Healthy From the Start-Lifestyle Interventions in Early Childhood.

Lifestyle interventions are effective from the earliest years of childhood. To best promote health, lifestyle factors should be implemented for children and their families from birth. This includes introducing families to the benefits of a whole-food plant-based (WFPB) or plant-predominant diet, daily physical activity, positive family and peer social connections, avoidance of risky substances for caregivers, optimal sleep habits, and stress management and mindfulness for all family members. Through attention to these six pillars of lifestyle medicine, children and their families can succeed in initiating and maintaining optimal lifelong physical and mental health.

Generational awareness education as a strategy to prepare IPPE and APPE students for the modern workplace.

INTRODUCTION: There is limited literature on generational awareness improving the student-preceptor relationship and student experiences. The primary objectives of this study were to determine the level of generational awareness of pharmacy students and to examine whether didactic instruction on generational diversity leads to student-perceived improvements in learning and student-preceptor relationships. METHODS: This was a longitudinal, quasi-experimental design study, including pharmacy students at two different institutions from May 2019 to May 2020. A generational lecture was delivered to students in pharmacy years 1, 2 and 3 (P1, P2, and P3). Pre-, post-, and follow-up surveys were created and collected from each student cohort. RESULTS: A total of 388 respondents were included in the pre- and post-survey analysis. Overall scores for each question were significantly improved in the post- compared to the pre-period (P < .001). A total of 124 responses were received for the follow-up survey. Seventy-one percent of respondents agreed or strongly agreed that understanding generational differences improved their learning, communication, and professional relationships during their experiential rotations. Majority of respondents (82.3%) agreed or strongly agreed that further education on generational differences should be provided. CONCLUSIONS: This study indicates that providing education on generational differences to students is beneficial and positively impacts student experiential rotations.

The Daniel K. Inouye College of Pharmacy Scripts: The Development of Antimicrobial Stewardship Programs in Hawai'i.

In recent years the misuse of antimicrobials has contributed to the growing problem of antimicrobial resistance. Antimicrobial Stewardship Programs (ASP) decrease the misuse of antimicrobials by supporting a rational, systematic approach. ASP strategies vary from broad-ranging policies and other decision support tools to prospective audit review of patients on antimicrobials. Many healthcare facilities, however, have been slow to adopt stewardship attributable to the fact that early ASP models required individuals with specialized training, and a significant amount of time and infrastructural investment from facilities. In response to the increasing need for ASPs in Hawai'i, the Hawai'i Department of Health (HDOH) partnered with the Daniel K. Inouye College of Pharmacy (DKICP) to develop the Hawai'i Antimicrobial Stewardship Collaborative (HASC), a voluntary collaboration whose main objective is to assist hospital institutions in the implementation of a simplified model of the Centers for Disease Control and Prevention's Core Elements of Hospital Antimicrobial Stewardship Programs. The work of HASC places Hawai'i's health care institutions in an advantageous position to be able to comply with impending accreditation standards relating to antibiotics and infections.

Obesity increases risk of anticoagulation reversal failure with prothrombin complex concentrate in those with intracranial hemorrhage.

BACKGROUND: Not all patients with warfarin-related acute intracranial hemorrhage (ICH) achieve full reversal of international normalized ratio (INR) after the first dose of weight-based prothrombin complex concentrate (PCC). We sought to identify factors associated with anticoagulation reversal failure after the first dose of PCC. METHODS: Consecutive patients who were hospitalized with warfarin-related acute ICH at a tertiary center between 1 January 2010 and 31 December 2012 were studied. Anticoagulation reversal failure was defined as INR ≥ 1.5 after the first dose of PCC. Logistic regression was performed to determine the predictors of anticoagulation reversal failure. RESULTS: Fifty-one patients with acute ICH received PCC for warfarin reversal using a weight-based protocol. Overall, 23 (45%) patients did not achieve full reversal of INR after the first dose. Those with anticoagulation reversal failure were obese (body mass index > 30 kg/m(2)) (41% vs. 14%, p = 0.03), had a higher initial INR (3.0 ± 1.4 vs. 2.0 ± 0.7, p = 0.001), and had a higher prevalence of initial INR >2.0 (22% vs. 67%, p = 0.001), compared with those who were successfully reversed. Multivariable logistic regression identified obesity (odds ratio 7.88, 95% CI 1.12 to 55.68) and initial INR >2.0 (odds ratio 12.49, 95% CI 2.27 to 68.87) as independent predictors of anticoagulation reversal failure. CONCLUSIONS: Obesity and elevated initial INR are independently associated with anticoagulation reversal failure using the weight-based PCC protocol in patients with warfarin-related acute ICH. Further studies are needed to determine more effective dosing protocols and individualized strategies for anticoagulation reversal after acute ICH, especially among obese patients.

Big data in pharmacy practice: current use, challenges, and the future.

Pharmacy informatics is defined as the use and integration of data, information, knowledge, technology, and automation in the medication-use process for the purpose of improving health outcomes. The term "big data" has been coined and is often defined in three V's: volume, velocity, and variety. This paper describes three major areas in which pharmacy utilizes big data, including: 1) informed decision making (clinical pathways and clinical practice guidelines); 2) improved care delivery in health care settings such as hospitals and community pharmacy practice settings; and 3) quality performance measurement for the Centers for Medicare and Medicaid and medication management activities such as tracking medication adherence and medication reconciliation.

Virtually epimerization-free synthesis of peptide-alpha-thioesters.

Under slightly basic or neutral reaction conditions peptide-alpha-thioesters are photochemically synthesized from peptide-alpha-nitroindoline precursors, either in solution, or by direct photorelease from a solid support.