Menstrual health matters. Period.

Menstrual health is composed of physical and psychosocial factors and fundamental to the well-being of menstruating individuals. Clinicians are urged to assess markers of menstruation as a vital sign, informing potential current and future health risks. Period poverty, or lack of access to menstrual hygiene products, sanitation, and clinical support, is a concern worldwide, particularly for vulnerable populations. As global health authorities and professional medical associations call for menstrual health as a priority, pharmacists are well-positioned to contribute solutions through access, education, advocacy, and research.

Finding our Voice: Evaluation of Goal Setting Using the Habits of Preceptors Rubric in Terms of Focus, "SMARTness," and Impact.

INTRODUCTION: Effective leadership propels teams from effectiveness to greatness and is accomplished when everyone achieves and contributes their full potential, or "voice." The Clinician Educators Program Teaching and Learning Curriculum fosters preceptor development using the Habits of Preceptors Rubric (HOP-R) to guide participants in finding their precepting "voice." After the HOP-R self-assessment, participants select a habit of focus (HOF) and craft a SMART (specific/measurable/achievable/relevant/time-bound) goal. This report describes a pilot rubric, SMART-EP (emotional intelligence(EI)/professionalism), exploring goal "SMARTness" alongside change (impact) in participants' perceived precepting capabilities. METHODS: HOP-R self-ratings (2018-2020) and HOF/SMART goals (2019-2020) were retrospectively reviewed by two raters. Perceived preceptor capabilities were measured by analyzing the change in self-assessed habit level ratings between the first/fourth-quarter surveys. SMART goals were categorized by HOF and inclusion of SMART-EP components. Participants were guided in the inclusion of SMART, but not -EP, components. RESULTS: In aggregate, 120 participants completed HOP-R surveys (2018-2020). Within-subject changes across all 11 habits were significant (P < .001). For the SMART-EP rubric analysis (2019-2020), 71 participants had an average "SMARTness" score of 3.92 (of 5) with corresponding interrater reliability of 0.91. Goals included 2.77 (of 4) EI traits and 1.72 (of 3) professionalism components. DISCUSSION: The SMART-EP rubric provided insights into preceptor development opportunities among participants. Beyond SMART components, participants often included elements of EI and professionalism. Ratings confirm and support the consistency of the HOP-R as a tool to assess precepting habits.

Evaluation of the leadership strengths of the officers serving within an APhA-ASP chapter: Implications for the profession.

BACKGROUND AND PURPOSE: To evaluate the strengths of the officers who recently served within an American Pharmacists Association Academy of Student Pharmacists (APhA-ASP) chapter and to discuss the potential impacts of these strengths upon the pharmacy profession. EDUCATIONAL ACTIVITY AND SETTING: The chapter officers from the Classes of 2010-2016 (n = 67; 66% female) voluntarily participated in a variety of leadership development programs created by the chapter advisors. Each of these programs included activities based upon the book, Strengths Based Leadership, and the determination of each officer's top five strengths using the StrengthsFinder 2.0 assessment. For this study, all of the officer's top five strengths were compiled (n = 335) and evaluated based upon their individual frequencies and their association with each of the strengths based leadership domains (i.e. executing, influencing, relationship building, and strategic thinking). FINDINGS: All 67 officers completed the StrengthsFinder 2.0 assessment with the five most frequently identified strengths being achiever (n = 27), harmony (n = 27), learner (n = 26), input (n = 19), and individualization (n = 17). In addition, the officer's strengths most frequently corresponded to the leadership domain of relationship building (35%), followed by the domains of executing (28%), strategic thinking (26%), and influencing (11%). SUMMARY: These findings may help explain why the profession continues to succeed with respect to implementing collaborative patient-centered care, but continues to be challenged with respect to maximizing professional advocacy.

What new therapeutic options exist for the relief of menopausal symptoms?

Two new products recently approved for the treatment of menopausal symptoms contain estrogen receptor agonists/antagonists, which have varying effects on bone, breast, endometrial, and vaginal tissues. Ospemifene improves symptoms of dyspareunia associated with vulvovaginal atrophy. Bazedoxifene combined with conjugated estrogens improves vasomotor symptoms and bone mineral density in postmenopausal women. Clinicians must consider the increased risk for venous and arterial thromboembolic disease posed by these drugs. Clinical trials are ongoing to fully evaluate the drugs' efficacy and safety compared with traditional estrogen-based regimens.

The pharmacist's role in promoting preconception health.

OBJECTIVE: To review the pharmacist's role in preconception health. DATA SOURCES: PubMed search using the terms preconception, immunizations, epilepsy, diabetes, depression, tobacco, asthma, hypertension, anticoagulation, pharmacist, pregnancy, and current national guidelines. DATA SYNTHESIS: Preconception health has become recognized as an important public health focus to improve pregnancy outcomes. Pharmacists have a unique role as accessible health care providers to optimize preconception health by screening women for tobacco use, appropriate immunizations, and current medication use. Counseling patients on preconception risk factors and adequate folic acid supplementation as well as providing recommendations for safe and effective management of chronic conditions are also critical and within the scope of practice for pharmacists. CONCLUSION: Pharmacists play an important role in medication screening, chronic disease state management, and preconception planning to aid women in preparing for healthy pregnancies.

An elective course on pharmacy-based health screenings.

OBJECTIVE: To provide an elective course for pharmacy students focused on the knowledge and skills necessary to implement health screenings in a pharmacy environment. DESIGN: Course lectures focused on expert recommendations for health screenings as well as regulatory requirements and procedures integral to the implementation of screening services. Workshops provided hands-on experience with blood glucose, body composition, bone density, and cholesterol testing devices. ASSESSMENT: Attainment of knowledge and skills was assessed by patient case assignments, screening device demonstrations, group projects, and a final quiz. Annual course evaluations revealed consistently favorable student feedback regarding the course design and content. students reported a high level of preparedness and interest in participating in health screening services in future practice. CONCLUSION: An elective course focused on the delivery of health screenings in pharmacy settings was well received by student participants and exposed students to a unique opportunity in patient care.

Immunizations and pregnancy: an update for pharmacists.

OBJECTIVE: To review the safety of immunizations in pregnancy. DATA SOURCES: PubMed search using the terms vaccine, immunizations, and pregnancy, as well as current national guidelines. DATA SYNTHESIS: Immunizations for women of childbearing age are an integral component of pregnancy planning. Some vaccines are compatible with pregnancy, whereas others, in particular live-attenuated vaccines, are contraindicated because of the theoretical risk to the fetus. The immunizing pharmacist must be aware of updated guidelines regarding the safe and appropriate use of vaccines during pregnancy. Certain routine adult vaccines are contraindicated during pregnancy, including the live-attenuated intranasal influenza, measles-mumps-rubella, varicella, zoster, and human papillomavirus vaccines. The trivalent inactivated influenza vaccine is specifically recommended for all women who are pregnant during influenza season. The hepatitis B, tetanus-diphtheria-acellular pertussis, and several other routine adult and travel vaccines may be administered safely in pregnancy if the patient meets certain risk criteria. Breast-feeding is compatible with all routine adult vaccines. Vaccinia (smallpox) and yellow fever vaccines are cautioned against use except in certain circumstances. CONCLUSION: Pharmacists can play an important role in recommending safe and appropriate vaccines before and during pregnancy.

Cranberry and warfarin interaction: a case report and review of the literature.

This case reports on a patient whose International Normalized Ratio (INR) increased after ingestion of cranberry sauce while stabilized on warfarin. It is followed by a review of the published literature on the potential interaction between the two.An 85-year-old woman on chronic warfarin therapy for atrial fibrillation experienced INR elevations of two- to three-fold after two separate ingestions of cranberry sauce. In each case, her INR values decreased after withholding three to four doses and resuming a similar maintenance dose of warfarin. Although the majority of the pharmacokinetic and pharmacodynamic studies did not find a significant interaction between cranberry and warfarin, several case reports indicate that cranberry products may increase INR values in patients on warfarin. Practitioners should consider cranberry usage as a potential contributor in the evaluation of supratherapeutic INR values in patients on warfarin.

Assessment of anticoagulation management in a simulated ambulatory care clinic.

OBJECTIVES: To assess the effectiveness of adding a simulated anticoagulation clinic practical examination for formal assessment of PharmD students' skills. DESIGN: A practical examination requiring students to review a mock medical record and role-play a follow-up anticoagulation clinic visit with a standardized patient was designed. Students assessed the patient's vital signs, laboratory values, and subjective complaints during an in-depth interview and documented clinical recommendations in a progress note. ASSESSMENT: Student feedback indicated that the simulated clinic was pertinent to preparation for experiential rotations. Ninety-five percent of the students recommended that it be continued as a required component of the course. CONCLUSION: The simulated ambulatory care clinic exercise reinforces principles of anticoagulation management as well as the assessment of clinical data, performance of a patient interview, and written documentation of recommendations.

Health food stores' recommendations for nausea and migraines during pregnancy.

BACKGROUND: Many pregnant women use dietary supplements during pregnancy; however, relatively scant information is available on the safety of these products. Consumers of dietary supplements often rely on employees of health food stores to provide recommendations. OBJECTIVE: To evaluate recommendations made by health food store employees in the Phoenix metropolitan area regarding treatment of nausea/vomiting and migraines during pregnancy. METHODS: Phone calls were made by a disguised shopper to 155 health food stores in the greater Phoenix area. The caller posed as a woman 8 weeks' pregnant asking for recommendations for treatment of nausea/vomiting and migraines. Responses and recommendations were recorded and then compared with current scientific evidence obtained during a search of the literature using MEDLINE (1966-September 2004) as to whether or not the supplements and the methods of their use during pregnancy were contraindicated. RESULTS: Eighty-nine percent of stores offered recommendations for nausea/vomiting, and 82% provided recommendations for migraines. The use of ginger was the most recommended therapy for nausea/vomiting. Only 3.6% of respondents recommended correct usage, but failed to supply the correct dosage and duration. A total of 15 of 278 (5%) recommendations, for both nausea/vomiting and migraines, were for products contraindicated in pregnancy. CONCLUSIONS: In light of the increased use of dietary supplements by women during pregnancy, the willingness of personnel in health food stores to make any recommendations should foster concerns by patients and healthcare providers alike. Use of dietary supplements contraindicated in pregnancy could cause significant harm to the mother and/or fetus. Studies are needed to address the need for more stringent guidelines regarding health food stores and their recommendations.