How Debate Could Facilitate Group Function in Pharmacy Schools.

Objective. To study how a debate format could be a helpful tool to enhance group functionality and decision-making in schools of pharmacy.Methods. This study examines the potential of a debate format to facilitate discussion and shift viewpoints. Changes in viewpoint and feedback from the Academic Leadership Fellows Program (ALFP) Cohort 16 debates at the February 2020 American Association of Colleges of Pharmacy (AACP) Interim Meeting generated two data sets for each discussion topic to analyze debate effectiveness. Pre- and post-debate audience viewpoints were compared to determine the extent to which debates influenced viewpoints. Continuing pharmacy education (CPE) evaluations of the debate learning objectives provided information on participants' views of the debate format.Results. The debate format appeared to shift opinions on all three topics discussed. In addition, audience members responded in agreement or strong agreement that the debate format was of benefit to both leadership interactions and team environments.Discussion. While group functionality is an important aspect of effective decision-making, it is not always considered in pharmacy school operations. Incorporating debate components could improve the quality of group functionality, thereby positively impacting decision-making in schools of pharmacy.

Dual antiplatelet therapy for minor ischemic stroke and transient ischemic attack.

ABSTRACT: Traditional preventive management of patients suffering from a minor ischemic stroke and/or transient ischemic attack indicated dual antiplatelet agents for 90 days. Newer clinical trial data suggest that therapeutic effectiveness is reached much sooner than previous guideline recommendations. Continued use of dual antiplatelet therapy beyond newly studied durations of efficacy has shown an increased risk in hemorrhagic complications with little to no additional preventive benefit. This article highlights newer trial data and recognizes a significant change in therapeutic management for patients suffering a minor ischemic stroke and/or transient ischemic attack.

Evaluation of the Use of a Diabetes Risk Test to Identify Prediabetes in an Employee Wellness Screening.

BACKGROUND: The American Diabetes Association (ADA) Diabetes Risk Test (DRT) is a screening tool to identify people at risk for developing diabetes. Individuals with a DRT score of 5 or higher may have prediabetes or diabetes and should see a healthcare provider. OBJECTIVE: To determine how many additional employees are identified as being at risk for developing diabetes during an employee wellness screening by using a more stringent DRT cutoff score of 4 instead of 5. METHODS: During an annual employee wellness screening event, a hemoglobin A1C (A1c) was drawn for participants with a DRT score of > 4 or by request regardless of risk score. A1C values were classified as normal (<5.7%), prediabetes (>5.7 and <6.5%) or diabetes (>6.5%). Risk scores and A1C values were analyzed using descriptive statistics. Cost of additional laboratory testing was also reviewed. RESULTS: An A1C was collected for 158 participants. Fourteen of 50 (28%) participants with a DRT of 4 had A1c values in the prediabetes range and no history of diabetes or prediabetes. Using the lower DRT score of 4 resulted in an additional expenditure of $305 with $85.40 resulting in the identification of an otherwise unaware person at risk for developing diabetes. CONCLUSION: Using a DRT cutoff score of 4 as part of an employee wellness screening program resulted in additional laboratory costs to identify persons at risk for developing diabetes but also allowed for earlier education to slow or stop the progression to diabetes which may reduce healthcare costs over time.

A Systematic Review of the Efficacy and Safety of Over-the-Counter Medications Used in Older People for the Treatment of Primary insomnia.

OBJECTIVE: The purpose of this systematic review is to evaluate the available evidence for safety and efficacy of over-the-counter (OTC) sleep aids used for the treatment of insomnia in older people.
DATA SOURCES: PubMed, EBSCO, and International Pharmaceutical Abstracts.
STUDY SELECTION: Five studies were included that involved humans 65 years of age and older being evaluated on OTC sleep aids in the outpatient setting.
DATA EXTRACTION: Data extraction from each study included primary and secondary efficacy endpoints, such as differences in the mean total sleep time, sleep latency, sleep efficiency, and number of awakenings, along with safety endpoints, such as psychomotor ability, cognitive ability, and adverse effect profiles. Both subjective and objective measures of changes in sleep and adverse effects were included.
DATA SYNTHESIS: Diphenhydramine had a statistically significant increase in sedation and decrease in number of awakenings but was not shown to be any less or more safe than compared products. Despite lacking safety issues, valerian was found to have no effect on subjective or objective sleep outcomes. Overall, melatonin had the most evidence and was found to have a statistically significant positive impact on sleep measures without safety issues.
CONCLUSION: Diphenhydramine and melatonin appear to be efficacious in improving some sleep measures while causing minimal adverse effects. However, there are very few studies that examine the use of over-the-counter sleep aids in those 65 years of age and older with primary insomnia. Additional studies are needed in this population.

Evaluation of Antibiotic Utilization in a Rural, Outpatient Clinic: An Antimicrobial Stewardship Initiative.

BACKGROUND: Antibiotics are commonly prescribed for uncomplicated urinary tract infection (UTI) and acute otitis media (AOM) and may be unnecessary at times. The aim of this study was to evaluate prescribing practices for UTIs and AOM in a rural ambulatory care setting and to identify areas for improvement. METHODS: In a single-center, retrospective review conducted at a rural clinic, patients diagnosed with uncomplicated UTI and AOM were included. Patients were identified by International Classification of Diseases, Tenth (ICD-10) codes, and data were collected for visits between January 1, 2017, and December 31, 2017. The primary outcome was to assess adherence of antimicrobial prescribing to current treatment guidelines. RESULTS: Of the 76 patients identified, 28 met inclusion criteria. Of the 28 patients, 75% received an agent recommended first line in the treatment guidelines, and 18 of the 21 received a recommended dose. Only 17% of patients were prescribed an appropriate duration of treatment. CONCLUSION: Opportunities exist for antimicrobial stewardship interventions for uncomplicated UTIs and AOM. Prescribers are not consistently adhering to guidelines in regard to antibiotic choice, dose, or duration. Additional education and stewardship interventions are crucial considering the increased prevalence of antimicrobial resistance.

Pharmacists' Perspectives on Prescribing and Expanding Access to Hormonal Contraception in Pharmacies in the United States.

INTRODUCTION: Pharmacist prescribing of contraception is becoming increasingly available in selected states. The objective of this study was to assess US community pharmacists' perspectives on expanding access, barriers, and facilitators since states have begun pharmacist scope of practice expansions for prescribing contraception. METHODS: A survey study of US community pharmacists' support for expanded access models, pharmacist prescribing practices and interest, and importance of safety, cost, and professional practice issues for prescribing was conducted. RESULTS: Pharmacists are generally supportive of pharmacist prescribing and behind-the-counter models for hormonal contraception and generally opposed to over-the-counter access. A majority (65%) are interested in prescribing hormonal contraception. The top motivation for prescribing contraception is enjoying individual patient contact (94%). Safety concerns (eg, patients not obtaining health screenings) remained most important for pharmacist implementation, followed by cost (eg, lack of payment or reimbursement for pharmacists' services), and professional practice (eg, pharmacist time constraints and liability) issues. CONCLUSION: This study provides an updated understanding of attitudes toward models of expanded access to hormonal contraception, interest in prescribing, and barriers and facilitators to this service among community pharmacists. Many barriers such as time and reimbursement remain unchanged. This information can inform policy and implementation efforts.

Leadership Lessons and Career Advice From the Musical Hamilton.

The musical Hamilton, written by Lin-Manuel Miranda, creatively depicts the life and career of founding father Alexander Hamilton. While Hamilton is the primary focus, highlights of the career and personal journeys of other leaders, such as George Washington, Thomas Jefferson, and Aaron Burr, are interjected throughout the production. Often the musical numbers in Hamilton focus on aspects of leadership and career development that Hamilton and his contemporaries were learning or needed to learn. These lessons are applicable to the challenges that faculty members in academic pharmacy face today at different stages of a career. These include the importance of maximizing opportunities, listening, self-reflection, compromise, patience, empathy, prioritizing, tending relationships, making difficult decisions, knowing when to say goodbye, and managing a legacy.

Pharmacist self-perception of readiness to prescribe hormonal contraception and additional training needs.

INTRODUCTION: Our objectives were to describe pharmacist perceptions of training and preparation to prescribe hormonal contraception (HC), identify training gaps, and elicit preferred training methods. METHODS: In this cross-sectional survey, pharmacists in the United States (US) completed an online 29-item survey. Descriptive statistics were used to analyze responses. RESULTS: Of 823 participating pharmacists, 58% felt they received adequate training to prescribe HC. Prescribing any medications within the last five years or completion of residency training were significantly associated with more participants feeling adequately trained. Of those who indicated HC was not covered in their pharmacy school curriculum, most (78%) felt they were either not adequately trained or unsure. Only 36% were aware of the Centers for Disease Control and Prevention US Medical Eligibility Criteria for Contraceptive Use (CDC MEC). Residency-trained pharmacists were statistically more likely to have used the CDC MEC and feel comfortable prescribing for adolescents. Most participants desired more training about switching between products (80%) and patient specific product selection (72%). Preferred methods for additional training were basic (

Trends in potentially abused medications returned during medication take-back days.

OBJECTIVE: To observe rates of returns and to identify trends in returns of potentially abused medications during medication take-back events. METHODS: A retrospective cross-sectional study was conducted of returned medications during medication take-back days from 2013 to 2016 based on a partnership between local law enforcement and a school of pharmacy in a rural South Carolina town. Data collected on returned items included active ingredients, estimated quantity, and prescription fill date if available. The medications were classified by therapeutic class and further identified drugs of potential abuse according to National Institute of Drug Abuse classifications. Descriptive statistics were used to analyze the data collected. RESULTS: In 2013, 742 different medications were returned, and 64 (8.63%) were potential drugs of abuse. In the years 2014-2016, 117 (11.43%) returned medications were potential drugs of abuse. In 2017, 40 (13.27%) returned medications were potentially abused drugs. Opioid analgesics were the most common potentially abused medication returned, accounting for 51.6%, 62.4%, and 65% of potentially abused medications returned in 2013, 2014-2016, and 2017, respectively. The other most common potentially abused returned medications were benzodiazepines (10.9%, 12.8%, 7.5%). The return of hypnotic medications increased over the study period from 0% in 2013 to 12.5% of potentially abused medications in 2017. The return of other medications such as loperamide and dextromethorphan varied over the study period. CONCLUSION: The rate of potentially abused medications returned steadily rose over the period of the study. Heightened awareness and increased opportunities for proper disposal including the placement of permanent drug disposal locations may account for the decreased number of prescriptions returned following 2013.

Patterns of Diabetes Screening and Prediabetes Treatment during Office Visits in the US.

INTRODUCTION: The American Diabetes Association recommends annual screenings for prediabetes if the patient meets the suggested requirements. The overall prevalence of prediabetes has decreased from an estimated 86 million adults in 2012 to 84.1 million adults in 2015 in the United States. Along with lifestyle modifications, the use of metformin as a treatment option or in combination has shown a decrease in weight and health care costs. This study was designed to review the prevalence of screening and treatment of prediabetes in the United States by using the National Ambulatory Medical Care Survey, as well as identify any factors associated with screenings and treatment. METHODS: The National Ambulatory Medical Care Survey was used to examine a study sample of office visits between 2012 and 2015, reviewing the prevalence of screenings and lab services ordered or provided at each patient visit. Inclusion criteria consisted of the recommendations given by the American Diabetes Association including any patient ≥45 years or adult patient <45 years with a body mass index of ≥25 kg/m2 and an additional risk factor. Patients with a previous diagnosis of diabetes were excluded from the sample. RESULTS: A total of 105,721 office visits (2012 to 2015) were included in the analysis. The diabetes screening prevalence increased from 10% in 2012 to 13.4% in 2015. Metformin (n = 140, 76.1%) was the most common antidiabetic medication prescribed to treat prediabetes. CONCLUSIONS: The prevalence of diabetes screening during office visits remained lower than 15% between 2012 and 2015 in the United States. Physicians primarily prescribe lifestyle modifications, including a healthy diet and exercise, with metformin being used in some cases for the prevention of diabetes.

Incorporating an Entrepreneurial Certificate into the Pharmacy Curriculum.

Objective. To describe the implementation and assessment of an entrepreneurial certificate program within an elective. Methods. An entrepreneurial certificate program through the Kauffman Foundation was integrated within an entrepreneurial elective to provide students at Presbyterian College School of Pharmacy with more in-depth training regarding entrepreneurial skills. A pre-/post-survey was administered to assess knowledge and skills obtained. Results. Thirty-three students completed the survey. By completing the entrepreneurial certificate, 67% of students increased their knowledge and skills in entrepreneurism. Conclusion. Incorporating an entrepreneurial certificate program into the pharmacy curriculum increases student confidence in entrepreneurial principles and skills.

Guide for Drug Selection During Pregnancy and Lactation: What Pharmacists Need to Know for Current Practice.

OBJECTIVE: To provide guidance for clinicians on risk assessment of medication use during pregnancy and lactation. DATA SOURCES: Authors completed PubMed searches to identify articles focused on the use of medications in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease. STUDY SELECTION AND DATA EXTRACTION: Articles were reviewed to provide overall guidance to medication selection during pregnancy. The following information was reviewed: medication use in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease. DATA SYNTHESIS: This article will provide an overview of medication safety considerations during pregnancy and lactation. Information was interpreted to help clinicians predict the potential risk and benefit in each patient to make an evidence-based decision. The article concludes with guidance on risk assessment and how pharmacists may support fellow health care providers and their patients when considering medication use. CONCLUSIONS: Information about the effects of medication use during reproductive periods is limited. With the removal of the Food and Drug Administration pregnancy categories, clinicians will be relying on pharmacists to aid in the appropriate selection of therapies for patients. It is critical that pharmacists keep abreast of resources available and be able to assess data to help prescribers and their patients.

Student pharmacist perceived benefit of a sequential training model for health testing.

PURPOSE: This article describes the health testing training process used at Presbyterian College School of Pharmacy and evaluates perceptions of the sequential training model among students in their first, second, and third professional years. EDUCATIONAL ACTIVITY AND SETTING: After observing student deficiencies in the knowledge and skills necessary for performing health tests, despite receiving didactic training within the core curriculum, faculty members searched for supplemental training programs used by other schools of pharmacy. No literature regarding structured programs was found. Consequently, faculty developed test-specific training modules for a variety of health screenings. Students who participated in the sequential self-learning followed by a live skills assessment were surveyed to determine their perceptions of the training. FINDINGS: During the 2014-2015 academic year, 78 students successfully completed health testing training modules. Of these students, 56 (72%) completed an attitudinal survey designed to assess their perceptions. Nearly 93% of respondents perceived improved confidence after completing the training. Regardless of the year in pharmacy school, 88% of respondents believe they would not have been adequately prepared to conduct the health test(s) without this training. SUMMARY: Student perception and acceptance of health testing training were positive. Using sequential training modules to teach and reinforce the skills necessary for performing health tests can improve student ability and confidence. Consequently, students have the opportunity to impact the health of the community while becoming practice ready in the area of health testing.

Evaluation of the Prevalence and Effectiveness of Education on Metered-Dose Inhaler Technique.

BACKGROUND: The objectives of this study were: (1) to assess the prevalence of and types of education methods provided to participants who use a metered-dose inhaler (MDI), (2) to determine the prevalence of MDI misuse in adults using objective and subjective assessments, and (3) to determine whether any associations exist between the education method and the participant's ability to properly use an MDI. METHODS: Adult participants who had a current or previous history of MDI use were recruited from retail pharmacies and physician offices in Laurens County, South Carolina. Exclusion criteria included the use of an MDI spacer, inability to speak/understand English, or current acute respiratory illness. Participants completed a survey regarding inhaler use and previous education, a subjective checklist assessment by demonstrating use of an MDI, and an objective assessment by using the Aerosol Inhalation Monitor (AIM). RESULTS: Of 100 participants, 25% reported never having received education about inhaler technique, and 94% were found to have insufficient MDI technique. No association between the method of education and successful MDI technique with the AIM was identified (P = .31). Participants were less likely to correctly use the AIM if they missed >3 steps in the subjective assessment. (P = .032). CONCLUSIONS: Although most participants received inhaler education, inhaler misuse was very common. No associations were found regarding method of education and proper inhaler technique.

Clinical Pharmacokinetics and Pharmacodynamics of Insulin Glargine 300 U/mL.

Concentrated insulin analogs have recently been approved and are available for clinical use in the management of diabetes mellitus. One new product is insulin glargine U-300 (Sanofi), a basal concentrated insulin of 300 U/mL. Several studies have been conducted and completed evaluating blood samples for the pharmacokinetics of insulin glargine U-300 and euglycemic clamp procedures for the pharmacodynamics. This concentrated insulin has a low within-day variability and high day-to-day reproducibility, allowing for a more constant and prolonged duration of action, compared with insulin glargine U-100 (100 U/mL). Insulin glargine U-300 is equally effective, when compared with insulin glargine U-100 for glycemic control in patients with type 1 and 2 diabetes mellitus. Insulin glargine U-300 has a similar efficacy profile to insulin glargine U-100 for glycemic control, yet with lower rates of nocturnal and severe hypoglycemia. Insulin glargine U-300 can be considered an acceptable basal insulin for patients with type 1 and 2 diabetes mellitus, and it has a potential role among patients who are naïve to insulin therapy or require titration of basal insulin. Titration of insulin glargine U-300 would result in less volume and a lower risk of hypoglycemia, compared with insulin glargine U-100. This article evaluates and summarizes the pharmacokinetics and pharmacodynamics of insulin glargine U-300, for patients with type 1 or 2 diabetes mellitus, and summarizes its application to clinical practice.

What are the latest recommendations for pneumococcal vaccines?

The Advisory Committee on Immunization Practices recently updated its guidelines on pneumococcal pneumonia vaccines for older adults. The new guidelines recommend that patients age 65 years and older receive the PCV13 vaccine in a series along with the PPSV23 vaccine. This article summarizes these changes along with a review of when to vaccinate other key adult populations.

Liraglutide, GLP-1 receptor agonist, for chronic weight loss.

INTRODUCTION: Since 1990, the prevalence of obesity has been steadily increasing in the United States. Over the past four years, new medications have become approved and available, allowing for more options in the management of chronic weight loss among overweight or obese patients. This review article summarizes the efficacy, safety, and clinical attributes of liraglutide among overweight or obese patients with or without comorbidities. Areas covered: A MEDLINE search, from 1970 to June 2016, was conducted using key terms-glucagon-like peptide-1 receptor agonist, liraglutide, overweight, and obesity. Published clinical trials, in the English-language and with primary endpoints related to weight loss, were reviewed and critiqued in this article. Expert commentary: Available as a subcutaneous daily injection, liraglutide is the first glucagon-like peptide-1 (GLP-1) receptor agonist indicated for obesity management, as adjunct therapy with lifestyle and behavioral modifications. Liraglutide 3 mg daily has been associated with greater weight loss than placebo or orlistat in patients without type 2 diabetes. Additionally, liraglutide has resulted in reductions in waist circumference, systolic and diastolic blood pressure, and improvements in lipid panel among overweight and obese patients with and without type 2 diabetes.

Utilization of the Newest Vital Sign (NVS) in Practice in the United States.

Health literacy refers to the ability of a patient to obtain, communicate, process, and understand basic information related to health and services. It is estimated that the majority of adult Americans may have difficulty understanding health information. In addition, limited health literacy of patients is linked to over $100 billion in health care costs. Measurement of health literacy may aid in improving communication with patients, and thus to improving outcomes and decreasing costs. The Newest Vital Sign (NVS) is a tool that has been used to assess health literacy in a variety of patients. It has been validated against other measures including the Test of Functional Health Literacy in Adults (TOFHLA). Patients are categorized as high likelihood of limited health literacy, possible limited health literacy, or adequate literacy. The NVS has been used in a variety of settings and tested among a wide range of patient groups. The most common setting for use is in primary care, probably due to the relatively quick assessment of health literacy (within 3 minutes). The NVS has been used in Caucasians, African Americans, Hispanics, and several other ethnicities. Assessment with the NVS has been conducted in adult patients across the age continuum, and with several different health conditions, including diabetes, kidney disease, and pain. This article seeks to review the published uses to date and to provide suggestions for potential uses of the NVS.