Pharmacokinetics of Sublingual Versus Oral Estradiol in Transgender Women.

OBJECTIVE: To investigate the pharmacokinetics of 17ß-estradiol (E2) administered orally versus those of 17ß-E2 administered sublingually in transgender women. METHODS: Single doses of 17ß-E2 were administered orally (1 mg) to 10 transgender women and then sublingually (1 mg) after a 1-week washout period. Blood samples were collected at baseline (0 hour) and at 1, 2, 3, 4, 6, and 8 hours after dosing. The samples were frozen and analyzed using liquid chromatography mass spectrometry (LC-MS/MS) and immunoassay. RESULTS: The results demonstrated that sublingual E2 had a significantly higher peak serum E2 concentration of 144 pg/mL, measured using LC-MS/MS, compared with an oral E2 concentration of 35 pg/mL, measured using LC-MS/MS (P = .003). Sublingual E2 peaked at 1 hour and oral E2 peaked at 8 hours, as measured using LC-MS/MS. The area under the curve (AUC) (0-8 hours) for sublingual E2, measured using LC-MS/MS, was 1.8-fold higher than the AUC (0-8 hours) for oral E2, measured using LC-MS/MS. Additionally, sublingual E2 was found to have an increased E2-to-estrone ratio at all time points (1.1 ± 1.0 vs 0.7 ± 0.4, P ≤ .0001), the clinical significance of which is unclear. CONCLUSION: Oral E2 administered sublingually has a different pharmacokinetic profile, with higher serum E2 levels and AUC (0-8 hours) than traditionally administered oral E2. Multidaily dosing may be necessary to suppress testosterone levels with sublingual E2. The appropriate dosing, efficacy, and safety of sublingual E2, compared with those of other E2 preparations, are unknown.

Implementation and evaluation of an interprofessional physical assessment skills workshop for Wisconsin pharmacists.

BACKGROUND: Pharmacists have a critical, expanding role in health care delivery. In particular, pharmacists in community pharmacy and ambulatory care settings are important and frequent access points for health care services. OBJECTIVE: We describe the interprofessional development and implementation of an interactive, broadly applicable physical assessment skills-based continuing pharmacy education program to provide an avenue for the attainment of this warranted set of skills for pharmacists who desire to provide advanced patient care services in their respective practices. METHODS: Pharmacists, in collaboration with family medicine and emergency medicine physicians, developed workshop content, design, and flow. The structure of the workshops consisted of didactic training, hands-on practical application, simulated practice, and case-based certification examinations. RESULTS: On a postworkshop survey, all respondents answered "agree" or "strongly agree" when asked if the workshops were useful, advanced their skills, and advanced their confidence. It was also found that more than 50% of the participants used their physical assessment skills monthly and 11% daily. The most common assessment performed was obtaining an accurate manual blood pressure. CONCLUSION: The interprofessional development and implementation of workshops dedicated to physical assessment skills education is feasible and led to the incorporation of these skills into pharmacists' practice, particularly in the community and ambulatory care settings.

Transferability of a diabetes escape room into an accelerated pharmacy program.

BACKGROUND AND PURPOSE: Educational games can be used to increase students' knowledge of diabetes management. Students perceive educational games to be valuable learning tools. This study evaluated the transferability of a serious game, the diabetes escape room, between skills laboratories in a traditional program and an accelerated program. The authors believe that this is a valuable addition to educational methods for students in any pharmacy program. EDUCATIONAL ACTIVITY AND SETTING: Faculty at an accelerated, three-year pharmacy program replicated a diabetes escape room previously used by a traditional, four-year pharmacy program. The diabetes escape room required students to compete in a team-based educational game in which they solved diabetes-themed puzzles. Students completed pre- and post-game knowledge assessments and a perception survey linked to activity participation. The accelerated program students completed an additional delayed post-game knowledge assessment. FINDINGS: Students showed a statistically significant difference between pre- and post-game knowledge assessment scores at both institutions as well as in the delayed post-game knowledge assessment implemented at the accelerated program. Perception survey results were statistically significantly higher for the accelerated program, however both cohorts suggested positive perceived engagement with and usefulness of the escape room. SUMMARY: The use of a diabetes escape room resulted in statistically significant gains in knowledge and positive student perceptions. The diabetes escape room is a transferrable activity that can be used by other colleges or schools of pharmacy.

A "Sense"-ational HPV Vaccination Quality Improvement Project in a Family Medicine Residency Practice.

BACKGROUND: Human papillomavirus (HPV) vaccination uptake for adolescents and young adults in the United States remains far from national goals. Using a multi-component intervention aligned with community-wide efforts, we implemented a quality improvement project to increase HPV vaccinations among 9-26 year-old male and female patients in an urban, low income, minority population family medicine residency practice. METHODS: The pre-intervention year was November 2, 2014 to October 31, 2015 and the intervention year was November 1, 2015 to October 31, 2016. Based on community input and published literature, the interventions were creative, practice-specific provider-, patient-, and system-level strategies. To compare pre- and post-intervention vaccinations, HPV vaccination data were extracted from an electronic medical record request for age-eligible patients seen in the practice during the intervention year. Chi-square, McNemar's and 2-tailed, 2-sample Z tests were used to test differences in vaccination initiation (≥1 dose) and completion (3 doses) across groups and over time. RESULTS: Despite high pre-intervention rates (58% and 75%), HPV vaccine initiation significantly increased 12.8 percentage points (PP) for males and 10.6 PP for females from pre- to post-intervention (P < 0.001). HPV vaccine completion also significantly increased 16 PP for males and 10.9 PP for females (P < 0.001). Young adult patients (18-26 years-old) had significant increases in completion rates (9.9 PP; P < 0.001), not observed among adolescents (20 PP; ns). CONCLUSIONS: Consistent and abundant positive HPV vaccination messaging, low-cost sensory rewards, process change, and community, clinician, and nonclinical staff engagement were associated with higher HPV vaccine initiation and completion, especially among young adults.