Depression, anxiety, and stress among students, faculty, and staff.

Objectives: To identify and compare the prevalence of depression, anxiety, and stress among and between students and faculty/staff; and to determine and contrast the coping mechanisms utilized and barriers to mental health care perceived within and between these two populations. Participants: A total of 448 students and faculty/staff from a Midwestern university. Methods: An electronic survey including the 21 question Depression, Anxiety, and Stress Scale and an exploration of individual coping mechanisms and perceived barriers to mental health care. Results: Approximately one-third of the campus community experience symptoms consistent with severe or extremely severe depression (28.3% faculty/staff, 31% students), anxiety (38.6% faculty/staff, 41.8% students), and/or stress (31.1% faculty/staff, 33.9% students). There were significant differences between faculty/staff and students in regard to mental health coping mechanisms utilized and perceived barriers to professional mental health treatment. Conclusion: Mental health problems are common in both faculty/staff and student populations.

Half of Purposeful Baseline Sandbaggers Undetected by ImPACT's Embedded Invalidity Indicators.

OBJECTIVE: The main objectives of this study were to determine how accurately the embedded invalidity indicators (EIIs) identify purposeful underperformers on the baseline Immediate Post-concussion Assessment and Cognitive Test (ImPACT); and to assess the effectiveness of each individual EII. METHODS: A randomized controlled trial was conducted in which all participants completed a baseline ImPACT assessment. Participants were randomized into a control or purposeful underperformance (sandbagging) group. The primary outcomes measured were the number of participants identified as invalid (via any EII), as well as the ability of each individual EII to detect purposeful sandbagging. Additionally, participants mean raw composite scores and percentiles were evaluated. RESULTS: Seventy-seven participants completed the study (control n = 37, sandbag n = 40.) None of the participants in the control group, and 50% of the purposeful sandbaggers were identified as invalid via the current EIIs. Of the five EIIs, three were unable to identify more than 15% of purposeful sandbaggers. The best performing EIIs were Word Memory and Three Letters, identifying 40% and 35% of purposeful sandbaggers, respectively. Sixty- five percent of the purposeful sandbaggers had at least one composite score ≤1st percentile. Using a composite score ≤1st percentile as potential marker of invalidity would have accurately identified more purposeful sandbaggers than all existing EIIs combined. CONCLUSION: Half of purposeful sandbaggers were not identified by ImPACT's current EIIs. Multiple EIIs were only able to identify <15% of purposeful underperformers, suggesting that reevaluation and/or recalibration of EII cutoffs may be appropriate.

Drug information: from education to practice.

Drug information is a specialty area within the realm of clinical pharmacy that has evolved as technology and clinical practice have changed. Drug information specialists are trained individuals who have clinical knowledge and skills that allow them to provide clear, concise, and accurate recommendations regarding drug use. The constant changing culture of drug information and health care in general has prompted the need for continual growth and refinement of the standards that govern drug information practice. This article outlines specific standards to help ensure that the education and practice of drug information will continue to meet the needs of the health care community. This opinion paper is divided into two sections: Education and Training, and Practice Areas. The Education and Training section is organized to describe the role of drug information and that of the drug information specialist in the training of all pharmacy students and advanced trainees, as well as to describe the role of focused training for those individuals wishing to specialize in drug information. This article also affirms the recommendations for the standards-based approach to drug information education and specialty training. The Practice Areas section is organized to describe the role of the drug information specialist within various practice settings, to identify some of the challenges faced by the drug information specialist within those settings, and to provide recommendations for the different practice areas. The areas found within this section include academia, institutional health systems, managed care, industry, medical writing, and informatics.

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.

Utilization patterns and medication adherence in patients with type 2 diabetes: variations based on type of pharmacy (chain vs independent).

BACKGROUND: Independent pharmacies have demonstrated a positive effect on patient satisfaction, dispensing errors, and patient consultation/counseling. However, there is a lack of studies demonstrating whether these benefits translate into outcomes such as medication adherence. OBJECTIVE: To estimate the variations in utilization patterns and adherence to oral hypoglycemic agents (OHAs) based on type of pharmacy (chain/independent). METHODS: A retrospective cohort design was used to meet the study objective. Newly diagnosed type 2 diabetes patients during a 4-year period were identified from a Medicaid claims database. The provider of the index prescription was classified as a chain or independent pharmacy. Utilization patterns (switching, augmentation, discontinuation, nonmodification) and adherence to OHAs (medication possession ratios) were computed for a 12-month follow-up period from the date of the index OHA prescription. A multivariate framework was used to estimate the effect of type of pharmacy on utilization patterns and adherence after controlling for confounding variables. RESULTS: A total of 2696 newly diagnosed type 2 diabetes patients were identified (independent pharmacy=987; chain pharmacy=1709). Utilization patterns were significantly different between the 2 groups with patients filling their prescription at a chain pharmacy 1.3 times more likely to augment therapy as compared to patients filling prescriptions at an independent pharmacy (P=.035). Independent sample t tests indicated that adherence to OHAs (Mean+/-SD) was significantly higher for patients filling their prescriptions at a independent pharmacy (0.90+/-0.13) as compared to those filling prescriptions at a chain pharmacy (0.88+/-0.13, P=.01). Results of a semi-log Ordinary Least Squares model also indicated that controlling for covariates, patients filling prescriptions at an independent pharmacy had significantly higher adherence to OHAs as compared to those filling prescriptions at a chain pharmacy (P=.02). CONCLUSION: Results of the study indicated that patients with type 2 diabetes who received their OHAs from an independent pharmacy have slightly higher adherence rates as compared to those filling their OHA prescriptions at a chain pharmacy.

Risk factors for developing gadolinium-induced nephrogenic systemic fibrosis.

OBJECTIVE: To identify medications and other potential risk factors, in addition to renal dysfunction, for developing gadolinium-induced nephrogenic systemic fibrosis (NSF). DATA SOURCES: Information was obtained from PubMed, International Pharmaceutical Abstracts, Iowa Drug Information Service, and Google Scholar, using the unlimited search terms nephrogenic systemic fibrosis, NSF, nephrogenic fibrosing dermopathy, NFD, gadolinium, gadodiamide, gadoversetamide, gadopentetate, gadobenate, and gadoteridol. Information was also obtained from the Food and Drug Administration, as well as the manufacturers of the above-mentioned products. Data were collected during April and May 2007. STUDY SELECTION AND DATA EXTRACTION: All identified articles and information were evaluated. Articles and other information that included data regarding concurrent medications, disease states, and other risk factors for developing gadolinium-induced NSF were included in this review, as were clinical practice guidelines. DATA SYNTHESIS: NSF is a mysterious and severe disorder that occurs in individuals with severe renal impairment. Virtually all cases of NSF have been associated with the administration of gadolinium-containing contrast media. However, not all renally impaired patients who receive gadolinium develop NSF. Thus, additional risk factors for the development of NSF have been suggested. These risk factors include medications that could cause transmetallation of gadolinium, medications that could cause acidosis, and high doses of erythropoietin. Concomitant medical conditions, including hyperphosphatemia, acidosis, recent surgery, hepatic disease, hypercoagulability, and proinflammatory processes may also predispose patients to NSF. CONCLUSIONS: Gadolinium-based contrast agents should be avoided in patients with significant renal impairment unless the benefits clearly outweigh the risks. If gadolinium is required, nonionic linear chelates (eg, gadodiamide, gadoversetamide) should not be used. Renally impaired individuals who require gadolinium should be screened proactively for underlying disease states and concomitant drugs that may increase their risk of developing NSF; therapy should be adjusted accordingly.

Drug information education in doctor of pharmacy programs.

OBJECTIVE: To characterize pharmacy program standards and trends in drug information education. METHODS: A questionnaire containing 34 questions addressing general demographic characteristics, organization, and content of drug information education was distributed to 86 colleges and schools of pharmacy in the United States using a Web-based survey system. RESULTS: Sixty colleges responded (73% response rate). All colleges offered a campus-based 6-year first-professional degree PharmD program. Didactic drug information was a required course in over 70% of these schools. Only 51 of the 60 colleges offered an advanced pharmacy practice experience (APPE) in drug information, and 62% of these did so only on an elective basis. CONCLUSION: Although almost all of the PharmD programs in the US include a required course in drug information, the majority do not have a required APPE in this important area.

Perceived utility of pharmacy licensure examination preparation tools.

OBJECTIVES: To identify board examination preparation tools most commonly used by recent pharmacy graduates and determine which tools are perceived as most valuable and representative of the actual content of licensure examinations. METHODS: An electronic survey was sent to all 2004 graduates of colleges of pharmacy in Indiana. Participants identified which specific preparation tools were used and rated tools based on usefulness, representativeness of licensure examination, and monetary value, and provided overall recommendations to future graduates. RESULTS: The most commonly used preparation tools were the Pharmacy Law Review Session offered by Dr. Thomas Wilson at Purdue University, the Complete Review for Pharmacy, Pre-NAPLEX, PharmPrep, and the Kaplan NAPLEX Review. Tools receiving high ratings in all categories included Dr. Wilson's Pharmacy Law Review Session, Pre-NAPLEX, Comprehensive Pharmacy Review, Kaplan NAPLEX Review, and Review of Pharmacy. CONCLUSIONS: Although no preparation tool was associated with a higher examination pass rate, certain tools were clearly rated higher than others by test takers.