Impact of NCCN Guideline Adherence in Adult Cancer Pain on Length of Stay.

To improve the management of cancer related pain, the National Comprehensive Cancer Network (NCCN) publishes the Adult Cancer Pain guideline on an annual basis. However, a large majority of oncology patients still report inadequate pain control. Single-center, retrospective cohort study of adult patients admitted for uncontrolled pain or pain crisis between 3/1/19 and 06/30/20 were assigned to cohorts of either adherent or non-adherent to NCCN guideline recommendations for management of pain crises based on their initial opioid orders. Patients must have reported a pain score >/= 4 and received at least one dose of opioids within 24 hours upon admission. The length of stay (LOS), pain scores, and naloxone administration were compared between both groups. Patients in the adherent group had a shorter median LOS (3.7 days [range: 1 to 18.93] vs 5.4 days [range: 1.45 to 19.64 days], p = 0.04). Patients that received lower doses than recommended had longer LOS compared to adherent group (6.1 vs. 3.7 days; p = 0.009). When adjusted for confounders, this significance did not remain. The lowest reported pain score within 24 hours of admission was lower in the adherent group (median 3 vs 4, p = 0.04). Predictors of LOS included opioid tolerance and a pain or palliative care consult. Adherence to NCCN guidelines for acute pain crisis management in adult patients with cancer remains poor. Patients who received guideline adherent initial opioid regimens demonstrated a trend toward a shorter LOS. Opioid-tolerant patient outcomes remain inadequate; appropriate pain management for these patients need to improve.

Yeasts from temperate forests.

Yeasts are ubiquitous in temperate forests. While this broad habitat is well-defined, the yeasts inhabiting it and their life cycles, niches, and contributions to ecosystem functioning are less understood. Yeasts are present on nearly all sampled substrates in temperate forests worldwide. They associate with soils, macroorganisms, and other habitats and no doubt contribute to broader ecosystem-wide processes. Researchers have gathered information leading to hypotheses about yeasts' niches and their life cycles based on physiological observations in the laboratory as well as genomic analyses, but the challenge remains to test these hypotheses in the forests themselves. Here, we summarize the habitat and global patterns of yeast diversity, give some information on a handful of well-studied temperate forest yeast genera, discuss the various strategies to isolate forest yeasts, and explain temperate forest yeasts' contributions to biotechnology. We close with a summary of the many future directions and outstanding questions facing researchers in temperate forest yeast ecology. Yeasts present an exciting opportunity to better understand the hidden world of microbial ecology in this threatened and global habitat.

Incorporation of novel therapies for the management of sickle cell disease: A pharmacist's perspective.

Patients with sickle cell disease (SCD) experience significant disease-related morbidity including multiorgan damage, chronic anemia, and debilitating pain crises. While hydroxyurea has been the primary disease modifying modality in SCD, novel therapies with unique mechanism of action have recently been approved. This review article examines the evidence surrounding the available SCD therapies to guide pharmacists on potential treatment selection and management strategies for patients with SCD. A systematic search of online databases was performed to identify literature on the management of SCD. While the newly approved novel agents have demonstrated clinical benefit it remains unclear how these agents fit into the treatment paradigm. Pharmacists should be aware of the data supporting the use of these novel agents to optimize use on a patient-specific basis.

Financial Impact of an Automated Oncology Dose-Rounding Initiative: One-Year Analysis.

PURPOSE: Infusion drugs are regarded as one of the high-cost health care expenditures. One approach to decrease drug expenditures is by dose-rounding biologics and cytotoxic agents. The Hematology/Oncology Pharmacy Association recommends that biologic and cytotoxic agents are rounded to the nearest vial size if they are within 10% of the ordered dose. The purpose of this initiative is to determine the impact of an automated dose-rounding algorithm on drug expenses. METHODS: The dose-rounding algorithm was developed and integrated into the computerized physician order entry system for automated dose rounding to minimize impact on current workflow and to reduce medication errors. Twenty-four medications were preselected for dose rounding and included in the analysis. Ordered doses were automatically rounded to the nearest vial size if the dose was within 10% of the original dose. Prescribers then either reviewed and signed the rounded dose or manually entered the nonrounded dose. Cost savings were calculated as drug expense savings from doses rounded down. RESULTS: From July 2018 to June 2019, 10,206 doses of the selected medications were administered. Dose rounding occurred in 5,069 doses (49.7%). All 24 medications within the initiative were administered within the time of analysis. Of the rounded doses administered, 2,516 (49.6%) were rounded down to a commercially available vial size. Using wholesale acquisition cost pricing, the drug expense savings was approximately $3.6 million US dollars (USD). The medications with the highest savings were trastuzumab and ipilimumab, with annual savings of $756,780 USD and $494,517 USD, respectively. CONCLUSION: The automated dose-rounding algorithm at Michigan Medicine reduced drug expenditures substantially, and its integration within the computerized physician order entry system had minimal impact on current workflow.

Pharmacy Phamilies as a Component of a Co-Curricular Program for Doctor of Pharmacy Students.

BACKGROUND: Pharmacy student professional growth depends heavily on co-curricular involvement, in addition to classroom learning. Co-curricular programming can be supported by an innovative structure using self-directed learning and a unique mentorship process. INNOVATION: A novel faculty and peer mentorship structure, called Pharmacy Phamilies, is integrated into a credited Lifelong Learning course that spans the 4 years of our PharmD program. This course is comprised of student-chosen activities to meet requirements in six domains, as well as reflections and other assignments. Recent changes include a new Pharmacy Phamily group reflection process and the use of co-curricular logs to document student activities. FINDINGS: Based on a student survey, the majority of respondents were satisfied with their level of engagement with their Pharmacy Phamily (72%) and with their advisor (76%). The majority also reported that the Pharmacy Phamily program is meeting its goals of establishing a sense of community at the college (76%) and enhancing students' professional development (72%). A total of 86% of students preferred the Pharmacy Phamily group reflection over the former six individual reflections and 93% of students agreed the co-curricular log was a useful tool to document involvement in professional activities. CONCLUSION: Pharmacy Phamilies and peer-reviewed, group reflection can provide an inclusive structure of support and social connection for students at the college of pharmacy.

VIGILÂNCIA E ATENÇÃO À SAÚDE DE POPULAÇÕES EXPOSTAS A AGROTÓXICOS: METODOLOGIAS E PRÁTICAS INTEGRADAS / SURVEILLANCE AND ATTENTION TO THE HEALTH OF POPULATIONS EXPOSED TO PESTICIDES: METHODOLOGIES AND INTEGRATED PRACTICES / VIGILANCIA Y ATENCIÓN A LA SALUD DE POBLACIONES EXPUESTAS A LOS PLAGUICIDAS: METODOLOGÍAS Y PRÁCTICAS INTEGRADAS

O alto consumo de agrotóxicos na Bahia e o impacto do uso de agrotóxicos na saúde e no ambiente exigem a aplicação de metodologias integradoras de vigilância e atenção à saúde das populações expostas. O texto relata uma experiência de educação em saúde voltada para a construção de metodologias e práticas integradas de vigilância e atenção à saúde de populações expostas a agrotóxicos, por meio da capacitação de técnicos das secretarias estadual e municipais de saúde, dos âmbitos central, regional e municipal. Nessa experiência, adotou-se a metodologia dialógica, valorizando as experiências individuais. Utilizaram-se instrumentos e mecanismos que permitiram a construção coletiva com base em uma determinada temática, potencializando a reflexão crítica da realidade. A abordagem teve como princípio a articulação intra e interinstitucional, a gestão da informação para a ação e a qualificação das equipes de saúde para atuarem em situações de rotina e em eventos inusitados. O Grupo de Trabalho de Agrotóxicos da Secretaria da Saúde do Estado da Bahia elaborou o plano de ação estadual, identificando estratégias para sua operacionalização, dentre elas o curso para técnicos de municípios definidos como prioritários, das áreas de Vigilância em Saúde e Centro de Referência Regional em Saúde do Trabalhador, bem como das respectivas Diretorias Regionais de Saúde. A experiência vivenciada pelos participantes durante o processo de concepção e realização do curso foi transformadora enquanto metodologia participativa e aprendizado coletivo, possibilitando a reflexão sobre a prática e o agir dos sujeitos.

The high consumption of pesticides in Bahia and the impact of pesticide use on human health and the environment and require the application of integrative methodologies of surveillance and attention to the health of the exposed population. This text reports on a health education experience focused on building methodologies and integrated surveillance and health care practices for populations exposed to pesticides through the capacitation of technicians from state and municipal departments of health, central, regional and municipal areas. For this experience the dialogic methodology was adopted, valuing individual experiences. Tools and mechanisms that allowed the collective construction based on a particular subject, potentiate the critical reflection on reality. The approach has had as principle the articulation intra and inter institutional, the management of information for the action and the qualification of health teams to work in routine situations and in unusual events. The Pesticide Working Group of the Department of Health of the State of Bahia elaborated the state action plan, identifying strategies for its operation, including the course for technicians of the municir municipalities defined as priority areas of Public Health Surveillance and Occupational Health´s Reference Center as well as the respective Regional Health Board. The experience experimented by the participants during the process of conception and execution of the course was exceptional as participative methodology and collective learning, allowing the reflectio on the practice and action of the subjects.

El alto consumo de plaguicidas en Bahia y el impacto del uso de plaguicidas en la salud y el medio ambiente exigen la aplicación de metodologías integradoras de vigilancia y atención a la salud de las poblaciones expuestas. El texto presenta la experiencia de educación para la salud dirigida a la construcción de metodologías y prácticas integradas de vigilancia y atención a la salud de las poblaciones expuestas a los plaguicidas, a través de la capacitación técnica de las secretarías de salud estatal y municipal, de los niveles central, regional y municipal. Por lo tanto, se ha adoptado la metodología dialógica, para valorar las experiencias individuales. Se han utilizado instrumentos y mecanismos que permitieron la construcción colectiva basada en una temática específica, potenciando la reflexión crítica de la realidad. El abordaje tuvo como principio la articulación intrainstitucional e interinstitucional, el manejo de la información para la acción y la calificación de los equipos de salud para actuar en situaciones de rutina y eventos inusuales. El Grupo de Trabajo de Plaguicidas del Departamento de Salud de Bahia ha elaborado el plan de acción estatal identificando estrategias para su operacionalización, entre ellas el curso para técnicos de municipalidades definidas como prioritarias, de las áreas de vigilancia de la salud y de los centros de referencia de salud de los trabajadores, así como de las respectivas Juntas Directivas Regionales de Salud.