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.

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.

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.

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.

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.

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.

Liraglutide: an injectable option for the management of obesity.

OBJECTIVE: To review the efficacy and safety of liraglutide, marketed as Saxenda, a glucagon-like peptide-1 analog for obesity management. DATA SOURCES: A MEDLINE search (1970 to March 2015) was conducted for English-language articles using the terms glucagon-like peptide 1, liraglutide, and obesity. STUDY SELECTION AND DATA EXTRACTION: Published articles pertinent to the efficacy and safety of liraglutide for short- and long-term obesity management among overweight or obese patients and special populations were reviewed and summarized. DATA SYNTHESIS: Based on randomized placebo-controlled and active-comparator studies, liraglutide can increase weight loss among overweight and obese patients in a dose-dependent manner with once-daily doses of 1.2 to 3.0 mg. It has been shown that a higher proportion of patients experienced 5% and 10% weight loss from baseline compared with placebo and orlistat. Data support the potential benefit of liraglutide among overweight and obese patients with prediabetes, as well as women with polycystic ovary syndrome (PCOS) with an inadequate response to metformin. Larger and more robust studies are needed to determine the clinical significance of liraglutide among other agents for obesity in diverse populations. CONCLUSIONS: Liraglutide is an adjunct to lifestyle modifications to improve success rates among overweight or obese individuals without diabetes. It may have a potential role in special populations, such as in those with prediabetes and women with PCOS. Based on its clinical evidence, liraglutide can result in more weight loss from baseline compared with orlistat and placebo. Adverse events associated with liraglutide are primarily gastrointestinal and usually dose dependent.

Are antidepressants safe in the first trimester of pregnancy?

Antidepressants have been linked to cardiac malformations when used early in pregnancy, particularly the first trimester. However, recent analyses suggest that the overall risk of malformations is very low. When determining appropriate therapy for pregnant women or women who plan to become pregnant, providers should consider the growing body of evidence compared with the potential harm caused if maternal medical conditions are not treated.

Roles of the pharmacist in the use of safe and highly effective long-acting reversible contraception: an opinion of the women's health practice and research network of the American College of Clinical Pharmacy.

The U.S. population continues to experience an alarmingly high rate of unintended pregnancies that have an impact on individual families and society alike. Lack of effective contraception accounts for most unintended pregnancies, along with incorrect use of contraceptives. The most common reversible contraceptive method used in the United States is the oral contraceptive pill, which has significant failure and discontinuation rates. Use of long-acting reversible contraceptive (LARC) methods has been increasing in recent years after efforts to educate providers and patients. Women are more likely to use LARC methods when barriers such as access and cost are removed. An uptake in the use of LARC methods would allow for markedly reduced contraception failure rates and higher user satisfaction and thus higher continuation rates than those seen with current contraception use. Promoting the use of LARC methods is an important strategy in improving both individual and public health outcomes by reducing unintended pregnancies. The pharmacist's role in family planning is expanding and can contribute to these efforts. Although knowledge regarding LARC has not been studied among pharmacists, a knowledge deficit exists among health care professionals in general. Thus pharmacist education and training should include LARC methods along with other contraceptives. The American College of Clinical Pharmacy Women's Health Practice and Research Network advocates for the pharmacist's role in the use of safe and highly effective LARC methods. These roles include educating patients, informing providers, facilitating access by providing referrals, and modifying institutional procedures to encourage provision of LARC methods.

The Needs and Opportunities for Medication Disposal Programs.

The continued increase in the usage of medications has led to a variety of negative consequences, including adverse effects on our environment and an increase in misuse/abuse of these products. Improper disposal of unused medications results in significant effects to wildlife and the potential to adversely affect human cells. Increases in misuse/abuse have resulted in significant increases in emergency department visits for drug-related issues. Drug overdose is now the leading cause of accidental death in the United States. Education of both health care providers and the general public about these issues and the proper disposal of unused medications is crucial.