Enhancing Clinical Pharmacy Specialist Involvement in Transitions of Care Focusing on Ambulatory Care Sensitive Conditions within a Veterans Affairs Healthcare System.

The purpose of this quality improvement project was to evaluate the impact of clinical pharmacy specialist (CPS) involvement in the post-discharge period on 30-day readmission rates within a Veterans Affairs Healthcare System. Patients eligible for inclusion were discharged from a Veterans Affairs (VA) acute care facility with a principle or secondary diagnosis of heart failure (HF), chronic obstructive pulmonary disease (COPD), or both HF and COPD from 15 October 2018 through 14 January 2019. CPSs functioning as a mid-level provider with a scope of practice conducted telephone and in-clinic medication management appointments within 7 and 21 days post-discharge for qualifying patients discharged with a principle or secondary diagnosis of HF or COPD. CPS appointments focused on medication reconciliation, ensuring continuity of care, disease state counseling, and medication management. By enhancing the role of the CPS in the post-discharge period, there was an observed decrease in 30-day COPD index (p = 0.35), HF index (p = 0.23), and all-cause (p = 0.62) readmission rates from pre- to post-intervention. The results of this intervention show that CPS intervention in the post-discharge period may reduce index and all-cause readmission rates for patients discharged with a principle or secondary discharge diagnosis of COPD or HF.

A high proportion of red snapper sold in North Carolina is mislabeled.

Seafood mislabeling occurs when a market label is inaccurate, primarily in terms of species identity, but also regarding weight, geographic origin, or other characteristics. This widespread problem allows cheaper or illegally-caught species to be marketed as species desirable to consumers. Previous studies have identified red snapper (Lutjanus campechanus) as one of the most frequently mislabeled seafood species in the United States. To quantify how common mislabeling of red snapper is across North Carolina, the Seafood Forensics class at the University of North Carolina at Chapel Hill used DNA barcoding to analyze samples sold as "red snapper" from restaurants, seafood markets, and grocery stores purchased in ten counties. Of 43 samples successfully sequenced and identified, 90.7% were mislabeled. Only one grocery store chain (of four chains tested) accurately labeled red snapper. The mislabeling rate for restaurants and seafood markets was 100%. Vermilion snapper (Rhomboplites aurorubens) and tilapia (Oreochromis aureus and O. niloticus) were the species most frequently substituted for red snapper (13 of 39 mislabeled samples for both taxa, or 26 of 39 mislabeled total). This study builds on previous mislabeling research by collecting samples of a specific species in a confined geographic region, allowing local vendors and policy makers to better understand the scope of red snapper mislabeling in North Carolina. This methodology is also a model for other academic institutions to engage undergraduate researchers in mislabeling data collection, sample processing, and analysis.

Navigating pleiotropy in precision medicine: pharmacogenes from trauma to behavioral health.

A strong emerging principle in the field of precision medicine is that variation in any one pharmacogene may impact clinical outcome for more than one drug. Variants tested in the acute care setting often have downstream implications for other drugs impacting chronic disease management. A flexible framework is needed as clinicians and scientists move toward deploying automated decision support for gene-based drug dosing in electronic medical records.