Interpersonal Psychotherapy-Adolescent Skills Training With Youth From Asian American and Immigrant Families: Cultural Considerations and Intervention Process.

Although research has identified effective evidence-based depression prevention interventions for diverse youth, little is known about how the intervention process unfolds with immigrant family youth. This study utilized a qualitative approach to explore cultural and clinical differences in the implementation of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) in two schools, one serving youth from primarily immigrant, Asian American families and the second, youth from mostly nonimmigrant, non-Hispanic White families. A total of 131 IPT-AST sessions were audio recorded, transcribed, and coded for presence and patterns of cultural and clinical constructs. Results revealed that sessions with immigrant family youth were more likely to contain discussions of interpersonal problems characterized by estrangement, goals of spending time together with important others, mentions of emotion suppression and academic achievement expectations, conversations about acculturation, differences in value orientation, and discomfort with implementing new intervention skills. Dialogue from interventionist and youth exchanges is presented to illustrate how these themes emerged and were addressed by interventionists in a culturally responsive manner. The study highlights how IPT-AST with immigrant family and Asian American youth may unfold differently compared to youth from nonimmigrant families. Implications of findings for providers are discussed.

Pediatric Emergency Department Interventions of Pharmacy Residents.

OBJECTIVE: We sought to assess the frequency and types of interventions performed by pharmacy residents in a pediatric emergency department (ED). METHODS: The study was conducted in an academic ED with 77,000 annual visits, of which 17% are pediatric. Six pharmacy residents completed a total of 9 two-week rotations in the pediatric ED as part of their pharmacy residency programs from February 2016 to December 2018. Pharmacy residents recorded pharmacy intervention data in real time. We quantified the number and type of interventions and time spent making the interventions. RESULTS: Of 1608 pediatric patients present during the ED shifts when pharmacy residents were on service, pharmacy residents intervened on 294 patients (18.3%). A total of 400 activities and interventions were recorded. The majority (72%) of patients required 1 intervention, whereas the remaining 28% had 2 or more interventions documented. The median time spent per patient was 15 minutes (interquartile range, 10-20 minutes). Pharmacy residents were most commonly involved with medication selection and dosing. CONCLUSIONS: The presence of a dedicated pharmacy team member in the pediatric area of the ED allows for a high level of involvement and interaction with other members of the health care team primarily through providing recommendations regarding medication selection, dosing, optimization, and answering drug information and medication administration questions.

Safety of parenteral ketorolac use for analgesia in geriatric emergency department patients.

OBJECTIVE: To assess the safety of a single dose of parenteral ketorolac for analgesia management in geriatric emergency department (ED) patients. METHODS: This was a retrospective study of all administrations of parenteral ketorolac to adults ≥65 years of age and matched controls. The primary outcome was the occurrence of any of the following adverse events within 30 days of the ED visit: gastrointestinal bleeding, intracranial bleeding, acute decompensated heart failure, acute coronary syndrome, dialysis, transfusion, and death. The secondary outcome was the occurrence of an increase in serum creatinine of ≥1.5 times baseline within 7 and 30 days of the ED visit. RESULTS: There were 480 patients included in the final analysis, of which 120 received ketorolac (3: 1 matching). The primary outcome occurred in 14 of 360 patients who did not receive ketorolac and 2 of 120 ketorolac patients (3.9% vs 1.7%, p = 0.38; OR 2.39, 95% CI 0.54-10.66). There was no occurrence of dialysis or death in either group. The secondary outcome occurred in 1 of 13 and 1 of 23 ketorolac patients with both a baseline serum creatinine and a measure within 7 and 30 days, respectively, but did not occur in patients who did not receive ketorolac (7 days: 7.7% vs 0.0%, p = 0.29; 30 days: 4.4% vs 0.0%, p = 0.22). CONCLUSION: The use of single doses of parenteral ketorolac for analgesia management was not associated with an increased incidence of adverse cardiovascular, gastrointestinal, or renal adverse outcomes in a select group of older adults.

The Validation of Neogen Reveal® Q+ for DON.

BACKGROUND: Reveal® Q+ for DON is an immunochromatographic test for quantitative determination of deoxynivalenol (DON) in grains. OBJECTIVE: A study was conducted to validate performance of this method for determination of DON in naturally contaminated corn and wheat and in DON-spiked corn/soy blend, soybeans, barley, malted barley, buckwheat, brown rice, sorghum, and distillers dried grain. METHODS: In addition to matrix testing, LOD, linearity, selectivity, robustness, and stability/lot-to-lot consistency testing were performed. RESULTS: The LOD was determined to be 0.014 ppm in corn and 0.037 ppm in wheat, and the LOQ 0.042 ppm in corn and 0.11 ppm in wheat. Recovery ranged from 90 to 104% across a range of reference values of 0.5 to 34.5 ppm. Linearity calculation comparing test results with reference values produced R2 values of 0.999 in both matrixes. Internal results with corn and wheat were corroborated in independent laboratory testing. For DON-spiked commodities, mean recovery across a range of DON concentration from 0.5 to 30 ppm ranged from 90 to 109%. Results of selectivity testing showed no cross-reactivity with other mycotoxins and no interference in detection of DON. Reagent lot-to-lot consistency and stability studies showed consistent results across a range of DON levels and established expiration dating for the test of 18 months after manufacture when stored under specified conditions. Conclusions and Highlights: The Reveal Q+ for DON test offers reliable performance as well as the advantages of aqueous sample extraction, procedural simplicity, minimal labor and equipment requirements, and rapid results. CONCLUSIONS: The Reveal Q+ for DON test is validated as a Performace Tested Method in Corn, Wheat, and a variety of other grains. HIGHLIGHTS: The test provides rapid results from a simple aqueous extraction and requires minimal labor and equipment.

Comparison of In-Hospital Bleeding and Cardiovascular Events with High-Dose Bolus Tirofiban and Shortened Infusion to Short-Duration Eptifibatide as Adjunctive Therapy for Percutaneous Coronary Intervention.

Potent platelet inhibition is one of the most important medical interventions to prevent ischemic complications during and after percutaneous coronary intervention (PCI). Practice has evolved with the introduction of potent oral P2Y12 inhibitors that provide quick, effective platelet inhibition, and the need for routine glycoprotein IIb/IIIa inhibitors (GPIs) has decreased. Additionally, a shorter duration of GPI infusion has been shown to be safe with adequate oral antiplatelet loading, but clinical outcome data are limited to eptifibatide. This single-center, retrospective cohort study analyzed in-hospital outcomes for patients who received adjunctive GPI therapy for PCI before and after an institution-wide switch to high-dose bolus tirofiban with shortened infusion from short-duration eptifibatide. The primary end point was a composite in-hospital outcome of major and minor bleeding and cardiovascular events (death, myocardial infarction, coronary artery bypass grafting, ischemic stroke, and target vessel revascularization). Secondary end points included bleeding and cardiovascular event types. A total of 357 and 446 patients received eptifibatide and tirofiban, respectively, from February 1, 2014 through September 30, 2017. Thirty five eptifibatide and 46 tirofiban patients experienced an in-hospital composite event (9.8% vs 10.3%, p = 0.81). There was no difference found between in-hospital bleeding (6.4% vs 5.4%, p = 0.52) or cardiovascular events (5.6% vs 6.5%, p = 0.60) with the use of eptifibatide or tirofiban, respectively. Multivariable analysis showed that patients with transradial access or an indication of unstable angina were less likely to experience an in-hospital composite event (OR 0.30 and 0.19, respectively, p <0.001 for both). In conclusion, the use of high-dose bolus tirofiban with shortened infusion versus short-duration eptifibatide was not associated with an increase of in-hospital bleeding or cardiovascular events.

Perceived sustainability of community telepharmacy in North Dakota.

OBJECTIVES: To assess the sustainability of the business model underlying the North Dakota Telepharmacy Project (NDTP). SETTING: Of the 38 community pharmacy organizations (14 central, 24 remote), 27 organizations (11 central and 16 remote sites) in North Dakota provided a useable set of responses (71.1% response rate). A twelfth organization (a community pharmacy) ceased operations over the study's time frame and was not included in the data analysis. PRACTICE DESCRIPTION: Emphasis is placed on NDTP community telepharmacies, because the community telepharmacy business model is more established than hospital telepharmacies. Yet little is known about the long-run financial viability of telepharmacies. PRACTICE INNOVATION: Originally funded by a series of federal grants, the goal of the NDTP was to create the infrastructure necessary to support the development of telepharmacy sites. A 48-item questionnaire assessed the self-reported operational, financial, and community impacts of a community telepharmacy. EVALUATION: The questionnaire was administered from December 2015 to February 2016 to all NDTP community telepharmacy owners-managers. Thus, 1 participant (owner-manager) addressed both central and remote-site locations served by a pharmacy. RESULTS: Most respondents reported that their telepharmacy sites (especially remote sites) generate small positive financial returns for the organization. Respondents also reported that the closure of their remote sites would significantly harm the communities they serve. CONCLUSION: NDTP aims of restoration and retention have been achieved via the investment and shared decision making with pharmacy owners in North Dakota. The telepharmacy model is sustainable, even if it does not generate significant economic profit.

Pharmacist contributions to the ten essential services of public health in three National Association of Boards of Pharmacy regions.

BACKGROUND: Pharmacists have contributed to improved population health through the delivery of public health services, but their contributions often go unrecognized within the larger health care system. OBJECTIVES: To determine pharmacist perceptions of their contributions to the 10 essential services of public health and to compare those contributions among pharmacists in Iowa, North Dakota, and Manitoba. METHODS: Licensed pharmacists in Iowa, North Dakota, and Manitoba were sent an online survey of their perceived level of achievement of the 10 essential services of public health. RESULTS: A total of 649 pharmacists completed the survey. The 3 essential services that scored the highest overall were enforce laws and regulations that protect health and ensure safety, inform and educate people about health issues, and participate in ongoing training beyond continuing education requirements. Contributions of pharmacists to the 10 essential services of public health were previously evaluated by frequency of citation in the published literature. There was relative agreement between what was reported in the literature and what was determined by survey. One exception was "enforce laws and regulations that protect health and ensure safety," which was rarely reported in the literature but was reported in the survey to be the most frequently delivered service. CONCLUSION: Pharmacist contributions to improved population health should be reported with the use of the 10 essential services of public health. This will increase recognition of pharmacist contributions and better align the disciplines of pharmacy and public health. In particular, pharmacists should consider ways to increase their level of involvement in the community and in partnership with other health care professionals.

Assessment of pharmacists' delivery of public health services in rural and urban areas in Iowa and North Dakota

Background: The profession of pharmacy is expanding its involvement in public health, but few studies have examined pharmacists’ delivery of public health services. Objective: To assess Iowa and North Dakota pharmacists’ practices, frequency of public health service delivery, level of involvement in achieving the essential services of public health, and barriers to expansion of public health services in rural and urban areas. Methods: This study implemented an on-line survey sent to all pharmacists currently practicing pharmacy in Iowa and North Dakota. Results: Overall, 602 valid responses were analyzed, 297 in rural areas and 305 in urban areas. Three practice settings (chain stores [169, 28.2%], independent community pharmacies [162, 27.0%], and hospital pharmacies [156, 26.0%]) comprised 81.2% of the sample. Both chain and independent community pharmacists were more commonly located in rural areas than in urban areas (P<0.05). For some public health services, pharmacists in rural areas reported higher frequency of delivery than did pharmacists in urban areas (P < .05) that included: medication therapy management, immunizations, tobacco counseling, and medication take-back programs. For some essential services, pharmacists (particularly independents) in rural areas reported more frequent delivery than did pharmacists in urban areas (P < .05), these included: evaluate the services the pharmacy provides, partner with the community to identify and help solve health problems, and conduct needs assessments to identify health risks in my community. Conclusion: Rural pharmacists more frequently deliver public health services than urban in both Iowa and North Dakota. These findings should be interpreted to be primarily due to differences in the role of the rural pharmacist and the quest for certain opportunities that rural pharmacists are seeking (AU)

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Assessment of pharmacists' delivery of public health services in rural and urban areas in Iowa and North Dakota.

BACKGROUND: The profession of pharmacy is expanding its involvement in public health, but few studies have examined pharmacists' delivery of public health services. OBJECTIVE: To assess Iowa and North Dakota pharmacists' practices, frequency of public health service delivery, level of involvement in achieving the essential services of public health, and barriers to expansion of public health services in rural and urban areas. METHODS: This study implemented an on-line survey sent to all pharmacists currently practicing pharmacy in Iowa and North Dakota. RESULTS: Overall, 602 valid responses were analyzed, 297 in rural areas and 305 in urban areas. Three practice settings (chain stores [169, 28.2%], independent community pharmacies [162, 27.0%], and hospital pharmacies [156, 26.0%]) comprised 81.2% of the sample. Both chain and independent community pharmacists were more commonly located in rural areas than in urban areas (P<0.05). For some public health services, pharmacists in rural areas reported higher frequency of delivery than did pharmacists in urban areas (P < .05) that included: medication therapy management, immunizations, tobacco counseling, and medication take-back programs. For some essential services, pharmacists (particularly independents) in rural areas reported more frequent delivery than did pharmacists in urban areas (P < .05), these included: evaluate the services the pharmacy provides, partner with the community to identify and help solve health problems, and conduct needs assessments to identify health risks in my community. CONCLUSION: Rural pharmacists more frequently deliver public health services than urban in both Iowa and North Dakota. These findings should be interpreted to be primarily due to differences in the role of the rural pharmacist and the quest for certain opportunities that rural pharmacists are seeking.

A pilot study of Brief IPT-A delivered in primary care.

OBJECTIVE: The objective was to examine the feasibility, acceptability and preliminary effectiveness of a brief version of Interpersonal Psychotherapy for Depressed Adolescents (BIPT-A) in low-income Latino adolescents treated in an urban pediatric primary care setting. METHOD: Ten adolescents, ages 12 to 19 years, who were referred by their pediatric providers and met criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, depression diagnosis participated. Participants received 6 weekly sessions of BIPT-A. Acceptability and feasibility were measured by examining session attendance, treatment completion and treatment satisfaction. Paired-samples t tests were used to preliminarily examine treatment outcome as measured by both self-report and clinician-administered assessments of depression, social functioning and global impairment. RESULTS: Ninety percent of adolescents completed treatment, with 60% of parents having participated in at least one session. Adolescents attended 82% of their treatment sessions, and all participants were very satisfied with the treatment they received. Significant improvement was found for all outcome measures. CONCLUSION: The open trial provides preliminary evidence suggesting that BIPT-A may be a feasible and acceptable treatment model capable of engaging adolescents with mild to moderate depression and impairment in treatment in a primary care setting.

Effects of a senior practicum course on nursing students' confidence in speaking up for patient safety.

As patient advocates, nurses are responsible for speaking up against unsafe practices. Nursing students must develop the confidence to speak up for patient safety so that they can hold themselves, as well as their peers and coworkers, accountable for patients' well-being. The purpose of this study was to examine the effects of a senior practicum course on confidence for speaking up for patient safety in nursing students. Confidence in speaking up for patient safety was measured with the Health Professional Education in Patient Safety Survey. The study showed a significant increase in nursing students' confidence after the senior practicum course, but there was no significant change in students' confidence in questioning someone of authority.

[Interpersonal psychotherapy for depressed adolescents: an overview of theory, techniques and research]. / Psychothérapie interpersonnelle à l'intention des adolescents souffrant de dépression : théories, techniques et recherche.

Interpersonal psychotherapy for depressed adolescents (IPT-A) is a brief, evidence-based psychotherapy that has been found to be successful in treating unipolar depression in non-bipolar, non-psychotic adolescents. This article provides an overview of the theoretical principles, developmental adaptations, interpersonal focus and techniques of IPT-A. Treatment specifically targets communication skills and social support in current relationships from a skills perspective. Therefore, the therapeutic focus is on improving the adolescent's relationships with the underlying assumption that this will improve the adolescent's mood. The empirical support for the effectiveness of IPT-A, preliminary findings from clinical trials of adaptations of IPT-A and future directions for research in unipolar adolescent depression are presented briefly.