Assessment of an education tool to improve knowledge and reduce stigma of a syringe service program (SSP) at a VA Medical Center.

BACKGROUND: Drug overdose deaths are a growing epidemic in the United States owing in part to inadequate support from health care systems. In response, the Veterans Health Administration (VHA) plans to implement syringe service programs (SSPs) across VHA medical centers. This SSP education project aims to positively affect health care staff perceptions regarding SSPs and reduce the stigma surrounding substance use. OBJECTIVES: The purpose of this research was to allow Advanced Pharmacy Practice Experience (APPE) students to implement and assess an educational program regarding SSP enactment at this institution. Furthermore, the objectives of the educational program were to address the stigma associated with substance use and provide knowledge to staff about SSPs. PRACTICE DESCRIPTION: Eleven complete and one abbreviated (no questionnaire) presentations were delivered by APPE students throughout the main facility and outpatient clinics, with presentations being delivered to physicians, nurses, and a range of other professions. PRACTICE INNOVATION: APPE students developed educational content and pre- and postsurveys that were used to assess for changes in knowledge and perception surrounding substance use and SSPs. EVALUATION METHODS: The primary outcome was to assess individual pre- and postprogram survey responses using mean, SD, and mean change to measure the impact that the presentation had on individualized stigma. RESULTS: A total of 104 completed surveys were analyzed in Microsoft Excel and subcategorized by profession; 10 of the 15 questions asked in the questionnaire yielded statistical significance when comparing pre- and postpresentation results (P < 0.05). CONCLUSIONS: A presentation method developed and delivered by APPE students resulted in a statistically significant change in perception and knowledge, proving to be an effective method for educating health care staff on SSPs.

Assessment of a naloxone distribution plan in a veteran population who experienced an opioid-related overdose event.

BACKGROUND: The Veteran Health Administration prioritizes the distribution of naloxone to veterans diagnosed with opioid use disorder (OUD) to prevent deaths due to opioid-related overdose. The Overdose Education and Naloxone Distribution (OEND) program was created with tools to supplement efforts in identifying veterans at risk of opioid-related adverse events secondary to OUD or other comorbidities and increase access, education, and distribution of naloxone. Utilizing the OEND tool, Veteran Health Indiana (VHI) employed two different distribution initiatives to increase access to naloxone. OBJECTIVE: The purpose of this study is to assess naloxone distribution efforts at a VA medical center and evaluate outcomes in patients who experienced opioid overdose events before and after the OEND initiatives were implemented. The primary outcome is to assess the distribution of naloxone within the year prior to the documented overdose event before and after the OEND initiatives. Secondary outcomes include assessment of the number of naloxone doses administered during the overdose event, substances involved in the overdose, and distribution of outpatient naloxone prescriptions after the overdose event. METHODS: This study was a retrospective electronic chart review of all patients who experienced an opioid-related overdose event at VHI from March 1, 2019, to March 1, 2022. RESULTS: Of the 59 opioid-overdose events analyzed, the percentage of patients with a naloxone prescription within 12 months prior to an opioid-overdose event was similar between the pre- and post-OEND initiatives. Within 12 months following the overdose event, naloxone was dispensed to nearly 10% more patients in the post-OEND group compared to the pre-OEND group. CONCLUSIONS: The OEND initiatives increased naloxone distribution amongst patients who ultimately experienced an opioid-related overdose. Additional research is needed to assess if these efforts prevented further overdoses.

Exceptionally preserved North American Paleogene metatherians: adaptations and discovery of a major gap in the opossum fossil record.

A major gap in our knowledge of the evolution of marsupial mammals concerns the Paleogene of the northern continents, a critical time and place to link the early history of metatherians in Asia and North America with the more recent diversification in South America and Australia. We studied new exceptionally well-preserved partial skeletons of the Early Oligocene fossil Herpetotherium from the White River Formation in Wyoming, which allowed us to test the relationships of this taxon and examine its adaptations. Herpetotheriidae, with a fossil record extending from the Cretaceous to the Miocene, has traditionally been allied with opossums (Didelphidae) based on fragmentary material, mainly dentitions. Analysis of the new material reveals that several aspects of the cranial and postcranial anatomy, some of which suggests a terrestrial lifestyle, distinguish Herpetotherium from opossums. We found that Herpetotherium is the sister group to the crown group Marsupialia and is not a stem didelphid. Combination of the new palaeontological data with molecular divergence estimates, suggests the presence of a long undocumented gap in the fossil record of opossums extending some 45Myr from the Early Miocene to the Cretaceous.