Reduction of SARS-CoV-2 salivary viral load with pre-procedural mouth rinses: a randomised, controlled, clinical trial.

Introduction The purpose of this study was to test the short-term efficacy of four commercial mouthwashes versus water in reducing SARS-CoV-2 viral load in the oral cavity over clinically relevant time points.Methods In total, 32 subjects that were proven SARS-CoV-2-positive via polymerase chain reaction (PCR)-based diagnostic test were recruited and randomised into five parallel arms. Cycle threshold (Ct) values were compared in saliva samples between the groups, as well as within the groups at baseline (pre-rinse), zero hours, one hour and two hours post-rinse, using SARS-CoV-2 reverse transcription-PCR analysis.Results We observed a significant increase in Ct values in saliva samples collected immediately after rinsing with all the four mouthwashes - 0.12% chlorhexidine gluconate, 1.5% hydrogen peroxide, 1% povidone iodine, or Listerine - compared to water. A sustained increase in Ct values for up to two hours was only observed in the Listerine and chlorohexidine gluconate groups. We were not able to sufficiently power this clinical trial, so the results remain notional but encouraging and supportive of findings in other emerging mouthwash studies on COVID-19, warranting additional investigations.Conclusions Our evidence suggests that in a clinical setting, prophylactic rinses with Listerine or chlorhexidine gluconate can potentially reduce SARS-CoV-2 viral load in the oral cavity for up to two hours. While limited in statistical power due to the difficulty in obtaining this data, we advocate for pre-procedural mouthwashing, like handwashing, as an economical and safe additional precaution to help mitigate the transmission of SARS-CoV-2 from a potentially infected patient to providers.

Utilizing an optional cumulative examination in a skills-based lab course series to assess student performance and knowledge retention.

INTRODUCTION: In the doctor of pharmacy curriculum, students are subjected to scenarios where success is contingent upon accurate retention of information learned during class. To provide incentive to students and simultaneously gauge student retention of course material, an optional honors examination was created for a skills laboratory course. The objectives of this research were to determine student pharmacist performance on the examination and to assess student pharmacist interest and motivation for taking (or not taking) the optional examination. METHODS: An optional comprehensive honors examination was implemented simultaneously within a laboratory course series. Student performance was analyzed across cohorts and students were given a web-based survey prior to the examination to gauge initial interest and engagement. A second survey was conducted after the examination to identify motivation for taking the optional examination. Surveys were analyzed using quantitative and qualitative methods. RESULTS: There were 238 responses to the initial survey (47%) and 183 (96%) responses to the post-examination survey. Common topics of motivation for taking the examination included enhancing transcripts, gauging their own retention, and assessing readiness for experiential activities. One hundred sixty-one students participated in the optional examination, and 65 achieved a score of 90% and the honors designation. The majority (96%) of students who chose to take the examination thought the activity was valuable to their education. CONCLUSIONS: An optional comprehensive honors examination is one method of evaluating student retention of course material and provides an opportunity for students to set themselves apart from colleagues with an honors designation.

Using the patient activation measure during a pharmacist-led rural patient home visit pilot project.

BACKGROUND: Many pharmacists use motivational interviewing as a tool to inspire patients to engage in managing their health. Assessing patient engagement and willingness to actively participate in chronic disease management is a necessary component in improving activation and health outcomes. The patient activation measure (PAM) is a validated assessment tool used to give providers insight into a patient's level of confidence, knowledge, and skills in self-managing their health. In 2017, 2 pharmacists conducted patient home visits using care coordinators to identify patients who would benefit from pharmacist intervention. The PAM-13 was integrated into the pharmacist-led home visits to collect information on patient activation and engagement in addressing their own health problems. OBJECTIVES: To describe the implementation of the PAM-13 in pharmacist-led patient home visits and to analyze the collected patient PAM-13 scores and levels to determine whether change occurred after meeting with a pharmacist. METHODS: The PAM was used as part of a pilot program involving pharmacist-led patient home visits to assess drug-related problems within a cohort of high-risk rural patients with uncontrolled chronic conditions. RESULTS: During this 6-month study, PAM-13 scores decreased in 3 patients, increased in 9 patients, and did not change in 2 patients whereas PAM-13 levels decreased in 2 patients, increased in 7 patients, and did not change for 5 patients. CONCLUSION: PAM-13 was used as part of a pilot program involving pharmacist-led patient home visits with a cohort of high-risk rural patients with uncontrolled hypertension and diabetes. PAM-13 is a useful tool that could help pharmacists provide targeted motivational interviewing and medication management by assessing and improving patient activation and engagement.

A case of pharmacist-led care team interventions to maximize rural patient quality of life.

A 64-year-old rural home bound patient in Washington State was identified to be at increased risk for negative health care outcomes related to chronic end kidney disease and poorly controlled diabetes. The patient lacked understanding of the use of monitoring equipment as well as diabetes education to improve quality of health; he also did not have access to medical supply equipment. A pharmacist-led care team comprised of a pharmacist, a community health worker, and a home health nurse implemented comprehensive medication review techniques as well as direct patient care education to engage the patient in managing his health. Involvement with this home visit care team combined with the patient's recently developed interest in managing his health re-engaged the patient. He began attending more frequent visits with his providers and increased his interest in meeting with a diabetes educator at the local clinic. Resulting interactions with the patient's providers, pharmacy, and community resources increased patient's compliance, access to specialists of care, and in-home safety measures. Factors contributing to poorer overall health and higher rates of death among rural patients include increased travel time to health care facilities and providers, higher rates of unhealthy lifestyle choices such as cigarette smoking and obesity, higher rates of poverty and less access to healthcare in general. This scenario emphasizes the important role an interprofessional team plays in the care of isolated, rural health patients in managing chronic disease states for stability as well as quality of life.

Does a Difference Exists in Comprehensive Basic Science Examination Scores of 4-Year versus 6-Year Oral-Maxillofacial Surgery Residents?

PURPOSE: The Comprehensive Basic Science Examination (CBSE) scores have significant effects on the applications of oral-maxillofacial surgery (OMS) residency candidates. However, a comparison of the scores of residents that match to 4-year versus 6-year programs is lacking. The present study compared the CBSE scores of OMS residency candidates who had matched to 4-year and 6-year tracks in the 2018-2019 application cycle. MATERIALS AND METHODS: In the present cross-sectional analysis, an anonymous questionnaire was sent electronically to program directors of all OMS residency programs in the United States using the online survey engine Survey Monkey. Data were collected on the CBSE scores of their postgraduate year 1 categorical residents and whether the resident was on a 4-year or 6-year track. The CBSE scores were summarized overall and by the type of residency program (4 vs 6 year) using the mean, standard deviation, median, mode, minimum, and maximum. In addition, the 2-sample t test was used to compare the mean CBSE score between the 4-year programs (4YPs) and 6-year programs (6YPs). RESULTS: A total of 37 scores were received from the 4YPs and 31 from the 6YPs. The overall mean CBSE score was 68.9. Using the 2-sample t test, the mean CBSE score differed significantly between the 4YPs and 6YPs (t = -6.59; df = 66; P < .0001). CONCLUSIONS: Candidates matching into 6-year positions showed significantly higher mean scores on the CBSE examination compared with those matching into 4-year positions.

Patient Fall Risk Caused by Unintended Diphenhydramine Use.

A 62-year-old patient living in a rural community was referred to participate in a pharmacist-led home visit program because of concerns with the patient's increasing falls and medication complexity. The patient reported experiencing an increasing number of falls over the past few months, resulting in a recent hospitalization and mild head trauma. The patient's past medical history included diabetes mellitus type 2, hypertension, hyperlipidemia, gastroesophageal reflux disease, paroxysmal atrial fibrillation, unspecified back pain, and benign prostatic hyperplasia. During the comprehensive medication review, pharmacists determined the patient had inadvertently purchased an acetaminophen/ diphenhydramine combination medication, rather than his usual acetaminophen. According to the 2019 Beers criteria, use of acetaminophen/diphenhydramine for back pain without insomnia is not the best option and may contribute to falls. With an estimated four to eight tablets per day, the patient was taking 200-400 mg of diphenhydramine daily. Pharmacist recommendations included contacting the prescribing physician to obtain a prescription for acetaminophen. By asking the local pharmacy to dispense acetaminophen as a prescription, the risk of the patient inadvertently purchasing an inappropriate product is reduced. After removing the diphenhydramine from the patient's regimen, the falls ceased. This case demonstrates the effects of inappropriate diphenhydramine use in an especially vulnerable population. It also highlights the critical role that rural community pharmacists can play in improving their patients' health care.

Medication Management; Hypertensive Crisis During a Home Visit.

This report describes a case of hypertensive crisis identified by two pharmacists conducting a patient home visit. A 72-year-old woman living in a rural town in Eastern Washington state was referred for a pharmacist home visit by her care coordinator, who had concerns of possible medication-related issues. The patient had a history of type 2 diabetes mellitus, hypertension, ischemic stroke, heart failure with preserved ejection fraction, hypothyroidism, and unspecified back pain. This patient also experienced additional challenges resulting from living in a rural and medically underserved community. During the home visit, the patient's chief complaint was recurrent, painful migraine headaches that she self-treated with nonsteroidal anti-inflammatory medication. Upon examination, the pharmacists found the patient's blood pressure to be 223/132 mm Hg and her self-monitoring log consistently showed blood pressure readings greater than 180/110 mm Hg with a pulse between 75 bpm to 80 bpm. The patient was referred to the emergency department after determining her blood pressure met criteria for hypertensive crisis despite her adherence to her current antihypertensive regimen. She was hospitalized for three days. After her hospitalization, she was referred to her primary care providers and her pharmacist for follow up. The pharmacist reconciled her current medication regimen and made guideline-directed adjustments to her antihypertensive medications. Six months after her hospitalization her blood pressure was within goal and associated headaches had resolved.

Supervising pharmacists' opinions about pharmacy technicians as immunizers.

OBJECTIVES: To determine the opinions of pharmacists who supervise immunizing pharmacy technicians regarding initial trust of immunizing technicians, perceived quality of the training program, need for additional on-the-job training, frequency of technician utilization, and recommendations for other pharmacists who are considering implementation of an immunizing technician. SETTING: Albertsons pharmacies located in the state of Idaho in May 2017. PRACTICE DESCRIPTION AND INNOVATION: Qualitative descriptive study of semistructured key informant interviews with Idaho pharmacists who currently supervise a pharmacy technician trained to administer immunizations. EVALUATION: Informant interviews were recorded, transcribed, and coded to evaluate key themes. RESULTS: Nineteen individual pharmacist interviews were conducted at different Albertsons pharmacy locations in the state of Idaho. Pharmacists in this study felt that their immunizing technicians were properly trained to administer immunizations, capable of giving immunizations, and empowered by their new role within the pharmacy. Participants expressed challenges with initial comfort in allowing a technician to immunize, support of this new advanced technician role, and additional on-the-job training for individual technicians. Findings also included a pharmacist-perceived increase in vaccination rates and recommendation for other technicians to be trained to administer immunizations. CONCLUSION: Community pharmacists who supervise pharmacy technicians trained to administer immunizations were receptive to this new advanced technician role. Pharmacists' opinions revealed that working with newly trained immunizing pharmacy technicians has not only positively affected the morale of their team, but can help to increase the number of vaccinations given by the pharmacy. Understanding pharmacist perceptions about technicians as immunizers may lead to regulation changes and adoption of this advanced technician role.

Rural patient perceptions of pharmacist-provided chronic condition management in a state with provider status.

OBJECTIVE: To understand rural patient opinions regarding their willingness to participate in pharmacist-provided chronic condition management. DESIGN: Qualitative semi-structured key informant interview using The Concept of Access as a theoretical framework. SETTING: Three community pharmacies serving patients in rural Washington State from November 2016 to November 2017. PARTICIPANTS: Current patients from 3 rural independent community pharmacies. MAIN OUTCOME MEASURES: Qualitative analysis of patient attitudes, acceptance, perceptions, and preferences regarding pharmacist-provided chronic condition management services in a community pharmacy. RESULTS: Eighteen key informant interviews were conducted between November 2016 and November 2017. Five themes were identified: trust between the pharmacist, patient, and physician is key; patients already value pharmacists' knowledge about chronic condition medications; participants identified the pharmacist as the first point of contact with regard to understanding appropriate use of medications to treat medical conditions; implementing clinical services in the community pharmacy setting may reduce the need for doctors' visits and improve timely patient care; and creating designated clinical space, appointment options, and efficient service may increase patient accommodation. CONCLUSION: Management of chronic conditions continues to be one of the largest health care expenditures in the United States. One promising method of addressing this public health concern is through sustainable clinical pharmacy services. The themes identified in this study provide insight into factors that community pharmacists might consider as medical provider status continues to gain momentum and the use of clinical pharmacy services becomes more prominent.

Training pharmacy technicians to administer immunizations.

OBJECTIVES: To evaluate the effectiveness of an immunization training program for pharmacy technicians on technicians' self-reported confidence, knowledge, and number of vaccines administered. METHODS: A one-group pre- and posttest study was conducted with certified pharmacy technicians from Albertsons and Safeway community pharmacies in Idaho. Thirty pharmacy technicians were recruited to participate in an immunization administration training program comprising a 2-hour home study and a 2-hour live training. Pharmacy technician scores on a 10-question knowledge assessment, responses on a pre- and posttraining survey, and number of immunizations administered in the 6-month period following the training were collected. RESULTS: Twenty-five pharmacy technicians completed the home study and live portions of the immunization training program. All 29 pharmacy technicians who took the home study assessment passed with greater than 70% competency on the first attempt. Technicians self-reported increased confidence with immunization skills between the pretraining survey and the posttraining survey. From December 2016 to May 2017, the technicians administered 953 immunizations with 0 adverse events reported. CONCLUSION: For the first time, pharmacy technicians have legally administered immunizations in the United States. Trained pharmacy technicians demonstrated knowledge of vaccination procedures and self-reported improved confidence in immunization skills and administered immunizations after participating in a 4-hour training program.