Pharmacists' attitudes, interest, and perceived skills regarding suicide prevention.

INTRODUCTION: Pharmacists have been called upon to be involved in suicide prevention efforts, but little is known regarding their attitudes, interest, and perceived skills in the area. METHODS: The study was a voluntary, anonymous survey of pharmacists who attended a large end-of-year continuing education program sponsored by a school of pharmacy. The survey included the Attitudes to Suicide Prevention (ASP) Scale, items concerning interest in suicide prevention, and items from the suicide skills section of the Suicide Knowledge and Skills Questionnaire. RESULTS: The survey was completed by 227/297 (76.4%) pharmacists. The percentage of participants who expressed interest in direct involvement, indirect involvement, and receiving training in suicide prevention were 25%, 46%, and 56%, respectively. The mean total score on the ASP was 32.2 ± 5.5. Approximately 4% to 8% of participants agreed that they had the requisite training, skills, or support/supervision to engage and assist suicidal patients, and 22% agreed to feeling comfortable asking their patients direct and open questions about suicide. The ASP scores and items relating to perceived skills were correlated with interest in direct involvement in suicide prevention. DISCUSSION: There were some positive findings, but overall, the pharmacists who participated in this survey felt unprepared to be frontline clinicians in suicide prevention efforts. Further studies should be conducted to determine if these findings are generally reflective of the broader pharmacy community. If the profession is to have a serious role in suicide prevention, then adequate suicide prevention training for pharmacy students and pharmacists may be necessary.

Effects of a psychiatric clinical rotation on pharmacy students' attitudes toward mental illness and the provision of pharmaceutical care to the mentally ill.

INTRODUCTION: Previous studies have found ineffectiveness of psychiatric clinical rotations to change pharmacy students' attitudes toward mental illness, but those studies had various limitations that cast doubt on this conclusion. METHODS: Pharmacy students who participated in a psychiatric clinical rotation over a 2-year time frame were invited to complete a survey at the beginning and end of their rotation. The survey included scales that measured attitudes toward dangerousness, social distance, stigmatization, suicide prevention, and provision of pharmaceutical care. RESULTS: Forty-one (100%) students participated in the study. Statistically significant positive changes in total scale scores from pre-rotation to post-rotation were seen in the areas of stigmatization toward patients with schizophrenia (P = .02), attitudes toward suicide prevention (P = .05), and provision of pharmaceutical care services to patients with schizophrenia (P < .00001) and depression (P = .0006). There were no statistically significant changes on the total scores of the other scales, but there was a moderate improvement in stigmatization toward patients with depression. DISCUSSION: Pharmacy students' participation in a psychiatric clinical rotation failed to have a major impact on their social distance from mentally ill patients. Findings were mixed in regards to stigmatization of mentally ill patients. However, pharmacy students' attitudes toward suicide prevention and providing pharmaceutical care services to mentally ill patients were significantly improved by participation in a psychiatric clinical rotation. Preceptors in the clinical setting should consider including educational techniques that address pharmacy students' attitudes toward mental illness, as improvement in such attitudes may further enhance their willingness to provide pharmaceutical care services.

Sleep quality among pharmacy students.

OBJECTIVE: To determine the quality of sleep among pharmacy students in the didactic portion of the curriculum at one school of pharmacy. METHODS: The study consisted of an anonymous, voluntary survey that included the Pittsburgh Sleep Quality Index (PSQI), a self-rated instrument that measures sleep habits for a month. RESULTS: The survey was completed by 253 students. Students in the lower grade point average (GPA) category had higher scores on 2 of 7 components of the PSQI and on the global score. Poor sleep quality, indicated by a global PSQI score of greater than 5, was reported by 140 students. The rate of poor sleeping was higher among students in the lower GPA category. CONCLUSION: Poor sleep quality was pervasive among surveyed pharmacy students in the didactic portion of the pharmacy school curriculum, especially among those with lower GPAs.

Pharmacy journal abstracts published in PubMed that abide by the CONsolidated Standards Of Reporting Trials (CONSORT) guidelines.

The purpose of this research was to determine the proportion of abstracts in pharmacy journals that are prepared according to the CONsolidated Standards Of Reporting Trials (CONSORT) criteria for abstracts. Certain abstracts for randomized controlled clinical trials (RCTs) indexed in PubMed were eligible for inclusion, with the primary endpoint being median overall compliance to CONSORT recommendations for abstracts. A total of 63 RCT abstracts were included in the analysis, with only 56% of the recommended CONSORT items represented in the sample. It is recommended that pharmacy journals encourage authors to follow CONSORT recommendations for abstracts when submitting RCTs for publication.

Pharmacist-developed sedation protocol and impact on ventilator days.

BACKGROUND: Up to one-third of intensive care unit (ICU) patients require mechanical ventilation. Mechanical ventilation is associated with numerous complications including ventilator-induced lung injury and gastrointestinal bleeding due to ulcerations.(1) Sedation protocols are used in order to optimize treatment and decrease days spent on mechanical ventilation. OBJECTIVE: The purpose of this trial is to evaluate the effectiveness of an ICU sedation protocol. The primary end point was days on mechanical ventilation. DESIGN: A retrospective chart review was performed. The medical records of 21 patients treated prior to the protocol and 21 patients treated after protocol implementation were reviewed. RESULTS: The duration of mechanical ventilation was decreased in the postprotocol patients compared to the preprotocol patients. The mean duration of mechanical ventilation in the preprotocol group was 6.39 ± 5.24 versus the postprotocol group which was 3.78 ± 3.21 days. After implementing the sedation protocol, the number of days to extubation was decreased by 2.61 days. CONCLUSION: The use of sedation protocols can decrease the days spent on mechanical ventilation. The results also illustrate the enormous impact pharmacists have on policy and protocol development.

Attitudes of matriculating first-year pharmacy students toward a mandatory, random drug-screening program.

OBJECTIVE: To determine the attitudes of incoming pharmacy students toward a mandatory, random urine drug-screening program. METHODS: This was an anonymous, voluntary survey of students at the McWhorter School of Pharmacy (MSOP) using an instrument composed of 40 items. The instrument was administered during orientation week prior to the session during which the policies and procedures of MSOP's drug-screening program were to be discussed. RESULTS: The survey instrument was completed by all 129 (100%) students in the class. Two-thirds of the students were aware of MSOP's drug-screening program prior to applying, but only a few felt uneasy about applying to the school because of the program. The greatest concerns expressed by the students included what would happen if a student unintentionally missed a drug screen or was busy with other matters when called for screening, how much time a drug-screening would take, and the possibility of false-positive drug screen results. The vast majority of students agreed with statements regarding the potential benefits of drug testing. Students who consumed alcohol in a typical week and those with current or past use of an illegal substance held less favorable attitudes toward MSOP's mandatory drug-screening program compared with students who did not share those characteristics. CONCLUSION: Although there were definite concerns expressed regarding pragmatic issues surrounding drug screening, the first-year pharmacy students held generally favorable opinions about the school's mandatory drug-screening program.

Factors that influence the career goals of pharmacy students.

OBJECTIVES: To identify pharmacy students' short- and long-term career goals, including projected areas of practice, and evaluate the factors that influence these goals. METHODS: A 19-question survey instrument was administered to pharmacy students in each of the 4 professional pharmacy years. The results were analyzed to determine factors influencing students' career goals and to compare choices among the different classes. RESULTS: The most important factor considered by pharmacy students was work environment. Their career goals upon graduation were predominantly in the retail chain setting. However, 5 years after graduation, their projected areas of practice were divided between retail and clinical settings. CONCLUSIONS: Specific factors influence pharmacy students' short- and long-term career goals and identifying these factors may provide insights to faculty members in planning the experiential curriculum and assist prospective employers in increasing job retention among new pharmacists and improving their overall job satisfaction.

Metabolic consequences of using low-dose quetiapine for insomnia in psychiatric patients.

Quetiapine is frequently prescribed for insomnia that is comorbid with psychiatric disorders, but there has been no documentation of metabolic adverse effects associated with this practice. The objective of this study was to document changes in weight, body mass index, and waist circumference that occurred when low-dose quetiapine was used at bedtime for insomnia. The study was a retrospective chart review conducted at a community mental health center. Patients were non-elderly (19-65 years old) psychiatric patients who received quetiapine at < or =200 mg at bedtime for the explicit indication of insomnia. Forty-three patients were included in the study. Weight and BMI increased by an average of 4.9 lb. (P = 0.037) and 0.8 points (P = 0.048), respectively. Males experienced statistically significant increases in weight and BMI, and Caucasians experienced a statistically significant increase in BMI. There were no significant differences between baseline and endpoint metabolic parameters when examined by baseline BMI, age category, psychiatric diagnosis, or concomitant psychotropic medication. Despite the low doses typically used when quetiapine is prescribed for insomnia, metabolic adverse effects can occur and should be considered in the overall benefit to risk analysis.

Google Scholar versus PubMed in locating primary literature to answer drug-related questions.

BACKGROUND: Google Scholar linked more visitors to biomedical journal Web sites than did PubMed after the database's initial release; however, its usefulness in locating primary literature articles is unknown. OBJECTIVE: To assess in both databases the availability of primary literature target articles; total number of citations; availability of free, full-text journal articles; and number of primary literature target articles retrieved by year within the first 100 citations of the search results. METHODS: Drug information question reviews published in The Annals of Pharmacotherapy Drug Information Rounds column served as targets to determine the retrieval ability of Google Scholar and PubMed searches. Reviews printed in this column from January 2006 to June 2007 were eligible for study inclusion. Articles were chosen if at least 2 key words of the printed article were included in the PubMed Medical Subject Heading (MeSH) database, and these terms were searched in both databases. RESULTS: Twenty-two of 33 (67%) eligible Drug Information Rounds articles met the inclusion criteria. The median number of primary literature articles used in each of these articles was 6.5 (IQR 4.8, 8.3; mean +/- SD 8 +/- 5.4). No significant differences were found for the mean number of target primary literature articles located within the first 100 citations in Google Scholar and PubMed searches (5.1 +/- 3.9 vs 5.3 +/- 3.3; p = 0.868). Google Scholar searches located more total results than PubMed (2211.6 +/- 3999.5 vs 44.2 +/- 47.4; p = 0.019). The availability of free, full-text journal articles per Drug Information Rounds article was similar between the databases (1.8 +/- 1.7 vs 2.3 +/- 1.7; p = 0.325). More primary literature articles published prior to 2000 were located with Google Scholar searches compared with PubMed (62.8% vs 34.9%; p = 0.017); however, no statistically significant differences between the databases were observed for articles published after 2000 (66.4 vs 77.1; p = 0.074). CONCLUSIONS: No significant differences were identified in the number of target primary literature articles located between databases. PubMed searches yielded fewer total citations than Google Scholar results; however, PubMed appears to be more specific than Google Scholar for locating relevant primary literature articles.

Faculty attitudes and scholarly productivity resulting from a seminar course.

OBJECTIVES: To determine faculty attitudes toward a professional seminar course for PharmD students, document scholarly production derived from the course, and ascertain whether that scholarly production or other faculty characteristics affected attitudes toward the course. METHODS: Faculty members served as facilitators for pharmacy students enrolled in a professional seminar course. A 34-item survey instrument intended to identify faculty attitudes toward the course and document scholarly productivity was developed. All 40 faculty facilitators involved in the course were asked to complete the survey instrument. RESULTS: Of the 30 (75%) faculty members who completed the survey instrument, 20 had an overall positive attitude toward the course. Faculty members had generated approximately 90 peer-reviewed scholarly works over a 9-year period as a result of the course. Significant associations were found between faculty members' attitudes toward the course and academic rank, academic department, and scholarly production derived from the course. CONCLUSIONS: Faculty members who had advanced academic rank, an appointment in the pharmacy practice department, and scholarly productivity as a result of serving as a facilitator for a Professional Seminar Course were more likely to have positive attitudes toward the course.

Efficacy of add-on topiramate therapy in psychiatric patients with weight gain.

BACKGROUND: Weight gain is a common adverse effect of many psychotropic medications including antipsychotics, antidepressants, and mood stabilizers. There is a growing body of evidence that topiramate may be useful as an add-on therapy to induce weight loss in patients who have experienced psychotropic-induced weight gain. OBJECTIVE: To determine the efficacy and tolerability of topiramate for treatment of weight gain in a naturalistic mental health clinic setting. METHODS: A retrospective chart review was conducted at a community mental health clinic. Subjects were non-elderly adults who received topiramate therapy beginning in 2002-2005 for documented weight gain during treatment with psychotropic drugs. Primary outcome measures included response rate (based on weight loss of any magnitude) and mean changes in weight and body mass index (BMI). RESULTS: Forty-one patients were included in the study. There was a 58.5% (n = 24) response rate. Mean reductions in weight and BMI were approximately 2.2 kg and 0.5 points, respectively. Responders lost an average of 7.2 kg, whereas nonresponders gained an average of 5.0 kg. Patients with a baseline weight of at least 91 kg and those receiving a greater number of psychotropic medications were more likely to experience success with topiramate therapy. Of the 24 patients who responded to therapy, 22 experienced onset of weight reduction by the next clinic visit (1-4 mo) following either initiation of therapy or titration to the eventual therapeutic dose, and the usual rate of weight loss was 0.45-1.4 kg per month. Therapy was typically initiated at 50 mg/day. The mean maximum dose was 93.9 mg/day and the median maximum dose was 100 mg/day. Seven (17.1%) patients had documented adverse effects to topiramate therapy. CONCLUSIONS: Topiramate therapy resulted in overall modest (ie, <2%) decreases in weight and BMI, but many patients experienced more impressive weight loss. Therapy was generally well tolerated.

Attitudes of pharmacists toward mental illness and providing pharmaceutical care to the mentally ill.

BACKGROUND: Few studies have examined the attitudes of pharmacists toward mental illness. OBJECTIVE: To study the attitudes of Alabama pharmacists toward both mental illness and the providing of pharmaceutical care to mentally ill patients. METHODS: The survey used in this project was composed of 3 sections. Section 1 collected demographic information, section 2 asked 11 Likert-type questions concerning attitudes toward mental illness, and section 3 asked about attitudes toward providing pharmaceutical care to mentally ill patients. The surveys were distributed to pharmacists attending 3 school-sponsored continuing education programs. RESULTS: One hundred eighty-seven pharmacists participated in the survey. The vast majority (>90%) of participants disagreed or strongly disagreed with statements that mentally ill patients are easily recognizable, unintelligent, and do not care how they look. Approximately 30-50% of participants expressed being "more" or "much more" confident, comfortable, interested, and likely to perform pharmaceutical care activities for mentally ill patients relative to medically ill patients, while only approximately 5-20% of participants expressed being "less" or "much less" so. Several demographic factors, including gender, age, and years in practice, were associated with attitudes toward providing pharmaceutical care to mentally ill patients. CONCLUSIONS: Pharmacists expressed generally positive attitudes toward both mental illness and the providing of pharmaceutical care to mentally ill patients.

Clonazepam for treatment of sleep disturbances associated with combat-related posttraumatic stress disorder.

BACKGROUND: Clonazepam is widely used for the treatment of posttraumatic stress disorder (PTSD)-related sleep disturbances despite very limited published data supporting its use for this indication. OBJECTIVE: We conducted a pilot-controlled trial to provide more data on this clinical practice and lay the foundation for more definitive studies. METHODS: The study was designed as a randomized, single-blind (ie, patient only), placebo-controlled, crossover clinical trial involving administration of clonazepam 1 mg at bedtime for one week followed by 2 mg at bedtime for one week. The following week served as a washout period before the alternate treatment was begun. Patients completed sleep diaries each morning upon awakening throughout the study. Parameters included quantity of sleep, quality of sleep, frequency and intensity of difficulty falling or staying asleep, and frequency and intensity of recurrent distressing dreams. RESULTS: Six patients with combat-related PTSD participated in the study. There were no statistically significant differences between clonazepam and placebo for any measure, although clonazepam therapy resulted in mild to moderate numeric improvements in difficulty falling or staying asleep. Adverse effects of clonazepam were generally mild and essentially indiscernible from those attributed to placebo. Only one patient elected to receive further treatment with clonazepam at the conclusion of the trial. CONCLUSIONS: Clonazepam therapy was largely ineffective in improving sleep disturbances, particularly nightmares, associated with combat-related PTSD. The small sample size was a significant limitation of this study, but the prospective design and single-blind, placebo-control parameters were strengths. Further studies are needed to further define the role of this widespread clinical practice.