Robot-Assisted Radical Prostatectomy in PIRADS 5 Lesions without Prior Biopsy: Is Biopsy Really Necessary in This Cohort?

INTRODUCTION: Conventionally, confirmation of clinically significant prostate cancer (csPCa) (Gleason grade group >/= 2) involves an initial multiparametric magnetic resonance imaging (mpMRI) followed by biopsy. Prostate biopsy incurs inherent risks of infection, bleeding, patient discomfort, and a 6 week delay before robotic assisted laparoscopic radical prostatectomy (RALP). We explored the feasibility of immediate RALP in men with PIRADS 5 lesions without preceding biopsy. METHODOLOGY: After obtaining institutional review board approval, a prospective analysis was conducted on 235 patients with PIRADS 5 on mpMRI from December 2018 to February 2023. Patients were divided into 2 groups: Group NoBiopsy (biopsy not done before RALP, cases, n=118) and Group YesBiopsy (biopsy done before RALP, controls, n=117). Baseline pre-operative, intra-operative and post-operative parameters were analyzed. Functional outcomes were monitored at 1, 3-, 6-, 9-, and 12-months follow-up post-RALP. Statistical analysis was performed using SPSS and STATA. RESULTS: 95% of cases and 87.17% controls had csPCa on final pathology post-RALP. Multivariable analysis did not find significant association between biopsy status and csPCa. Abnormal digital rectal examination (DRE), family history, pre-operative PSA and MRI lesion volume predicted csPCa. Significant differences were observed in console time (NoBiopsy vs YesBiopsy, 60±10 vs. 70±9 minutes, p < 0.001) and estimated blood loss (80±20 vs. 100±30 mL, p < 0.01) between groups. At 6 months post-RALP, 96% of men in Group NoBiopsy were continent, compared to 88% of men in Group YesBiopsy (p < 0.04). All men in the study cohort were continent (0 pads) at 12 months post-RALP. 98% of cases and 92% of controls at 9 months and 12 months, respectively, were able to have penetrative sex with or without PDE-5 inhibitors post-RALP. CONCLUSION: RALP without antecedent prostate biopsy in men with PIRADS 5 lesions demonstrated substantial csPCa detection rates and superior functional outcomes, warranting further validation.

Considerations of management and marketing courses within pharmacy curricula in the United States.

INTRODUCTION: To assess the extent pharmacy programs are offering courses in management and marketing. METHODS: We sampled the extent of management and marketing coursework in the doctor of pharmacy (PharmD) curricula in the United States (US) by examining website descriptions of the best pharmacy schools in 2020 (N = 134) as ranked by the US News and World report. Links to curriculum descriptions and catalogs were reviewed for coursework having the words, marketing, management, entrepreneurship, or business plan in the title. RESULTS: Of the 134 PharmD curricula reviewed, 36 (27%) had no required or elective management courses, and 101 (75%) had no required or elective marketing courses in their curriculum. Most schools did offer a core (n = 89) or elective (n = 9) management course. However, of those, about half (n = 46) provided only a single management course over the entire curriculum. Only 33 (25%) schools offered a marketing course, of which most (n = 27) were elective. CONCLUSIONS: Many pharmacy schools in the US are not providing pharmacy graduates with the business management and marketing education required for the role of a pharmacist. Pharmacy education should consider curriculum changes that equip pharmacy students with sufficient business knowledge and skills to be innovative and entrepreneurial in all practice settings.

Destigmatizing public health concerns and supply of COVID-19 vaccines.

The end of the global pandemic caused by COVID-19 and a future without masks and restrictions are promising with the discovery of a vaccine. Still, there is much worry about the vaccine itself. Fears about what is inside the vaccine, how quickly it was created and plans for distribution are major concerns. This article aims to address these concerns to relieve vaccine hesitancy. Methods for distribution within the United States as well as different strategies to ensure proper and equitable allocation of COVID-19 vaccine worldwide is also described.

Patient Assistance Programs and Technology in Medication Adherence.

BACKGROUND: Patient assistance programs, including medication management and counseling, have the potential to improve care in chronic disease states with complex therapies. Incorporating technology as a tool to foster adherence is becoming more commonplace in practice. OBJECTIVES: The purpose of this report is to identify barriers of medication adherence and review the impact of patient assistance programs and technology on medication adherence. METHODS: A literature search was conducted in secondary databases, PubMed/MEDLINE and EBSCOhost of peer-reviewed systematic reviews, experimental, quasi-experimental, and observational reports published in English within the last fifteen years. Terms searched included patient assistance program, pharmacist role, technology, adherence or compliance, income and health. RESULTS: Ten studies met our prespecified criteria. Male sex, several self-reported chronic diseases, negative expectancy of treatment, engagement in polypharmacy, financial hardships and lower education level correlated with lower medication adherence. Patient care assistance programs and utilization of technology (e.g., use of a mobile application) improved medication adherence. CONCLUSIONS: Patient assistance programs and technological tools, such as mobile applications,are necessary resources in improvingmedication adherence.

"Daltexpharma": A Case Addressing Potential Pharmaceutical Cargo Theft.

This paper is provided as an innovative resource for those in the academic and training arenas to use as a case example in discussing the problem of pharmaceutical cargo theft. The case delves into the worldwide, on-going dilemma of pharmaceutical trucking cargo theft losses and the effects of such theft. For those unfamiliar with the case method of instruction, the paper's ending may be rather unsettling. But that is where the student's learning and faculty instruction process come together. Typically, students (whether in teams or individually) will fully develop their responses based on the queries provided at the end. Faculty may then proceed in any number of ways to elicit the students' insights in a classroom setting. For decades the pharmaceutical industry has been plagued with a plethora of criminal acts that impact the daily processes and procedures of operations. Pharmaceutical warehouse and trucking thefts have not only aided in the currently debilitating state of the opioid crisis in the United States, but these thefts also aid the black market in the illegal sale of diverted prescription drugs. Due to the lack of security measures, vulnerability of the truck drivers, their rigs, and the value of the cargo being transported, pharmaceutical theft is a lucrative opportunity for organized crime. The case presented here describes the issues within the pharmaceutical industry as companies must deal with "last mile" cargo thefts. Daltexpharma represents a synthesized, hypothetical example of a pharmaceutical firm that must develop policies to deal with such potential thefts in its supply chain. Although a fictitious company, the case realistically details the important factors to consider in establishing strong security practices that may be necessary for a pharmaceutical company operating in today's environment. In order to protect the integrity and security of the authors' case notes, particularly for use in an academic setting, the Journal's editor will maintain control of them. They may be obtained by faculty upon presenting their request to the Editor.

A retrospective cohort study of the prevalence of anxiety and agitation in schizophrenic smokers and the unmet needs of smoking cessation programs.

Achieving abstinence in schizophrenic smokers using a combination of medications and cognitive behavioral therapy is feasible; however, abstinence rates are significantly lower compared to the general population and studies are scanty. Additionally, maintaining sustained abstinence and preventing relapse is a major limiting factor and represents key tasks in managing tobacco dependence in schizophrenic patients. Several theories have been postulated to explain the higher tendency of tobacco use among schizophrenic individuals. Schizophrenic patients may use nicotine as a "self-medication" strategy to improve negative symptoms of schizophrenia. However, studies suggest that although nicotine may act as an anxiolytic acutely, chronic use of nicotine may lead to increased anxiety with the possibility of increased catecholamines, which is confirmed with the prevalence of tachycardia and hypertension in smokers in general. On this basis, the main objective of our present study was to assess anxiety in schizophrenic smoking and nonsmoking patients by comparing the number of anxiety and agitation episodes and evaluating the amount of antianxiety/antiagitation medication used by each group. A separate objective was to document the unmet needs of smoking cessation programs in treating schizophrenic patients. Consequently, in the present retrospective cohort study, it was observed that schizophrenic smokers tend to have higher anxiety episodes and utilize as-needed medications at a higher frequency compared to nonsmokers for the relief of anxiety and agitation symptoms. Further research is warranted to examine these results on a larger scale.

Trends of cancer-associated venous thromboembolism (VTE) in the United States (2005-2014).

INTRODUCTION: Cancer patients are prone to higher risk of venous thromboembolism (VTE) compared to the general population. However, the estimated incidence of cancer-associated VTE varied among the studies. The primary objective of this study was to determine the national annual incidence and examine the trend of cancer-associated VTE in the US over the years from 2005 to 2014. METHODS: A retrospective population based study was conducted using data from the Medical Expenditure Panel Survey. The study included all noninstitutionalized US adults aged ≥18 years who had a final person-weight > 0 to be representative of the national population. Simple linear regression (SLR) and Mann-Kendall (MK) tests were used to examine the trend of cancer-associated VTE over the years. RESULTS: On average, there were 15,570,000 adult persons living with a cancer condition every year. Female represented 53.8% of the study population, and the mean of age was 63.5 years. The overall annual incidence of cancer-associated VTE varied between 1.80 and 0.72% over the years, with an overall average of 1.18%. The study found a non-significant downward trend in the incidence of cancer-associated VTE over the years. Patients who had cancer-associated VTE were significantly older than patients without VTE (mean 68.64 vs. 62.68 years, p < .0001). CONCLUSION: The study found cancer patients continued to have the risk of VTE over the years. The non-significant downward trend in cancer-associated VTE suggests that health care practitioners are heading in the right direction, but enhanced preventative care is needed to avoid further incidents of cancer-associated VTE.

Cultural Sensitivity and Global Pharmacy Engagement in Asia: India, Indonesia, Malaysia, Philippines, and Vietnam.

Schools and colleges of pharmacy in the United States increasingly interact with those in Asian countries for various purposes such as education and research. For both those visiting and those hosting, it is important to understand and respect the culture of the other's country to enrich these interactions. This paper, the second of two manuscripts on Asian countries, focuses on India, Indonesia, Malaysia, Philippines, and Vietnam. For each country, the following information is provided: general introduction, health care system, pharmacy practice, and pharmacy education, stereotypes and misconceptions, recommendations for US-based health care professionals, faculty members, and students who visit these Asian countries, and recommendations for them to host visitors from these Asian countries. The aim of this paper is to assist US health care professionals, faculty members, and students in initiating and promoting a culturally sensitive engagement.

Cultural Sensitivity and Global Pharmacy Engagement in the United States.

Objective. To provide a resource for schools and colleges of pharmacy in different regions of the world that are considering sending their students and faculty members to the United States for training. Methods. A literature review (2000-2018) was conducted that involved database and Internet searches using specific keywords and terms. Information was also solicited from authors in different regions of the United States who have hosted international students and faculty members. Recommendations for pharmacists and other health care practitioners on culturally sensitive engagement were formulated. Results. Global engagement between schools and colleges of pharmacy from different regions of the world and the United States is increasing. In addition to various cultural aspects, general information about the US health care system, pharmacy education programs, and pharmacy practice were found to be available to individuals who are charged with organizing and facilitating these exchanges. Common stereotypes and misconceptions about the United States were also identified. Conclusion. For international learners to have an enriching and fruitful engagement while in the United States, an understanding of American culture in general as well as the unique cultural aspects of different regions of the country as provided in this paper is critical.

Cultural Sensitivity and Global Pharmacy Engagement in the Arab World.

Objective. To create a resource on cultural sensitivity for schools and colleges of pharmacy that are currently engaged or considering future outreach opportunities in the Arab world. Methods. A literature review (2000-2018) of databases and Internet searches with specific keywords and terms were conducted. Authors who had experience in travelling to and hosting students and professionals from the Arab world and authors with local work experience in the Arab world were solicited. Results. General information about the Arab world, including unique aspects of individual countries, is presented. Stereotypes and misconceptions regarding the region and the people are discussed. Specific information about the government and infrastructure of each country, including their health care system is provided, with emphasis given to pharmacy education and practice in the region. In addition, recommendations for culturally sensitive engagement for pharmacy and other health care practitioners are discussed. Finally, recommendations for culturally sensitive engagement when hosting students and/or faculty members from the Arab world are also addressed. Conclusion. Global engagement between schools and colleges of pharmacy in the United States and those in the Arab world is increasing. For an enriching and fruitful engagement, sensitivity toward the cultural and clinical needs of the people, and in particular, the professionals of that region is critical.

A comparative study of the depth, breadth, and perception of pharmacogenomics instruction in a subgroup of US pharmacy curricula.

INTRODUCTION: This study was designed to assess the depth, breadth, and perception of pharmacogenomics education in pharmacy curricula in the United States (US). METHODS: A modified, online questionnaire from previous studies was sent to all accredited US schools and colleges of pharmacy. The survey covered three distinct areas related to the schools' educational environments, the depth and the extent of pharmacogenomics core competencies and topics taught, and the institutions' perceptions of the importance of pharmacogenomics in the curriculum and future plans for expanded pharmacogenomics education. Multiple approaches were used to increase the response rate, and results were analyzed using descriptive statistics. RESULTS: Of the 133 eligible programs, 32 participated in the survey. Six invalid surveys were excluded from our study, resulting in a 19.6% response rate. Results revealed that all responding schools included pharmacogenomics in the curriculum. Interestingly, 76.9% of the respondents believed pharmacists do not have the appropriate knowledge of pharmacogenomics. However, only 30.7% indicated that their programs planned to expand pharmacogenomics in their curriculum. CONCLUSIONS: The responding schools all included some pharmacogenomics in their curriculum. However, the depth and the extent of pharmacogenomics topics covered varied. Respondents perceived that pharmacists today do not possess the appropriate level of pharmacogenomics knowledge. Despite this, there is limited emphasis on expanding pharmacogenomics instruction in the responding schools' curriculums.

Patient Counseling Guidelines for the Use of Cannabis for the Treatment of Chemotherapy-Induced Nausea/Vomiting and Chronic Pain.

The use of cannabis medications has grown in recent years for the symptomatic relief of chemotherapy-induced nausea/vomiting (CINV) and chronic pain (cancer-related and non-cancer-related). As states legalize the use of cannabis, it is important for pharmacists and other health care professionals to be aware of how to counsel patients receiving prescriptions for cannabis medications. The aim of this study was to develop patient counseling guidelines for the use of cannabis products in treatment of CINV and chronic pain. A literature search was performed using Medline/PubMed resources and Google Scholar between July 2015 and August 2018 using broad search terms, e.g., cannabinoids adverse effects, cannabis, natural cannabinoids, and tetrahydrocannabinol. Using the American Society of Health-System Pharmacists patient counseling guidelines and medical information on cannabis medications gathered from drug databases, a comprehensive counseling guideline was developed. Medical evidence of the use of natural cannabis medications that are smoked or orally ingested have not been studied as extensively as oral therapeutic agents currently available. Cannabis medications have become more prevalent by approval of legislators in several states. Hence, pharmacists and health care professionals should counsel patients effectively on its use. This guideline needs to be tested to assess its utility in patients.

Third-year pharmacy students propose an interprofessional prediabetes educational programme: PreDiaMe (Prediabetes + Me).

The American Diabetes Association announced in 2012 that 86 million Americans were diagnosed with prediabetes compared to 79 million in 2010. Prediabetes + Me (PreDiaMe) is an innovative educational programme developed by pharmacy students at Nova Southeastern University College of Pharmacy, which provides collaborative interprofessional care for patients with prediabetes. A literature review using EBSCOhost, EMBASE, and MEDLINE databases searching the terms education, health services, interprofessional team, and prediabetes was conducted. Human studies published in English between 2006 and 2016 were included. Investigators interviewed a community pharmacist and a consultant pharmacist certified in diabetes education. Based on these interviews and the literature found, PreDiaMe was created to unite healthcare professionals through a three-step community outreach programme. The goal of PreDiaMe is to identify patients at risk of prediabetes, to decrease the prevalence of type 2 diabetes mellitus (T2DM), to reduce healthcare costs, and to improve the quality of life for patients with prediabetes. PreDiaMe benefits patients with prediabetes, the healthcare system, and pedagogy as it aims to decrease in the prevalence and economic burden and increase health outcomes of patients with prediabetes while being used as a tool to provide integrative education in health professional programmes.

Banning Tobacco Sales at the Retail Pharmacy: Natural Evolution of Drug Store As Responsible Health Provider Or Effective Marketing Strategy?

CVS Health has taken a strategic marketing move by banning tobacco sales. They risk losing customers who buy medications and cigarettes at their drugstores. They estimate they will lose 2 billion dollars by banning cigarette sales. CVS Health believes they will benefit from being regarded as health care partner by insurers and banning cigarette sales is an important step in being recognized as such. The Affordable Care Act expanded access to pharmacy-based medical clinics, increased affordability of medications, and expanded the clinical role of pharmacists. CVS Health is positioning itself to take advantage of these changes.

Patient attitudes toward community pharmacist attire.

The white coat has symbolized professionalism, while representing provider-patient fiduciary relationship. Although well described in the literature for physicians, few studies examine the impact of pharmacist attire on patients' opinions regarding professionalism and trust. Therefore, understanding patient perceptions regarding pharmacist's attire and its influence on comfort, confidence, trust, and professionalism may provide guidance on ways to enhance the quality of the provider-patient relationship. A 43-item Likert-type questionnaire was administered to 347 adults in a community pharmacy setting to determine preferences about the pharmacist's attire, accessories, and body art incorporating 8 photographs depicting a male pharmacist in various degrees of dress formality (ie, casual to professional). Descriptive and inferential statistics were used to summarize and analyze the data. Survey respondents reported it was desirable/strongly desirable that pharmacists be dressed in a shirt and tie, dress shoes, white coat, and name tag (mean 4.21-4.72), whereas they should not be dressed in jeans, casual shoes, or have visible body art (mean 2.17-2.78). Over 86% of the respondents felt that a pharmacist with a white coat instilled feelings of comfort, confidence, trust, and professionalism. In a community pharmacy setting, a pharmacist wearing a white coat appears to be the mainstay in displaying professionalism and inspiring trust in adult patients.

Marketing retail health clinics: challenges and controversies arising from a health care innovation.

Since their founding in 2000, retail-based health care clinics, also called convenient care clinics, have flourished but continue to generate controversy. This article examines the literature with respect to the industry's background, establishment of industry standards, types of services offered, marketing of retail health clinics, industry growth with new target markets, and patient demographics. It also examines the growing relationship with insurers and third-party payers, quality-of-care concerns by medical associations, and legal regulations and their potential impact on industry growth nationwide.

E-prescribing: attitudes and perceptions of community pharmacists in Puerto Rico.

E-prescribing may help reduce medical errors. Study objectives were to determine use, perceptions, and a model of adoption regarding e-prescribing. A questionnaire was developed and sent to pharmacists in Puerto Rico. Multiple regression analyses were used to test a model of influences on adoption. 438 pharmacists responded. The overall adoption model was significant. Perceived advantages had a positive influence on adoption. Pharmacist groups demonstrating higher adoption included: male > female, chain > independent, younger > older (all p < 0.05). Barriers had a negative influence (p = 0.01). The model employed here can help explain pharmacist adoption and integration of e-prescribing.

Influence on consumer behavior: the impact of direct-to-consumer advertising on medication requests for gastroesophageal reflux disease and social anxiety disorder.

A 68-question Internet survey was used to determine the impact of televised direct-to-consumer advertising (DTCA) on consumer-initiated medication changes for the treatment of gastroesophageal reflux disease (GERD) and social anxiety disorder (SAD). Of the 427 respondents, 10% that viewed DTCA for GERD and 6% that viewed DTCA for SAD reported that they subsequently initiated a conversation with their physician. Nearly half of respondents, 47.4% for GERD and 40% for SAD, reported that a change in therapy occurred as a direct result of these discussions. Televised DTCA for these two drug classes can have a significant impact on patient-initiated prescription requests.

Characteristics of physicians targeted by the pharmaceutical industry to participate in e-detailing.

Electronic detailing (e-detailing) has been introduced in the last few years by the pharmaceutical industry as a new communication channel through which to promote pharmaceutical products to physicians. E-detailing involves using digital technology, such as Internet, video conferencing, and interactive voice response, by which drug companies target their marketing efforts toward specific physicians with pinpoint accuracy. A mail survey of 671 Iowa physicians was used to gather information about the physician characteristics and practice setting characteristics of those who are usually targeted by pharmaceutical companies to participate in e-detailing. A model is developed and tested to explain firms' targeting strategy for targeting physicians for e-detailing.

Impact of direct-to-consumer advertising (DTCA) on patient health-related behaviors and issues.

The pharmaceutical industry spends billions of dollars annually on direct-to-consumer advertising (DTCA). Patient perspectives on the impact of televised DTCA on health-related behaviors and issues were assessed by means of a 68-question survey. 58.6% of respondents believed that DTCA allowed consumers to have a more active role in managing their health. However, 27.6% felt DTCA caused confusion, and an alarming 17.8% of respondents stopped taking their medication because of concerns about serious side effects mentioned in DTCA. Overall, participants believed DTCA plays a useful role in health self-management; however, a considerable percentage thought that the cost outweighs the benefits.