Respecting Conversational Norms Improves Reception of Expert Messages Among Unvaccinated Individuals.

The association of medical experts with politically left-leaning cities and states early in the COVID-19 pandemic may have exacerbated vaccine hesitancy in right-leaning states of the US. Criticism from outside experts violates rules of communication between social groups (i.e. an intergroup sensitivity effect), leading to rejection of messages promoting vaccine safety and efficacy. In two studies, we document the effects of shared geographical group membership for medical expert messages promoting vaccination. We also found evidence that satisfying conversational norms against intergroup criticism reduces message rejection. Specifically, an invitation from ingroup political elites for a doctor to speak reduced the negative effects of unshared group identity.

Survey of faculty workload and operational characteristics for academic drug information centers.

INTRODUCTION: A survey of drug information specialists from academic drug information centers in the United States was conducted to identify faculty workload, operational characteristics of the center, and contribution of those faculty and centers to pharmacy education. METHODS: A 32-item survey was administered to drug information specialists and pharmacy college/school deans. Faculty workload items included age, credentials, training, and responsibilities. Center operational items identified clients, number of requests, staffing structure, and funding source. Pharmacy education items included number and type of students training at the center as well as drug information's role in the curriculum. Participants were also asked to identify recent and anticipated changes as well as predict future challenges for academic drug information centers. RESULTS: The survey achieved a response rate of 81% from eligible institutions. The typical drug information specialist is between 31 and 50 years old, in a clinical track faculty position, and has an average of 13 years of drug information experience. Academic drug information centers are generally funded by the institution, open five days a week, and serve a variety of clients including the lay public. The average drug information specialist teaches one didactic course and is a preceptor for 17 advanced practice experience students, and 15 introductory practice experience students. CONCLUSIONS: Drug information specialists and centers play an important role in pharmacy education. Results of this survey could assist in the creation of benchmarks for academic drug information faculty and centers in terms of workload, resource allocation, and promotion.

Removal of Trace Elements by Cupric Oxide Nanoparticles from Uranium In Situ Recovery Bleed Water and Its Effect on Cell Viability.

In situ recovery (ISR) is the predominant method of uranium extraction in the United States. During ISR, uranium is leached from an ore body and extracted through ion exchange. The resultant production bleed water (PBW) contains contaminants such as arsenic and other heavy metals. Samples of PBW from an active ISR uranium facility were treated with cupric oxide nanoparticles (CuO-NPs). CuO-NP treatment of PBW reduced priority contaminants, including arsenic, selenium, uranium, and vanadium. Untreated and CuO-NP treated PBW was used as the liquid component of the cell growth media and changes in viability were determined by the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay in human embryonic kidney (HEK 293) and human hepatocellular carcinoma (Hep G2) cells. CuO-NP treatment was associated with improved HEK and HEP cell viability. Limitations of this method include dilution of the PBW by growth media components and during osmolality adjustment as well as necessary pH adjustment. This method is limited in its wider context due to dilution effects and changes in the pH of the PBW which is traditionally slightly acidic however; this method could have a broader use assessing CuO-NP treatment in more neutral waters.

A health policy course based on Fink's Taxonomy of Significant Learning.

OBJECTIVE: To incorporate Fink's Taxonomy of Significant Learning into a course and determine whether doing so increased students' knowledge of and interest in healthcare policy. DESIGN: A healthcare policy course for second-year doctor of pharmacy (PharmD) students was redesigned to incorporate activities reflecting Fink's Taxonomy including completing a required reading, outlining the required reading, presenting the outline to a small group of peers, attending lectures, and completing a final policy project and simulation activity. ASSESSMENT: The effectiveness of the course was assessed using a pre-post non-randomized control design, with nursing and social work students serving as the control group. Interest and knowledge scores increased significantly among students in the intervention group. Differences between the low-interest students and the rest of the class identified on the precourse tests were not apparent on the postcourse test. IMPLICATIONS: Applying Fink's Taxonomy to course activities increased students' interest in and importance placed on learning health policy.

Economic considerations in the treatment of invasive aspergillosis: a review of voriconazole pharmacoeconomic studies.

Invasive aspergillosis is a life-threatening fungal infection predominately affecting immunocompromised individuals. The incidence of inpatient-treated aspergillosis cases in the US is estimated to be between 3.02 and 3.80 per 10,000 hospitalized patients. The estimated difference in hospital costs of patients with an aspergillosis infection is US$36,867 to US$59,356 higher than those of patients without the infection. Voriconazole is a synthetic, broad spectrum triazole antifungal agent, with FDA-approved indications for the treatment of invasive aspergillosis, esophageal candidiasis, candidemia in nonneutropenic patients, invasive candidiasis, and infections due to Scedosporium apiospermum and Fusarium species in patients refractory to or intolerant of other therapy. Eight cost-effectiveness analyses, one cost-minimization analysis, and one cost analysis were identified from a Medline search. The 10 pharmacoeconomic analyses were conducted in six different countries comparing voriconazole to conventional amphotericin B, liposomal amphotericin B, itraconazole, and caspofungin. All the cost-effectiveness and cost-minimization analyses identified voriconazole as the most cost-effective therapy. The cost analysis demonstrated voriconazole cost-savings. While the acquisition costs of voriconazole are higher than those of conventional amphotericin B, the toxicity profile and rate of treatment success associated with voriconazole result in lower total treatment costs per successfully treated patient.

Use of personal digital assistants for documentation of pharmacists' interventions: a literature review.

PURPOSE: The literature describing pharmacists' use of personal digital assistants (PDAs) as intervention documentation tools in health systems is reviewed. METHODS: A literature search was conducted using MEDLINE and International Pharmaceutical Abstracts to find articles whose title and abstract indicated that the articles' content addressed pharmacists' use of PDAs as intervention documentation tools. Qualitative analyses were conducted to characterize the existing literature on pharmacists' use of PDAs to document interventions in health systems. The articles were categorized using eight characteristics: study type, objective, setting, participants, PDA platform, documentation software, results, and conclusions. RESULTS: A total of 12 articles were included in this review. All articles were classified as descriptive. Two studies lacked objectives, while 10 contained explicitly stated objectives or objectives that could be inferred from article content. The majority of implementation processes occurred in acute care teaching facilities. All study participants were pharmacists. The majority of articles described PDA-based documentation by more than one pharmacist. Results from the articles can be divided into four categories: no measurable comparison performed, anecdotal comparison performed, survey data reported, and measurable comparison performed. Three articles specifically presented information regarding security and confidentiality of patient information. Each article described the use of password protection for the PDAs. CONCLUSION: The use of PDAs may increase the frequency and number of interventions documented by pharmacists; however, there is a lack of well-designed studies reporting the overall outcomes of using PDAs for intervention documentation by pharmacists.

Implementation of a weight management pharmaceutical care service.

BACKGROUND: Obesity, a national epidemic, is one of the leading causes of preventable morbidity and mortality in the US. Pharmacists can play an integral role in weight management. Offering weight management services provides an opportunity to increase public awareness of pharmaceutical care and attract patients to pharmacy programs. OBJECTIVE: To describe the implementation and evaluate outcomes of a weight management pharmaceutical care service in a stand alone pharmaceutical care center on a college campus. METHODS: A retrospective review of data was conducted on 289 patient charts to evaluate the change in weight, body mass index (BMI), percent body fat, and weight-related health conditions in patients who participated in the Healthy Habits program. RESULTS: The net change (change in values observed from first to last appointment) in weight was a loss of 1021.8 kg. The maximum weight change (change seen from the first appointment to the lowest value obtained during the program) was a loss of 1530.5 kg. These values correspond to a net mean weight loss of 3.6 kg per patient (10% of baseline weight) and a maximum mean weight loss per patient of 5.5 kg (15% of baseline weight). Eighty-three patients were able to decrease their BMI category and 76 patients had a decrease in risk status from baseline. CONCLUSIONS: The Auburn University Pharmaceutical Care Center's Healthy Habits program has been successful in helping patients decrease total body weight, BMI, and risk of weight-related complications. In addition, the program has increased the opportunity to identify other pharmaceutical care needs of patients and help establish the role of pharmacists in the management of obesity.

Prospective randomized double-blind placebo controlled trial of recombinant human erythropoietin administration to reduce blood transfusions in anemic pediatric intensive care patients.

OBJECTIVE: The purpose of this study was to determine if the number of red blood cell (RBC) transfusions anemic pediatric intensive care unit patients receive could be reduced by the prophylactic administration of recombinant human erythropoietin (rHuEPO). METHODS: This was a randomized, double-blind placebo controlled trial. Patients were randomized to receive either intravenous rHuEPO 300 units/kg/day or placebo. Both groups received elemental iron 6 mg/kg/day. RESULTS: Twenty-seven patients, ages 1 month to 13 years, were enrolled. Baseline hematocrit (Hct), reticulocyte count, and erythropoietin concentration were similar between the two groups. Three patients randomized to rHuEPO received 1 RBC transfusion each, and 4 patients randomized to placebo received 9 transfusions total (P = .68). The end-of-study Hct was not significantly different between the rHuEPO and placebo groups, 30.3 ± 3.6 and 26.8 ± 4.8, respectively (P = .06). Additionally, neither the % Hct change (baseline to final), nor the % reticulocyte change (baseline to final), was statistically different between the two groups. CONCLUSION: In this small group of anemic pediatric intensive care unit patients, prophylactic rHuEPO administration did not reduce the number of patients who received RBC transfusions. Furthermore, it did not significantly increase Hct or reticulocyte count when compared to placebo.

Medication adherence and persistence: a comprehensive review.

Estimates of adherence to long-term medication regimens range from 17% to 80%, and nonadherence (or nonpersistence) can lead to increased morbidity, mortality, and healthcare costs. Multifaceted interventions that target specific barriers to adherence are most effective, because they address the problems and reinforce positive behaviors. Providers must assess their patients' understanding of the illness and its treatment, communicate the benefits of the treatment, assess their patients' readiness to carry out the treatment plan, and discuss any barriers or obstacles to adherence that patients may have. A positive, supporting, and trusting relationship between patient and provider improves adherence. Individual patient factors also affect adherence. For example, conditions that impair cognition have a negative impact on adherence. Other factors--such as the lack of a support network, limited English proficiency, inability to obtain and pay for medications, or severe adverse effects or the fear of such effects--are all barriers to adherence. There are multiple reasons for nonadherence or nonpersistence; the solution needs to be tailored to the individual patient's needs. To have an impact on adherence, healthcare providers must understand the barriers to adherence and the methods or tools needed to overcome them. This report describes the barriers to medication adherence and persistence and interventions that have been used to address them; it also identifies interventions and compliance aids that practitioners and organizations can implement.

Improving primary care in rural Alabama with a pharmacy initiative.

The effect of pharmaceutical care on the prevention, detection, and resolution of medication-related problems in high-risk patients in a rural community was studied. Adult patients who received care at clinics in a medically underserved area of Alabama and who were identified as being at high risk of medication-related adverse events were randomly assigned to a control group or an intervention group. The control group received standard medical care, and the intervention group received pharmaceutical care, including a medical record review, a medication history review, pharmacotherapeutic evaluation, and patient medication education and monitoring over a one-year period. A total of 69 patients completed the study (33 in the intervention group and 36 in the control group). The percentage of patients responding to hypertension, diabetes, dyslipidemia, and anticoagulation therapy increased significantly in the intervention group and declined in the control group. Ratings for inappropriate prescribing improved in all 10 domains evaluated in the intervention group but worsened in 5 domains in the control group. There were no significant differences between the groups at 12 months in health-related quality of life or medication misadventures. Medication compliance scores improved in the intervention group but not in the control group. Medication knowledge increased in the intervention group and decreased in the control group. Pharmaceutical care in a rural, community-based setting appeared to reduce inappropriate prescribing, enhance disease management, and improve medication compliance and knowledge without adversely affecting health-related quality of life.

Improving adherence and persistence: a review and assessment of interventions and description of steps toward a national adherence initiative.

OBJECTIVES: To identify the effectiveness of adherence interventions reported in the literature, to identify interventions being conducted and/or sponsored by large chain pharmacies and pharmaceutical manufacturers, and to seek input from a panel of pharmacists who address adherence issues on a daily basis as to the steps that should be taken to advance a national initiative to increase awareness of the importance of and opportunities associated with medication adherence and persistence. MAIN OUTCOME MEASURE: Effectiveness of the adherence interventions reported in the literature. METHODS: First, a literature search was conducted using MEDLINE, International Pharmaceutical Abstracts, CINAHL, and PsycINFO. Keywords were medication or drug and compliance or adherence or persistence and control group. Second, pharmaceutical manufacturers and chain pharmacies were surveyed. Third, an advisory panel reacted to the research findings and formulated a series of action steps that could support or be part of a national initiative to increase adherence. RESULTS: Reported adherence-related interventions were grouped into five categories--adherence aids, refill or follow-up reminders, regimen simplification, written and oral education, and comprehensive management. Median adherence increases ranged from 6% to 25% for these categories. Interviews with 10 chain pharmacies revealed that adherence is an important issue. Most chains have some form of adherence program in place, but current initiatives are product-focused rather than patient-focused. Interviews with 15 manufacturers revealed that they currently use a variety of adherence interventions and want to partner with pharmacies to implement and assess the initiatives. The advisory panel developed a series of action items for implementing a national adherence initiative. CONCLUSION: Comprehensive interventions can improve adherence and are mutually beneficial for patients, pharmacies, and manufacturers. Pharmacists must be able to assess patients' adherence, identify the reasons for nonadherence, and develop patient-specific interventions. Studies have shown that the most successful interventions have some follow-up component and address the underlying reason(s) for nonadherence. Pharmacies and pharmaceutical manufacturers have tried various adherence interventions, such as patient education and refill reminders. There is a growing sense that a national adherence initiative is needed to coordinate pharmacists' efforts to address this public health problem, and the American Pharmacists Association is well positioned to take a leadership role in such efforts.

Propylene glycol accumulation associated with continuous infusion of lorazepam in pediatric intensive care patients.

OBJECTIVE: To determine if propylene glycol accumulates in children receiving continuous lorazepam infusion and, if accumulation occurs, to determine if it is associated with significant laboratory abnormalities. DESIGN: Prospective study. SETTING: A tertiary care pediatric intensive care unit. PATIENTS: Eleven intubated pediatric intensive care patients receiving continuous lorazepam infusion for sedation. INTERVENTIONS: Propylene glycol accumulation was determined by comparing concentrations at baseline, after 48 hrs, and at end of therapy. Laboratory abnormalities were determined by comparing serum lactate and osmolar gap at baseline, after 48 hrs, and at end of therapy. Correlation between the cumulative dose of lorazepam received and the propylene glycol concentration measured at the end of therapy was determined. MEASUREMENTS AND MAIN RESULTS: Patients aged 1-15 months were studied. Lorazepam infusion rates ranged from 0.1 to 0.33 mg.kg.hr and lasted 3-14 days. Propylene glycol accumulated significantly in patients receiving continuous infusion of lorazepam. The propylene glycol concentration increased during the study from 86 +/- 93 microg/mL at baseline to 763 +/- 660 microg/mL at the end of the study ( p=.038). A statistically significant correlation between the cumulative dose of lorazepam received and propylene glycol concentration at the end of therapy was demonstrated ( r(2)=.65, p<.005). However, the propylene glycol accumulation was not associated with significant laboratory abnormalities. Neither serum lactate concentrations nor osmolar gap were significantly elevated over baseline. CONCLUSION: Propylene glycol accumulated significantly in pediatric intensive care patients receiving continuous lorazepam infusion, and propylene glycol concentration correlated with the cumulative lorazepam dose the patient received. However, significant laboratory abnormalities due to propylene glycol accumulation were not observed.