designed to elicit information on school policies and procedures for medication management and use of health care providers, including pharmacists, in the schools. Responses were collected during a 2-month period. RESULTS: Representatives from 29 schools participated in the survey (19% response rate). All 29 schools reported having a school policy regarding medication administration during school hours. Of those, 27 schools reported consulting with nurses on their policies. Only 1 of 27 respondents reported consulting with pharmacists on medication management policies. The majority of the respondents (93.1%) stated that administrative staff was responsible for medication administration at the schools. CONCLUSION: Use of pharmacists in creating and reviewing policies for schools and actual medication management at schools was extremely low. The findings in this study reinforce the findings in previous studies that pharmacists are not being used and are not a major presence in elementary school health.

Evaluation of a Teaching Assistant Program for Third-Year Pharmacy Students.

Objectives. To determine if a teaching assistant (TA) program for third-year pharmacy students (PY3s) improves confidence in teaching abilities. Additionally, 3 assessment methods (faculty, student, and TA self-evaluations) were compared for similarities and correlations. Methods. An application and interview process was used to select 21 pharmacy students to serve as TAs for the Pharmaceutical Care Laboratory course for 2 semesters. Participants' self-perceived confidence in teaching abilities was assessed at the start, midpoint, and conclusion of the program. The relationships between the scores were analyzed using 3 assessment methods. Results. All 21 TAs agreed to participate in the study and completed the 2 teaching semesters. The TAs confidence in overall teaching abilities increased significantly (80.7 vs 91.4, p<0.001). There was a significant difference between the three assessment scores in the fall (p=0.027) and spring (p<0.001) semesters. However, no correlation was found among the assessment scores. Conclusions. The TA program was effective in improving confidence in teaching abilities. The lack of correlation among the assessment methods highlights the importance of various forms of feedback.

Transitioning Pharmacogenomics into the Clinical Setting: Training Future Pharmacists.

Pharmacogenomics, once hailed as a futuristic approach to pharmacotherapy, has transitioned to clinical implementation. Although logistic and economic limitations to clinical pharmacogenomics are being superseded by external measures such as preemptive genotyping, implementation by clinicians has met resistance, partly due to a lack of education. Pharmacists, with extensive training in pharmacology and pharmacotherapy and accessibility to patients, are ideally suited to champion clinical pharmacogenomics. This study aimed to analyze the outcomes of an innovative pharmacogenomic teaching approach. Second-year student pharmacists enrolled in a required, 15-week pharmaceutical care lab course in 2015 completed educational activities including lectures and small group work focusing on practical pharmacogenomics. Reflecting the current landscape of direct-to-consumer (DTC) genomic testing, students were offered 23andMe genotyping. Students completed surveys regarding their attitudes and confidence on pharmacogenomics prior to and following the educational intervention. Paired pre- and post-intervention responses were analyzed with McNemar's test for binary comparisons and the Wilcoxon signed-rank test for Likert items. Responses between genotyped and non-genotyped students were analyzed with Fisher's exact test for binary comparisons and the Mann-Whitney U-test for Likert items. Responses were analyzed for all student pharmacists who voluntarily completed the pre-intervention survey (N = 121, 83% response) and for student pharmacists who completed both pre- and post-intervention surveys (N = 39, 27% response). Of those who completed both pre- and post-intervention surveys, 59% obtained genotyping. Student pharmacists demonstrated a significant increase in their knowledge of pharmacogenomic resources (17.9 vs. 56.4%, p < 0.0001) and confidence in applying pharmacogenomic information to manage patients' drug therapy (28.2 vs. 48.7%, p = 0.01), particularly if the student had received genotyping. Student pharmacists understanding of the risks and benefits of using personal genome testing services significantly increased (55.3 vs. 86.8%, p = 0.001) along with agreement that personal genomics would likely play an important role in their future career (47.4 vs. 76.3%, p = 0.01), particularly among students who participated in genotyping. The educational intervention, including personal genotyping, was feasible, and positively enhanced students' reflections, and attitudes toward pharmacogenomics in a professional pharmacy program.

Devices for ambulatory and home monitoring of blood pressure, lipids, coagulation, and weight management, part 2.

PURPOSE: The equipment and methods used for ambulatory and home monitoring of blood pressure, lipids, coagulation, and weight management are discussed. SUMMARY: Over 100 million people in the United States have one or more chronic diseases, such as diabetes, hypertension, and asthma. With the goal to improve health while reducing costs and the overall health care burden, ambulatory and home monitoring by pharmacists and patients are receiving more attention. Ambulatory and home monitoring of blood pressure, cholesterol, coagulation, and weight management (including devices for assessing overweight and obese patients, heart rate monitors, and pedometers) are convenient for clinicians and patients. Such monitoring provides pharmacists with an opportunity to differentiate their practices. Studies suggest that patients who are involved in ambulatory and home monitoring take a more active role in their health and may have better adherence to a prescribed diet and medication regimens. Studies also show that ambulatory and home monitoring, if done correctly, provide clinicians with a large quantity of reliable readings for future therapeutic decisions. Devices are also a means for pharmacists to increase their provision of pharmacy services. Ambulatory monitoring is billable in many clinic settings, and the devices can be a profitable addition to prescription services. CONCLUSION: Many devices are available to assist patients and clinicians in monitoring blood pressure, lipids, coagulation, and weight management. Familiarity with the devices will help in their proper selection and use.

Devices for ambulatory and home monitoring of blood pressure, lipids, coagulation, and weight management, part 1.

PURPOSE: The equipment and methods used for ambulatory and home monitoring of blood pressure, lipids, coagulation, and weight management are discussed. SUMMARY: Over 100 million people in the United States have one or more chronic diseases, such as diabetes, hypertension, and asthma. With the goal to improve health while reducing costs and the overall health care burden, ambulatory and home monitoring by pharmacists and patients are receiving more attention. Ambulatory and home monitoring of blood pressure, cholesterol, coagulation, and weight management (including devices for assessing overweight and obese patients, heart rate monitors, and pedometers) are convenient for clinicians and patients. Such monitoring provides pharmacists with an opportunity to differentiate their practices. Studies suggest that patients who are involved in ambulatory and home monitoring take a more active role in their health and may have better adherence to prescribed diet and medication regimens. Studies also show that ambulatory and home monitoring, if done correctly, provide clinicians with a large quantity of reliable readings for future therapeutic decisions. Devices are also a means for pharmacists to increase their provision of pharmacy services. Ambulatory monitoring is billable in many clinic settings, and the devices can be a profitable addition to prescription services. CONCLUSION: Many devices are available to assist patients and clinicians in monitoring blood pressure, lipids, coagulation, and weight management. Familiarity with the devices will help in their proper selection and use.

Limited Predictive Utility of Admissions Scores and Objective Structured Clinical Examinations for APPE Performance.

OBJECTIVE: To examine the relationship between admissions, objective structured clinical examination (OSCE), and advanced pharmacy practice experience (APPE) scores. METHODS: Admissions, OSCE, and APPE scores were collected for students who graduated from the doctor of pharmacy (PharmD) program in spring of 2012 and spring of 2013 (n=289). Pearson correlation was used to examine relationships between variables, and independent t test was used to compare mean scores between groups. RESULTS: All relationships among admissions data (undergraduate grade point average, composite PCAT scores, and interview scores) and OSCE and APPE scores were weak, with the strongest association found between the final OSCE and ambulatory care APPEs. Students with low scores on the final OSCE performed lower than others on the acute care, ambulatory care, and community APPEs. CONCLUSION: This study highlights the complexities of assessing student development of noncognitive professional skills over the course of a curriculum.

Institutional strategies to achieve diversity and inclusion in pharmacy education.

OBJECTIVE: To evaluate the impact of institutional initiatives to enhance recruitment of minority students as a strategy to increase diversity and inclusion. METHODS: The Office of Recruitment, Development, and Diversity Initiatives (ORDDI) was established and several initiatives were developed within the UNC Eshelman School of Pharmacy to promote student diversity and engagement. Applicant demographics and admission data were tracked from 2007-2012 to assess program performance and effectiveness. RESULTS: Over the 6-year period, 812 recruitment events were facilitated. Twenty-nine percent of the students admitted from 2007-2012 participated in 1 or more ORDDI recruitment programs prior to admission. Forty-two percent of this cohort were minorities. The overall average minority profile of students increased from 19% to 25% after establishing the ORDDI. CONCLUSIONS: To achieve student diversity and inclusion, a multifaceted effort is required, involving a continuum of institutional strategies, including innovative practice models and high impact programs.

A Spanish language module in a first-year pharmaceutical care laboratory course.

OBJECTIVE: To assess the impact of incorporating Spanish language lectures and activities in a required Pharmaceutical Care Laboratory course on first-year doctor of pharmacy (PharmD) students' perceptions of and comfort level with Spanish-speaking patients and basic knowledge of Spanish pharmacy terms. DESIGN: The 6-week module consisted of attendance at a 1-hour lecture on medical Spanish and Hispanic culture, and completion of 4 small-group activities: drug and product information, patient information, counseling and side effects, and a written scenario that involved filling a prescription for and counseling a Spanish-speaking patient. ASSESSMENT: All students enrolled in the Pharmaceutical Care Laboratory course in fall 2008 (153) and fall 2009 (152) completed a pre- and post-intervention questionnaire (100% response rate). Less than 4% of students considered themselves fluent in Spanish prior to participating in the Spanish language module. Students agreed or strongly agreed that it was important for pharmacists to be able to translate common pharmacy label instructions from English to Spanish (89.8%) and Spanish to English (73.8%). Student-reported confidence in their ability to pronounce common pharmacy and medical terms in Spanish significantly increased, as did their ability to correctly interpret pharmacy label instructions. CONCLUSIONS: While incorporation of a Spanish language module in a first-year Pharmaceutical Care Laboratory course did not result in students achieving fluency in Spanish, it was a beneficial method of exposing students to Spanish language and culture.

Assessment and recommendations of compounding education in AACP member institutions.

In August 2009, the American Association of Colleges of Pharmacy (AACP) Council of Sections established a Task Force to assess the current status of compounding education at its member institutions and to provide recommendations for future direction. The Task Force conducted a survey in late June 2010 of faculty members enrolled in the AACP Pharmaceutics and Pharmacy Practice sections to gain qualitative information of the current state of compounding education. The survey results were then organized around eight curricular topics for which the Task Force members provided interpretations and recommendations. A final report was sent to the AACP Council of Sections on February 15, 2011. This publication provides the information contained in that final report to the professional community.

Devices for home evaluation of women's health concerns.

PURPOSE: Devices used for home evaluation of fertility, pregnancy, menopause, colon cancer, breast cancer, and urinary-tract and vaginal yeast infections are discussed. SUMMARY: Ovulation-prediction devices monitor natural changes in a woman's body during the menstrual cycle, including changes in basal body temperature, urinary luteinizing hormone, and urinary estrone-3-glucuronide concentrations. Also available are devices that identify changes in the content of sodium chloride and other electrolytes in saliva and cervical-vaginal mucus. Home pregnancy tests are designed to detect human chorionic gonadotropin in the urine. Both urine and saliva tests are available for home evaluation of menopause; the most common devices use urine to measure follicle-stimulating hormone. The saliva tests measure estradiol, progesterone, and testosterone. Devices for home screening for colon cancer use either the guaiac test or the fecal immunochemical test. For aid in breast self-examination, patients may use a simulated-breast product designed to train them to detect lumps or a thin, silicone-containing pad intended to increase the sensitivity of the fingers to abnormalities. Urine-dipstick tests can be used to screen for urinary-tract infection, and a swab or panty liner can be used to detect vaginal pH changes indicative of vaginal yeast infection. Home-based tests may be convenient and economical but also have limitations; pharmacists can help educate patients and clinicians. CONCLUSION: Many devices are available to help evaluate women's health concerns at home.