Young Adults' Electronic Cigarette Use and Perceptions of Risk.

In the United States, 18.6% of college students between 19-and 22-years old report e-cigarette use in the last 30 days. Information regarding e-cigarette use and perceptions in this age group may assist in understanding how to decrease initiation of e-cigarettes in a population that may otherwise not use nicotine. The purpose of this survey was to determine current e-cigarette use and how e-cigarette use history relates to a college student's perceptions of health risks associated with e-cigarettes. A 33-item questionnaire was sent to students at a Midwestern university in Fall 2018. Overall, 3754 students completed the questionnaire. More than half of the respondents (55.2%) had used e-cigarettes and 23.2% identified as current users of e-cigarettes. Current e-cigarette users were more likely to agree that e-cigarettes are a safe and effective option to quit smoking, while never users were more likely to disagree (safe P < .001, effective P < .001). Current users were less likely to agree that e-cigarettes may harm a person's overall health than never users (P < .001). Young adults continue to be frequent users of e-cigarettes. There are significant differences in perceptions of e-cigarettes associated with use history. Additional research is needed to see how perceptions and use of e-cigarettes have changed considering lung injury reports and increased regulations in the U.S.

Evaluation of a Residency Peer-to-Peer Intervention in Opioid Prescribing.

BACKGROUND AND OBJECTIVES: Family physicians play a crucial role in addressing the opioid epidemic. We studied a novel peer-review opioid prescribing educational intervention for family medicine residents that incorporates guided instruction from an interdisciplinary care team. METHODS: We used a mixed-methods study design in the setting of a family medicine residency program in the Midwestern United States. Residents participated in small group, peer-to-peer discussions of patients chronically prescribed opioids with guidance and input from faculty, a pharmacist, and pharmacy students. Discussions followed a structured approach to evaluation based on guidelines, and written recommendations were given to the patients' resident primary care physician (PCP). For each patient, we reviewed electronic medical records to assess whether PCPs implemented the written recommendations. We used one-way analyses of variance to determine the statistical significance of changes made. The principal investigator interviewed seven participating residents to survey their satisfaction with the curriculum and collated suggestions for improvement. RESULTS: Over a 3-year period, we reviewed 59 patients as part of the intervention; of these, 53 had complete records reviewed for this study. Patients' morphine milligram equivalent dosage (MME) declined modestly (P=.035). The number and proportion of recommendations implemented was correlated with the decline in MME (P=.004 and P=.013, respectively). Interviewed residents unanimously evaluated the curriculum positively, citing that the structured approach helped align their practices with guidelines. CONCLUSIONS: The guided peer-review intervention effectively decreased chronic opioid use among patients, and residents positively evaluated the curriculum.

A "secret shopper" survey of community pharmacist prenatal vitamin recommendations.

BACKGROUND: As pharmacists assume a larger role in prenatal and preconception care, providing an evidence-based recommendation for a prenatal vitamin is essential. OBJECTIVES: To identify the prenatal vitamins that community pharmacists are recommending to patients and compare the contents with national and international standards. The secondary objectives were to compare responses between the type of pharmacy (chain, grocery, or independent) and region of Michigan. METHODS: A female student pharmacist posing as a patient anonymously interviewed 60 community pharmacists distributed across 5 different regions of Michigan through telephone to determine prenatal vitamin recommendations for preconception use. The regions of Michigan were included to determine if sociodemographic factors were associated with varying responses or recommendations. RESULTS: Of the pharmacists interviewed, 97% recommended a prenatal vitamin, with 81% recommending an over-the-counter (OTC) prenatal vitamin. Only 33% of the pharmacists provided a specific brand name. Folic acid was the most common ingredient that the pharmacists identified to look for in a prenatal vitamin, followed by docosahexaenoic acid and iron. No difference was detected in the pharmacist responses across type of pharmacy (chain, grocery store chain, or independent). A difference was found between regions of Michigan and recommendations for a specific prenatal vitamin brand (P = 0.017). CONCLUSION: Most of the community pharmacists recommended an OTC prenatal vitamin with an adequate amount of folic acid. Considering the broad range of prenatal vitamins on the market, a clear recommendation from a pharmacist about a specific prenatal vitamin that contains adequate nutrients is paramount. Expanding the knowledge and understanding of key prenatal vitamin ingredients and availability may strengthen future recommendations.

Pharmacy Students' Perceptions of Electronic Nicotine Delivery Systems as Compared to Those of Other Health Care Students.

Objective. To determine how pharmacy students' perceptions of electronic nicotine delivery systems (ENDS) differ from those of other health care students. Methods. A 33-item questionnaire was sent to health professional students at a Midwestern university to assess their tobacco use, insights regarding ENDS, cessation education, and perceptions. Health professions included were pharmacy, nursing, public health, optometry, dental hygiene, and others. Results. The overall response rate to the questionnaire was 41% (1152/2799). The study population reported high ENDS use. Almost half (47%) of the respondents had ever used ENDS and 14% were current users (6% pharmacy students vs 19% other health care students). A lower percentage of pharmacy students than other health care students agreed that using ENDS is healthier than using tobacco (18% vs 26%). Overall, pharmacy students more strongly agreed that they had received enough education to counsel patients regarding tobacco cessation (rated 4.7 by pharmacy students vs 3.6 by other health care students on a seven-point Likert scale) and ENDS cessation (rated 3.3 by pharmacy students vs 2.9 by other health care students). Finally, pharmacy students were less likely than other health care students to recommend the use of ENDS to aid patients in quitting traditional cigarette use (2.9 vs 3.2, respectively). Conclusion. The rapid rise in use of ENDS and the continued use of cigarettes in the United States makes it imperative for health care professionals to be knowledgeable about these products and prepared to counsel patients regarding them. We found that pharmacy students tended to have more negative perceptions about ENDS and a lower percentage of pharmacy students than other health care students agreed that ENDS should be used as a cessation tool for quitting traditional cigarettes.

Addressing meaningful use and maintaining an accurate medication list in primary care.

OBJECTIVES: The primary objective of this project was to determine the difference in medication list accuracy between an initial and follow-up medication reconciliation visit in a primary care office. Secondary objectives were to identify the difference in medication-related problems most commonly encountered during the visits, factors that may influence patient understanding of their medication regimen, and physician perceptions of the medication review visit. SETTING: Quasi-experimental study part of a larger pilot project to address the ability of how health information technology can be used to maintain an active medication list. PRACTICE DESCRIPTION: Three family medicine residency clinics in the Midwest. Adult patients with diabetes or chronic obstructive pulmonary disease who had 6 or more long-term medications listed in the electronic health record (EHR) were recruited to participate. PRACTICE INNOVATION: An initial comprehensive medication reconciliation visit was conducted by a resident physician and a pharmacist with the goal of ensuring an accurate, easy-to-follow, electronically developed medication list. A follow-up visit with the pharmacist occurred 3-6 months after the initial visit. EVALUATION: Medication list accuracy and medication-related problems were assessed at the initial and follow-up visits. Patient-related factors that could affect medication understanding were collected at the initial visit with status of enrollment in the EHR patient portal. RESULTS: Fifty-seven of 65 patients completed the study. The number of patients with an accurate medication list increased from 40% to 49% (P = 0.38). The number of medication-related problems decreased from 146 to 91 (P < 0.001). The use of special tools (e.g., pillboxes) was associated with fewer medication regimen errors (P = 0.036). Patients enrolled in the EHR patient portal were more likely to know the purpose of their medications as compared with those not enrolled (P = 0.019). CONCLUSION: An intentionally scheduled medication review with a primary care provider and pharmacist did not significantly improve the accuracy of the medication list, but it was associated with fewer drug-related problems.

Glucagon-like peptide-1 receptor agonists for weight loss in adult patients without diabetes.

PURPOSE: The efficacy and safety of glucagon-like peptide (GLP)-1 receptor agonists for weight loss in adult patients without diabetes is reviewed. SUMMARY: GLP-1 receptor agonists have been associated with significant weight loss in patients with diabetes, raising the question of whether these agents could be used for weight loss in patients without diabetes. The mechanism by which GLP-1 receptor agonists induce weight loss is believed to be related to multiple actions involving the brain and gastrointestinal tract, with the primary action related to an increase in satiety. Trials examining the effects of GLP-1 receptor agonists for weight loss have compared exenatide, liraglutide, and orlistat. Of the studies completed to date, the majority of patients have been enrolled in trials involving liraglutide. Based on the reviewed literature, both exenatide 10 µg twice daily and liraglutide in dosages of up to 3 mg daily resulted in significant weight loss in patients without diabetes. A decrease in the proportion of patients with prediabetes was also found in studies of liraglutide. Nausea and vomiting were the most frequently reported adverse events in patients from these studies. Symptomatic hypoglycemia was reported in only one study with liraglutide in patients without diabetes and was not objectively confirmed by laboratory data. A higher frequency of psychiatric disorders, specifically insomnia, was reported by patients taking high doses of liraglutide. CONCLUSION: GLP-1 receptor agonists offer a reasonable alternative for nondiabetic patients not able to achieve weight-loss goals with lifestyle modifications alone.

Nicotine conjugate vaccine as a novel approach to smoking cessation.

Despite significant reductions over the past 45 years in the percentage of individuals smoking cigarettes, tobacco-related illnesses remain the leading cause of preventable death in the United States. Although the health risks of tobacco use have been clearly outlined, addiction to nicotine traditionally has been one of the more challenging habits to break. Seven first-line therapies to treat tobacco use and dependence are available; however, annual quit rates remain surprisingly low, suggesting that continued research and development in the area of smoking cessation are warranted. In an attempt to improve long-term quit rates and blunt the reinforcing effects of nicotine in the brain, the nicotine conjugate vaccine was developed as a novel approach for the treatment of nicotine dependence. Vaccine administration produces nicotine-specific antibodies that bind to nicotine from exogenous sources, creating a large unit that is not able to cross the blood-brain barrier, which limits the rate and extent of nicotine absorption into the brain. Results of clinical trials indicate that individuals achieving high nicotine-specific antibody levels with the nicotine conjugate vaccine have greater success with smoking cessation at 12 months compared with those with lower levels. Adverse effects associated with the nicotine conjugate vaccine have been primarily mild and localized in nature, with minimal systemic effects. The most commonly reported adverse effects include tenderness and ache at the injection site, general discomfort, headache, and muscle ache. Awaiting results of phase III trials, the true clinical utility of the nicotine conjugate vaccine is yet to be realized, although this investigational vaccine represents a distinctive administration model that may improve patient adherence and increase the ability to achieve abstinence from cigarette smoking.

Breaking the barrier: the Health Belief Model and patient perceptions regarding contraception.

BACKGROUND: The study was conducted to determine the discrepancy between unintended pregnancies and use of contraception is attributed to imperfect use, misconceptions and an inability to adjust therapy to lifestyle. STUDY DESIGN: A survey administered at a Federal clinic incorporated the Health Belief Model to determine patient's emphasis in pregnancy prevention. Analysis focused on comparing participant demographics to reasons for contraceptive selection. RESULTS: Ease of use ranked the most important for contraception as patient's education levels increased (p=.001). As household income increased, emphasis on potential side effects became less (p=.02). Patients with private insurance ranked ease of use most frequently (p=.01). Males emphasized effectiveness and menstrual suppression more than females (p=.04 and .008). CONCLUSION: A positive correlation between perceived benefit regarding ease of use as educational level increased and perceived barriers due to side effects as income level decreased immerged. Special counseling by practitioners to improve patient's self-efficacy, ultimately enhancing contraceptive adherence, are warranted.