Impact of Providing a Living Learning Community for First-Year Pre-Pharmacy Students.

Objective. To conduct a retrospective cohort pilot study to evaluate the impact of a living learning community (LLC) designed for undergraduate pre-pharmacy students interested in pursuing a Doctor of Pharmacy (PharmD) degree program.Methods. Persistence, retention, and progression within the pre-pharmacy program, as well as grade point average (GPA) were measured for LLC students and their pre-pharmacy peers who did not participate in the LLC. Information was obtained from the university's data system and analyzed. Persistence was defined as the student continuing at the university from the fall to spring academic terms. Retention was defined as the student being enrolled at the university during a subsequent fall term. Progression was determined by whether the student had successfully completed the pre-pharmacy curriculum and began pharmacy school within two or three years of initial enrollment in the pre-pharmacy program.Results. Despite having admissions characteristics comparable to other pre-pharmacy students, students who participated in the LLC demonstrated significantly higher grade-point averages and retention than their peers who did not participate.Conclusion. Living learning community programs may be a valuable contributor to pre-pharmacy student success in terms of students' persistence, retention, and progression in a pre-pharmacy program.

Head impact exposures in women's collegiate rugby.

Objectives: To describe the incidence, magnitude, and distribution of head impacts and track concussions sustained in a collegiate level women's rugby season. Methods: Data on head impact incidence and magnitude were collected via Smart Impact Monitors (SIM) (Triax Technologies, Inc., Norwalk, CT) within fitted headbands during practices and games of one competitive season. Magnitude data included peak linear acceleration (PLA) and peak rotational velocity (PRV) measurements and were reported as median [IQR]. Results: Players sustained 120 head impacts ≥15 g (18.1 g - 78.9 g) with 1199 total athlete exposures. In eight games, 67 head impacts were recorded with a mean rate of 0.40 ± 0.22 hits per-player per-match, median PLA of 32.2 g, and PRV of 13.5 rad.sec-1. There were 53 head impacts in 47 practices with a mean rate of 0.05 ± 0.04 hits per-player per-practice, median PLA of 29.8 g and PRV of 15.7 rad.sec-1. Four concussions were reported and monitored. Conclusion: The incidence and magnitude of head impacts in collegiate level women's rugby over one season of practices and games were fewer than those reported in other comparable studies. These findings give insight into the impact burden that female collegiate rugby athletes withstand throughout a competitive season.

Pharmacists opinions of the value of specific applicant attributes in hiring decisions for entry-level pharmacists.

OBJECTIVE: The Hiring Intent Reasoning Examination (HIRE) was designed to (1) explore the relative value of applicant-specific attributes evaluated during the hiring of entry-level pharmacists; (2) examine how each of these attributes influences hiring decisions; and (3) identify which attributes practicing pharmacists perceive as most and least valuable. METHODS: An electronic questionnaire was developed and sent to 36,817 pharmacists; 3723 (11%) responded representing a broad cross-section of practice settings and job roles. Forty-eight attributes were analyzed, 24 character traits and 24 markers of academic success. Respondents identified: 1) the relative importance the possession of each attribute would play in the decision to hire an applicant; 2) the relative importance the lack of possession of the attribute would play on the decision to hire an applicant; 3) the 10 most important attributes used when considering an applicant, and; 4) the 10 least important attributes used when considering an applicant. After investigating the relative importance of the 48 traits, a factor analysis to further group the traits was undertaken. RESULTS: Character traits were consistently ranked higher than academic traits, both in importance and as more likely to effect the hiring decision. Additionally, "the top ten most important attributes" were dominated by character traits and "the top ten least important attributes" used in the hiring of an entry-level pharmacist were dominated by the academic traits. A factor analysis provided further evidence of the distinction of the character traits from the academic success markers. CONCLUSION: When selecting employees from a pool of qualified applicants, the most important attributes used in hiring decision relate to the character of the pharmacist. The results are similar across all practice settings and types of respondents completing the survey.

Pharmacy student awareness, aspiration, and preparation for post graduate education (PGE) fellowship in US: A cross-sectional study.

INTRODUCTION: Fellowship opportunities are seen by pharmacy students and graduates as an option to assist in furthering pharmacy knowledge in a specific field or area of interest. Pharmaceutical industry fellowships are the most common pharmacy fellowship available to students. There has been little research on what motivates students to pursue a fellowship and what student characteristics may help predict interest in a fellowship. METHODS: A survey was distributed to P1, P2, and P3 students. The survey took 10-15 min to complete and contained 28 questions. The difference in students' characteristics between fellowship interested students and non-fellowship interested students were examined using chi-square tests and t-tests for categorical variables and continuous variables, respectively. Logistic regression was used to examine predictors of pursuing a fellowship. RESULTS: Age, work experience, and attendance during a fellowship roundtable were all found to be statistically significant predictors of pursuit of a fellowship. Financial obligations, family obligations, and feeling unprepared were the most common reasons for not pursuing a fellowship. DISCUSSION AND CONCLUSIONS: Students earlier in the curriculum were more likely to express interest in pursuing a fellowship. Overall, students felt ill-prepared for the fellowship application process. In addition, fellowship roundtables may be useful for pharmacy programs to help students in their pursuit of fellowships.

Effects of Ebola Virus Disease education on student health professionals.

BACKGROUND AND PURPOSE: Ebola Virus Disease (EVD) is a severe, often fatal illness. Studies have shown that healthcare professionals lack an in-depth knowledge of EVD. Countries in Europe, Asia, and Africa are beginning to emphasize the need to train healthcare professionals about EVD, but the United States still lacks formal training for healthcare students. There is little research about the effectiveness of EVD training to support this study. The purpose of this study was to examine the knowledge-base and attitudes of healthcare students concerning EVD. EDUCATIONAL ACTIVITY AND SETTING: Two-hundred sixty-nine participants (including pharmacy students, physician assistant students, and nursing students) completed a pre- and post-survey. The survey measured both knowledge and perceptions. The post-survey was administered after the intervention to measure change. The intervention was comprised of a pre-recorded lecture about EVD transmission, prevention, and treatment. FINDINGS: All groups displayed significant changes in knowledge and perception, specifically in the areas of EVD transmission, prevention, and treatment. Pharmacy students' attitudes increased significantly over their baseline score for all three attitude questions, whereas there were no significant changes in attitude to EVD among nurses. Physician assistant students' attitudes changed regarding the topic of isolation. DISCUSSION: Education on EVD in pharmacy schools may provide beneficial results for students' knowledge, and it may also help schools provide evidence to meet current standards for accreditation. SUMMARY: This educational intervention represents an effective format that could be a useful tool to help enhance or augment knowledge for healthcare workers. This could lead to better care for patients.

Impact of Secondary Prevention on Mortality after a First Ischemic Stroke in Puerto Rico.

OBJECTIVE: The objective of this study was to evaluate the impact of the prescription of secondary prevention therapies on mortality in Puerto Rican patients hospitalized with a first ischemic stroke. METHODS: This was a retrospective secondary data analysis of the 2007 and 2009 Puerto Rico Stroke Registry electronic database. Information was obtained from the medical charts of patients discharged with ICD-9 codes 434 and 436 from 20 hospitals located in Puerto Rico. Descriptive analyses were conducted for demographics and comorbidities. Chi2 statistics compared the proportion of patients prescribed secondary prevention therapy and the proportion of patients not prescribed secondary prevention therapy. Lastly, survival rates were calculated from 2007 up to and including December 2010. RESULTS: The mean age of the 3,965 patients was 70 (±14) years. Secondary prevention therapy was prescribed to only 1% of the patients. The most frequent comorbidities were hypertension (85%), diabetes (52%), and hyperlipidemia (25%). The case fatality rate for patients prescribed secondary prevention therapy was 16%, compared to 26% for patients not prescribed secondary prevention therapy (p<0.01). The mean survival for stroke patients prescribed secondary preventions was 450 days (95% CI;182−718), compared to 266 days (95% CI; 244−287) for those not prescribed secondary prevention therapy (p = 0.175). CONCLUSION: A low percentage of patients with a first ischemic stroke were prescribed secondary prevention therapy. While not statistically significant, survival analysis suggests that secondary prevention therapy decreased mortality in patients with a stroke.

Pharmacists' Opinions of the Value of CAPE Outcomes in Hiring Decisions.

Objective. The Hiring Intent Reasoning Examination (HIRE) was designed to explore the utility of the CAPE 2013 outcomes attributes from the perspective of practicing pharmacists, examine how each attribute influences hiring decisions, and identify which of the attributes are perceived as most and least valuable by practicing pharmacists. Methods. An electronic questionnaire was developed and distributed to licensed pharmacists in four states to collect their opinions about 15 CAPE subdomains plus five additional business related attributes. The attributes that respondents identified were: necessary to be a good pharmacist, would impact hiring decisions, most important to them, and in short supply in the applicant pool. Data were analyzed using statistical analysis software to determine the relative importance of each to practicing pharmacists and various subsets of pharmacists. Results. The CAPE subdomains were considered necessary for most jobs by 51% or more of the 3723 respondents (range, 51% to 99%). The necessity for business-related attributes ranged from 21% to 92%. The percentage who would not hire an applicant who did not possess the attribute ranged from 2% to 71.5%; the percentage who considered the attribute most valuable ranged from 0.3% to 35%; and the percentage who felt the attribute was in short supply ranged from 5% to 36%. Opinions varied depending upon gender, practice setting and whether the pharmacist was an employee or employer. Conclusion. The results of this study can be used by faculty and administrators to inform curricular design and emphasis on CAPE domains and business-related education in pharmacy programs.

Effectiveness of early identification and electronic interventions for teens with risk factors for the development of heart disease and diabetes.

PURPOSE: Serum risk factors for the development of heart disease and diabetes are not routinely evaluated in teens. The intent of this study was to determine the prevalence of these risk factors in teens and evaluate the effectiveness of a two-part electronic education program (recurring electronic lifestyle education program [REEP]) on reducing risks. DATA SOURCES: Teens (n = 170) were recruited from one urban and one rural high school in the mid-Atlantic in 2014. Following baseline data collection in February, REEP was initiated and data collection repeated at 12 weeks. Data were analyzed and students sent a report with results and recommendations. CONCLUSIONS: One or more serum and/or physical risk factors were found in the majority of students with low vitamin D and elevated body mass index (BMI) being the most common. Correlations existed between elevated BMI and elevated diastolic blood pressure, low vitamin D, and low high-density lipoprotein. All but one risk factor (BMI) improved at 12 weeks. IMPLICATIONS FOR PRACTICE: The majority of teens had one or more physical and/or serum risk factors. Using multiple electronic methods to deliver healthy lifestyle recommendations helps lower these risks. Also, Blackboard, an electronic learning platform, was found to be an effective data management and communication center.

Systematic review and meta-analysis of the duration of clinical effect of onabotulinumtoxinA in cervical dystonia.

BACKGROUND: Botulinum toxins are considered first-line therapy for treatment of cervical dystonia (CD) and must be injected on a repeat basis. Understanding the duration of clinical benefit of botulinum toxins and its impact on health care utilization are thus important in the contemporary environment. However, there is currently no overall consensus on the duration of effect of onabotulinumtoxinA in the treatment of CD. We performed a systematic review and meta-analysis to identify the duration of effect of onabotulinumtoxinA in CD and investigate factors that may influence it. METHODS: A systematic literature search identified prospective or retrospective studies reporting duration of effect of onabotulinumtoxinA for the treatment of CD. Inclusion criteria included peer-reviewed, non-review, English-language articles published between January 1980 and January 2013. A formal meta-analysis using Comprehensive Meta-Analysis Version 2 was conducted to identify the duration of effect of onabotulinumtoxinA in the treatment of CD; both fixed and random effects models were performed. Subgroup analyses were performed to identify factors that influenced the duration of effect of onabotulinumtoxinA. RESULTS: A total of 18 studies (including >1,900 patients) met the inclusion criteria and were used for the meta-analysis. The mean duration of effect of onabotulinumtoxinA in CD was found to be 93.2 days (95% CI 91.8-94.6 days) for the fixed effects model and 95.2 days (95% CI 88.9-101.4 days) for the random effects model. A meta-regression found that dose of onabotulinumtoxinA and country of origin influenced the duration of effect of onabotulinumtoxinA, whereas quality score of the article and study type did not. In particular, doses ≥180 Units were associated with longer durations of effect than doses <180 Units (107-109 days vs. 86-88 days, respectively; p < 0.01). Limitations included pooling studies that used discrete definitions of duration and had different designs and study quality. CONCLUSIONS: Based on the published literature, the mean duration of effect of onabotulinumtoxinA in CD was 93-95 days (13.2-13.5 weeks). This suggests that, in general, patients with CD treated with onabotulinumtoxinA should require ~4 treatments per year.

Perceptions of pharmacy students, faculty members, and administrators on the use of technology in the classroom.

OBJECTIVES: To gather and evaluate the perceptions of students, faculty members, and administrators regarding the frequency and appropriateness of classroom technology use. METHODS: Third-year pharmacy students and faculty members at 6 colleges and schools of pharmacy were surveyed to assess their perceptions about the type, frequency, and appropriateness of using technology in the classroom. Upper-level administrators and information technology professionals were also interviewed to ascertain overall technology goals and identify criteria used to adopt new classroom technologies. RESULTS: Four hundred sixty-six students, 124 faculty members, and 12 administrators participated in the survey. The most frequently used and valued types of classroom technology were course management systems, audience response systems, and lecture capture. Faculty members and students agreed that faculty members appropriately used course management systems and audience response systems. Compared with their counterparts, tech-savvy, and male students reported significantly greater preference for increased use of classroom technology. Eighty-six percent of faculty members reported having changed their teaching methodologies to meet student needs, and 91% of the students agreed that the use of technology met their needs. CONCLUSIONS: Pharmacy colleges and schools use a variety of technologies in their teaching methods, which have evolved to meet the needs of the current generation of students. Students are satisfied with the appropriateness of technology, but many exhibit preferences for even greater use of technology in the classroom.

Prescribing patterns and safety of mezclitas for respiratory illnesses.

OBJECTIVE: To evaluate the prescribing patterns of compound mixtures of cough and cold liquid medications, known as mezclitas, which are prescribed to patients with respiratory illnesses in Puerto Rico. Secondary objectives include assessing the potential safety of these mixtures and patients' perception of them. METHODS: Using a cross sectional study approach, a convenience sample was obtained from five pharmacies in Puerto Rico, from October 2008 to October 2009. Patients were asked to complete a 9-item questionnaire about demographic information, in addition to their mezclita prescription data. RESULTS: The mean age of patients was 43 years with a range of less than 12 months to 101 years. For children < four years of age, 71% were prescribed cough and cold medications. Sixty-four percent of the prescriptions were given to females. The most prevalent ingredient employed was guaifenesin, which appeared in about 77% of the mezclitas. 'Common cold' was the principal diagnosis for 62% of the prescriptions, of which 75% of these prescriptions contained a corticosteroid and 17% contained a beta2 agonist bronchodilator. The top medical prescribing specialty was general medicine (51%). Thirty-eight percent of hypertensive patients were prescribed a decongestant. The majority of diabetic patients (60%) were dispensed a corticosteroid. Most (74%) patients reported that they had a rapid and good response to their mezclita. CONCLUSION: Mezclitas were most commonly prescribed for acute symptoms of upper respiratory illness by general physicians despite possible side effects. This study suggests that the prescription patterns of mezclitas do not always consider evidence-based medicine treatment guidelines.

The impact of a pharmacist assisted clinic upon medication adherence and quality of life in mental health patients / Impacto de una clínica asistida por farmacéutico sobre la adherencia a la medicación y la calidad de vida en pacientes mentales

Objectives: To determine if a pharmacist assisted psychiatric clinic would improve adherence to medications and quality of life over 6 months. The primary study endpoints were the change from baseline in Medication Adherence Rating Scale (MARS), Brief Evaluation of Medication Influences and Beliefs (BEMIB), World Health Organization Quality of Life - BREF (WHOQOL-BREF) scales as well as hospitalizations and emergency room visits. Secondary endpoints included metabolic and physiologic parameters. Methods: A prospective, single-center study conducted at an outpatient psychiatric clinic. Subjects were required to attend 3 clinic visits (baseline, 3 and 6 months) with the pharmacist. Subject and medication histories were obtained at each visit. Subjects’ records within the local health system were reviewed for emergency room visits and hospitalizations. Metabolic parameters were assessed at each visit. Results: Twenty-seven subjects enrolled and twenty subjects completed. Total MARS score at baseline and study end were 7.90 and 8.65, respectively. At baseline, 10 (50%) were nonadherent based on the BEMIB and 9 (45%) were nonadherent at 6 months. Statistically significant improvements were seen in 2 domains of the WHOQOL-BREF. Reductions in both ER visits and hospitalizations were achieved. There were significant improvements in total cholesterol and LDL. Conclusions: Improvements were seen in two domains of the WHOQOL-BREF – physical capacity and psychological well-being over the 6 month period. While improvements were seen in various rating scales, due to small sample sizes, these were insignificant improvements. Reductions in hospitalizations and ER visits were also seen during the study and up to 6 months post study. Statistically significant improvements were also seen in both total cholesterol and LDL. The lack of improvement in many of the study outcomes reflects the difficulty of the mental health population to adhere to treatment recommendations; but also underscores the need for continued research in this area. This pilot demonstrates the pharmacist’s ability to provide comprehensive medication management services to the psychiatric outpatient (AU)

Objetivos: Determinar si una clínica psiquiátrica asistida por farmacéutico podría mejorar la adherencia al tratamiento y la calidad de vida durante seis meses. Los resultados primarios del estudio fueron el cambio en relación al inicio en las escalas Medication Adherence Rating Scale (MARS), Brief Evaluation of Medication Influences and Beliefs (BEMIB), World Health Organization Quality of Life - BREF (WHOQOLBREF), así como las hospitalizaciones y visitas a urgencias. Los resultados secundarios incluían parámetros metabólicos y fisiológicos. Métodos: Estudio prospectivo, unicentrico realizado en una clínica ambulatoria psiquiátrica. Se solicitó a las personas que acudiesen a 3 visitas a la clínica con el farmacéutico (inicio, 3 y 6 meses). En cada visita se recogió las historias clínicas y medicamentosas. Se revisaron las fichas de los pacientes en el sistema local de salud para las visitas a urgencias y hospitalizaciones. En cada visita se evaluaron los parámetros metabólicos. Resultados: Se evaluó a 27 individuos y 20 completaron el estudio. Las puntuaciones del MARS al inicio y al final fueron 7,90 y 8,65, respectivamente. En el inicio, 10 (50%) eran incumplidores, basándose en el BEMIB y 9 (45%) fueron incumplidores a los 6 meses. Se encontraron mejoras estadísticamente significativas en 2 dominios del WHOQOL-BREF. Se consiguieron reducciones tanto en visitas a urgencias como hospitalizaciones. Hubo mejoras significativas en colesterol total y LDL. Conclusiones: Se encontraron mejoras en dos dominios del WHOQOL-BREF – capacidad física y bienestar psicológico durante el periodo de 6 meses. Aunque se encontraron mejora en varias escalas, debido a los pequeños tamaños de muestra, no fueron significativas. Se vieron reducciones en visitas a urgencias y hospitalizaciones durante los 6 meses de estudio y después del estudio. También se encontraron diferencias significativas tanto en colesterol como en LDL. La falta de mejoría en muchos resultados del estudio refleja la dificultad de la población psiquiátrica en adherir a las recomendaciones del tratamiento; pero también subraya la necesidad de investigación continua en este campo. Este estudio piloto demuestra la capacidad del farmacéutico en proporcionar servicios de gestión global de la medicación en pacientes psiquiátricos ambulatorios (AU)

The impact of a pharmacist assisted clinic upon medication adherence and quality of life in mental health patients.

OBJECTIVE: To determine if a pharmacist assisted psychiatric clinic would improve adherence to medications and quality of life over 6 months. The primary study endpoints were the change from baseline in Medication Adherence Rating Scale (MARS), Brief Evaluation of Medication Influences and Beliefs (BEMIB), World Health Organization Quality of Life - BREF (WHOQOL-BREF) scales as well as hospitalizations and emergency room visits. Secondary endpoints included metabolic and physiologic parameters. METHODS: A prospective, single-center study conducted at an outpatient psychiatric clinic. Subjects were required to attend 3 clinic visits (baseline, 3 and 6 months) with the pharmacist. Subject and medication histories were obtained at each visit. Subjects' records within the local health system were reviewed for emergency room visits and hospitalizations. Metabolic parameters were assessed at each visit. RESULTS: Twenty-seven subjects enrolled and twenty subjects completed. Total MARS score at baseline and study end were 7.90 and 8.65, respectively. At baseline, 10 (50%) were nonadherent based on the BEMIB and 9 (45%) were nonadherent at 6 months. Statistically significant improvements were seen in 2 domains of the WHOQOL-BREF. Reductions in both ER visits and hospitalizations were achieved. There were significant improvements in total cholesterol and LDL. CONCLUSIONS: Improvements were seen in two domains of the WHOQOL-BREF - physical capacity and psychological well-being over the 6 month period. While improvements were seen in various rating scales, due to small sample sizes, these were insignificant improvements. Reductions in hospitalizations and ER visits were also seen during the study and up to 6 months post study. Statistically significant improvements were also seen in both total cholesterol and LDL. The lack of improvement in many of the study outcomes reflects the difficulty of the mental health population to adhere to treatment recommendations; but also underscores the need for continued research in this area. This pilot demonstrates the pharmacist's ability to provide comprehensive medication management services to the psychiatric outpatient.

Clinical decision support tools: personal digital assistant versus online dietary supplement databases.

BACKGROUND: Clinical decision support tools (CDSTs) on personal digital assistants (PDAs) and online databases assist healthcare practitioners who make decisions about dietary supplements. OBJECTIVE: To assess and compare the content of PDA dietary supplement databases and their online counterparts used as CDSTs. METHODS: A total of 102 question-and-answer pairs were developed within 10 weighted categories of the most clinically relevant aspects of dietary supplement therapy. PDA versions of AltMedDex, Lexi-Natural, Natural Medicines Comprehensive Database, and Natural Standard and their online counterparts were assessed by scope (percent of correct answers present), completeness (3-point scale), ease of use, and a composite score integrating all 3 criteria. Descriptive statistics and inferential statistics, including a chi(2) test, Scheffé's multiple comparison test, McNemar's test, and the Wilcoxon signed rank test were used to analyze data. RESULTS: The scope scores for PDA databases were: Natural Medicines Comprehensive Database 84.3%, Natural Standard 58.8%, Lexi-Natural 50.0%, and AltMedDex 36.3%, with Natural Medicines Comprehensive Database statistically superior (p < 0.01). Completeness scores were: Natural Medicines Comprehensive Database 78.4%, Natural Standard 51.0%, Lexi-Natural 43.5%, and AltMedDex 29.7%. Lexi-Natural was superior in ease of use (p < 0.01). Composite scores for PDA databases were: Natural Medicines Comprehensive Database 79.3, Natural Standard 53.0, Lexi-Natural 48.0, and AltMedDex 32.5, with Natural Medicines Comprehensive Database superior (p < 0.01). There was no difference between the scope for PDA and online database pairs with Lexi-Natural (50.0% and 53.9%, respectively) or Natural Medicines Comprehensive Database (84.3% and 84.3%, respectively) (p > 0.05), whereas differences existed for AltMedDex (36.3% vs 74.5%, respectively) and Natural Standard (58.8% vs 80.4%, respectively) (p < 0.01). For composite scores, AltMedDex and Natural Standard online were better than their PDA counterparts (p < 0.01). CONCLUSIONS: Natural Medicines Comprehensive Database achieved significantly higher scope, completeness, and composite scores compared with other dietary supplement PDA CDSTs in this study. There was no difference between the PDA and online databases for Lexi-Natural and Natural Medicines Comprehensive Database, whereas online versions of AltMedDex and Natural Standard were significantly better than their PDA counterparts.

Clinical decision support tools: focus on dietary supplement databases.

OBJECTIVE: To assess the content of dietary supplement databases used for clinical decision support. METHODS: Four online dietary supplement databases were assessed according to scope, completeness, and ease of use. Additionally, a composite score integrating all 3 criteria was determined. One hundred two question-and-answer pairs were developed and distributed among 10 weighted categories dealing with the most clinically relevant aspects of dietary supplement therapy. Descriptive and inferential statistics were used to summarize the evaluation components and to compare databases. Chi-square was used to investigate differences in scope scores. Scheffe's multiple comparison procedure was used to determine statistical differences in completeness and ease of use. RESULTS: The percentage of questions that each database answered successfully were as follows: Natural Medicines Comprehensive Database, 84.3%; Natural Standard, 80.4%; AltMedDex, 74.5%; and Lexi-Natural Products, 53.9%, indicating 2 statistical groupings (P < .05) in which the first 3 databases performed significantly better than Lexi-Natural. Completeness scores were similarly stratified. Ease-of-use scores were Natural Standard, 1.96; Natural Medicines Comprehensive Database, 2.00; Lexi-Natural, 2.02; and AltMedDex, 2.50. Composite scores indicating overall performance were Natural Medicines Comprehensive Database, 81.5%; Natural Standard, 76.9%; AltMedDex, 71.6%; and Lexi-Natural, 50.7%. CONCLUSION: Many clinicians may be unprepared to deal with patient-related dietary supplement questions; therefore, clinical decision support tools that address this knowledge gap are needed. There was significant heterogeneity in the content of dietary supplement-focused online databases, with clustering in the top tier.

Effect of faculty-mediated interventions on pharmacy students' pursuit of postgraduate training.

PURPOSE: The influence of faculty-mediated interventions on the pursuit of postgraduate training (PGT) by pharmacy students was studied. METHODS: Three weeks before graduation, members of the class of 2005 (control group) at a Florida pharmacy school completed a questionnaire assessing their understanding of PGT opportunities. Members of the class of 2006 (intervention group) were exposed to faculty-mediated interventions during their final academic year of pharmacy school. The interventions consisted of informational pamphlets, a PGT booth during the school's career day, and PGT-related dinner programs. These students were surveyed before and after the interventions. RESULTS: Seventy-three percent (120/165) of control-group students and 63% (132/211) of intervention-group students completed the survey. Of the control students, 14% (15/108) reported plans to enter PGT after graduation. Sixteen percent (21/132) of intervention-group students reported such plans; the difference was not significant. All faculty-mediated interventions were reported to be helpful to students in making their postgraduation plans. Analysis of the combined groups suggested that students' interaction with faculty and residents during advance practice experiences positively affected pursuit of PGT. CONCLUSION: Students who received faculty- mediated interventions designed to inform them about PGT were not significantly more likely to pursue such training than students who did not receive the interventions. However, students reported the information to be helpful.

Clinical decision support tools: performance of personal digital assistant versus online drug information databases.

STUDY OBJECTIVES: To evaluate personal digital assistant (PDA) drug information databases used to support clinical decision-making, and to compare the performance of PDA databases with their online versions. DESIGN: Prospective evaluation with descriptive analysis. METHODS: Five drug information databases available for PDAs and online were evaluated according to their scope (inclusion of correct answers), completeness (on a 3-point scale), and ease of use; 158 question-answer pairs across 15 weighted categories of drug information essential to health care professionals were used to evaluate these databases. An overall composite score integrating these three measures was then calculated. Scores for the PDA databases and for each PDA-online pair were compared. RESULTS: Among the PDA databases, composite rankings, from highest to lowest, were as follows: Lexi-Drugs, Clinical Pharmacology OnHand, Epocrates Rx Pro, mobileMicromedex (now called Thomson Clinical Xpert), and Epocrates Rx free version. When we compared database pairs, online databases that had greater scope than their PDA counterparts were Clinical Pharmacology (137 vs 100 answers, p<0.001), Micromedex (132 vs 96 answers, p<0.001), Lexi-Comp Online (131 vs 119 answers, p<0.001), and Epocrates Online Premium (103 vs 98 answers, p=0.001). Only Micromedex online was more complete than its PDA version (p=0.008). Regarding ease of use, the Lexi-Drugs PDA database was superior to Lexi-Comp Online (p<0.001); however, Epocrates Online Premium, Epocrates Online Free, and Micromedex online were easier to use than their PDA counterparts (p<0.001). In terms of composite scores, only the online versions of Clinical Pharmacology and Micromedex demonstrated superiority over their PDA versions (p>0.01). CONCLUSION: Online and PDA drug information databases assist practitioners in improving their clinical decision-making. Lexi-Drugs performed significantly better than all of the other PDA databases evaluated. No PDA database demonstrated superiority to its online counterpart; however, the online versions of Clinical Pharmacology and Micromedex were superior to their PDA versions in answering questions.

Clinical decision support tools: analysis of online drug information databases.

BACKGROUND: Online drug information databases are used to assist in enhancing clinical decision support. However, the choice of which online database to consult, purchase or subscribe to is likely made based on subjective elements such as history of use, familiarity, or availability during professional training. The purpose of this study was to evaluate clinical decision support tools for drug information by systematically comparing the most commonly used online drug information databases. METHODS: Five commercially available and two freely available online drug information databases were evaluated according to scope (presence or absence of answer), completeness (the comprehensiveness of the answers), and ease of use. Additionally, a composite score integrating all three criteria was utilized. Fifteen weighted categories comprised of 158 questions were used to conduct the analysis. Descriptive statistics and Chi-square were used to summarize the evaluation components and make comparisons between databases. Scheffe's multiple comparison procedure was used to determine statistically different scope and completeness scores. The composite score was subjected to sensitivity analysis to investigate the effect of the choice of percentages for scope and completeness. RESULTS: The rankings for the databases from highest to lowest, based on composite scores were Clinical Pharmacology, Micromedex, Lexi-Comp Online, Facts & Comparisons 4.0, Epocrates Online Premium, RxList.com, and Epocrates Online Free. Differences in scope produced three statistical groupings with Group 1 (best) performers being: Clinical Pharmacology, Micromedex, Facts & Comparisons 4.0, Lexi-Comp Online, Group 2: Epocrates Premium and RxList.com and Group 3: Epocrates Free (p < 0.05). Completeness scores were similarly stratified. Collapsing the databases into two groups by access (subscription or free), showed the subscription databases performed better than the free databases in the measured criteria (p < 0.001). CONCLUSION: Online drug information databases, which belong to clinical decision support, vary in their ability to answer questions across a range of categories.

Pharmacoeconomics of Surgical Interventions vs. Cyclooxygenase Inhibitors for the Treatment of Patent Ductus Arteriosus.

Management of neonatal patent ductus arteriosus (PDA) often is resource-intensive and costly. Therefore, it is in hospitals' best interests to ensure the most cost-efficient use of associated resources. Clinical status, comorbidities, and response to prior therapy are considered in selecting the most appropriate intervention for PDA management. Currently, supportive measures (e.g., fluid restriction), surgical ligation, and pharmacologically based medical therapy are the primary treatment modalities for correcting PDA. Medical therapy, which comprises a small percentage (2.0%-5.0%)1 of overall PDA treatment expenses in the United States, consists of either of the 2 intravenous (IV) cyclooxygenase (COX) inhibitors: IV indomethacin and the newly available IV ibuprofen lysine. Although IV COX inhibitors represent a small portion of medical expenses, their benefits appear to be considerable. Pharmacoeconomic studies have evaluated indomethacin's beneficial impact on cost-effectiveness per quality-adjusted life year in PDA prophylaxis; however, no analysis to date prospectively assesses the effect of COX inhibitors on resource use or expenses in treating PDA. Such analysis is desirable and should consider efficacy and safety outcomes, impact on health care resource use and length of stay (LOS), and any differential effects of the agents' safety profiles; notably, IV indomethacin adversely affects renal and mesenteric blood flow and increases serum creatinine and oliguria significantly more than IV ibuprofen. These observations lay the foundation to conduct studies assessing the influence of these differences on resource use, LOS and expenses associated with PDA management.