Respiratory Syncytial Virus Vaccination in Older Adults: Considerations for Use and Shared Clinical Decision-Making.

PURPOSE: To evaluate the impact of two newly U.S. Food and Drug Administration-approved respiratory syncytial virus (RSV) vaccines, RSVpreF3 (Arexvy™, GSK) and RSVpreF (Abrysvo™, Pfizer), on morbidity in older adults. RSV is known to cause significant health issues in this demographic. METHOD: The current article reviews Phases 1 and 2 and Phase 3 published clinical trials, the recommendations for immunization practices outlined in the Morbidity and Mortality Weekly Report, and other relevant literature on RSV infection and vaccine coadministration. A case vignette is also included to illustrate an example of the shared clinical decision-making process for vaccination. RESULTS: Findings suggest that RSVpreF3 and RSVpreF vaccines effectively reduce health complications of RSV in older adults. Successful integration of these vaccines with other immunizations is also highlighted, emphasizing the role of an interprofessional team in this process. CONCLUSION: The introduction of RSVpreF3 and RSVpreF vaccines represents a significant advancement in the management of RSV in older adults. This article underscores the importance of shared clinical decision-making in vaccine administration and the effective coordination of an interprofessional team for coadministration with other vaccines. [Journal of Gerontological Nursing, 50(3), 7-12.].

Optimizing Pharmacotherapy for Direct Oral Anticoagulants in Older Adults: Strategies for Managing Drug Interactions.

Direct oral anticoagulants (DOACs) have been increasingly used by older adults. Although these medications offer several therapeutic advantages over traditional anticoagulants, such as warfarin, they have limitations. One significant concern associated with DOACs is their potential for drug-drug interactions. These interactions may compromise the safe and effective use of DOACs and can potentially lead to serious adverse events and complications, particularly major bleeding. Polypharmacy is common among older adults with chronic diseases, which can increase the risk of drug-drug interactions with DOACs. The current article discusses the impact and risks of drug-drug interactions with DOACs in the context of older adults and explores ways to improve and manage these interactions through the collaboration of an interprofessional team. [Journal of Gerontological Nursing, 49(9), 7-13.].

ASCP's 2021 Choosing Wisely® Recommendations: A Proud Accomplishment.

Choosing Wisely® (CW) is a campaign to engage physicians and patients in conversations about unnecessary tests, treatments, and procedures. The campaign began in the United States in 2012 and in Canada in 2014, and now many countries around the world are adapting the campaign and implementing it. Currently, approximately 80 societies in the United States have published CW recommendations. Each recommendation is supported by clinical guidelines (when necessary), evidence-based ratinale, including information about when these tests or procedures may be appropriate. A deprescribing task force led by Chair Beier was created by ASCP in November 2018 after several conversations between ASCP leadership (notably, President J. Hirshfield) and Beier. Task force members comprise pharmacists practicing in academia, community, and long-term care settings. The chair also invited pharmacists from international countries (Canada and Australia) where deprescribing initiatives have a strong focus and scientific literature base. One of the primary goals for Chair Beier was to add ASCP's voice to the ABIM CW Campaign. Because ASCP is a membership association that represents pharmacists, health care professionals, and students serving the unique medication needs of older patients, by adding its name to the list of supporting partners, the organization makes a compelling argument to address deprescribing initiatives, tools, scientific literature, and resources to assist in initiating deprescribing conversations and their subsequent implementation.

A Review of Topical Povidone-iodine to Decrease Viral Load of COViD-19.

Topical povidone-iodine (PVP-I) is currently being considered as a potential preventive measure against the spread of COVID-19. Diluted PVP-I solutions have been historically used in Asia to treat upper respiratory tract infections (URTIs) by decreasing the bacterial and viral load on oropharyngeal mucosa to decrease the transmission of diseases. Efficacy of gargling 0.23% PVP-I mouthwash in Japan demonstrated to be efficacious in lowering the prevalence of URTIs when compared with placebo. The 0.23% concentration was used in vitro on severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, which produced undetectable results after 30 seconds of exposure. Additionally, a recent study in 2020 proved the efficacy of PVP-I 0.45%-10% in reducing COVID-19 (SARS-CoV 2) viral load in vitro. Numerous clinical trials are being conducted to determine if there is a decrease in viral load, and thus transmission, when using oral or nasal topical PVP-I in COVID-19 patients. Because of the current lack of evidence for the use of PVP-I in vivo with COVID-19, it is recommended to await the clinical trial results before initiating this practice.

Students' Perspectives on Nebulized Drugs and Nebulizer Maintenance.

The geriatric population experiences a variety of respiratory concerns including chronic obstructive pulmonary disease, emphysema, asthma, pulmonary hypertension, and lower respiratory infections. Treating these illnesses often requires the use of inhaled therapies that can be delivered through multiple modalities, each of which carries its own pros and cons unique to its use in the geriatric population. Pharmacists have an opportunity to play a role in optimizing the selection of delivery devices and in providing patient and provider education on appropriate use of inhaled therapies. Through patient counseling and correct device selection, patient outcomes can be improved. This paper explores the differences among devices, provides specific information regarding drug mixing for nebulization, provides information regarding cleaning/maintenance of nebulizers, and addresses specific concerns related to geriatric care. It can serve as a reference for pharmacists and student pharmacists as they educate patients and providers.

Development and validation of an instrument to determine patient knowledge: the oral anticoagulation knowledge test.

BACKGROUND: Studies examining the relationship between patient knowledge regarding warfarin therapy and its safe and effective use are limited by the lack of validated knowledge assessment tools. OBJECTIVE: To develop and validate an instrument to assess patient knowledge regarding oral anticoagulation therapy. METHODS: Four nationally recognized anticoagulation experts participated in the instrument development process to ensure content validity. The Oral Anticoagulation Knowledge (OAK) test was administered to subjects on warfarin and a group of age-matched subjects not on warfarin to assess construct validity. A subgroup of warfarin subjects were retested approximately 2-3 months after initial testing to assess test-retest reliability. Internal consistency reliability was assessed by calculating a Kuder-Richardson 20 value. Item analysis was used to assess performance of individual questions. RESULTS: An initial 23 item instrument was pilot tested for readability and comprehension. The OAK test was administered to 74 subjects taking warfarin and 27 age-matched subjects not on warfarin. Thirty-two subjects on warfarin repeated the OAK test an average of 75 days following initial administration. Subjects taking warfarin scored significantly higher than those not on warfarin (72% vs 52%, respectively; p < 0.001), supporting the construct validity of the instrument. Test-retest reliability was acceptable, with a Pearson's correlation coefficient of 0.81. Internal consistency reliability was confirmed by a calculated Kuder-Richardson 20 value of 0.76. CONCLUSIONS: The OAK test is a brief, valid, and reliable knowledge assessment instrument that may be a useful tool for research and clinical practice to augment patient education programs.