Over-the-Counter Analgesic-Related Exposure and Toxicity in Pediatrics.

BACKGROUND: Analgesics are one of the most commonly purchased and used OTC medication classes from pharmacies in the United States. Drug toxicity is a leading cause of injury death in the United States. Limited studies, if any, have examined the impact of specific OTC medication toxicities in the pediatric population. OBJECTIVE: To examine the toxicity arising from the use of over-the-counter (OTC) analgesic medications in pediatric patients in Ohio. METHODS: Data from National Poison Data System for Ohio was obtained for the past 5 years. This data was processed to focus on target populations; pediatrics defined as ages 0-17 years experiencing toxicities related to OTC analgesic medications. The data was categorized into three groups: 0-6 years old, 7-12 years old, and 13-17 years old and reported toxicity was studied based on medications used/given, reasoning for toxicity, and medical outcomes. RESULTS: Patients aged 0-6 years mainly experienced toxicities from acetaminophen (35%) and ibuprofen (52.7%), due to unintentional exposure (general misuse and therapeutic error; 74.2% and 25.4%, respectively), causing primarily minimal clinical effect (48.4%). Ages 7-12 experienced toxicities from acetaminophen (38.5%) and ibuprofen (44.9%) due to unintentional exposure therapeutic error (44.8%) and intentional suspected suicides (30.1%), causing mainly minimal clinical effects (35.5%) and no effect (23.4%). Pediatric ages 13-17 experienced toxicities due to ibuprofen (36.3%) and acetaminophen (38.9%), with primary reasoning of intentional suspected suicide (81.3%), causing medical outcomes of minor effect and no effect (38.2% and 31.2%, respectively). A chi-square test was performed to analyze correlation between case intention (unintentional or intentional) and age group. Proportion of intentional exposures differ by age [X2 (2, N = 18,766) = 14672, p < .0001]. CONCLUSION: Observations from this study underscore the importance of raising awareness about OTC analgesic toxicities which remain prominent in Ohio.

Review of Current Clinical Options for the Management of Behavioral and Psychological Symptoms of Dementia.

Dementia is a disease most prevalent in the older adult population. The cognitive symptoms of dementia include impairments in problem-solving, memory, and language. Some patients experience noncognitive symptoms in addition to the cognitive symptoms of dementia. These noncognitive symptoms are called behavioral and psychological symptoms of dementia or BPSD. The primary objective of our study was to examine the therapeutic options, guidelines, and clinical considerations for the management of BPSD. The existing literature about BPSD was reviewed with searches in PubMed, MEDLINE, and online search platforms. Dysregulation of neurotransmission involving acetylcholine, dopamine, and serotonin has been shown to cause behavioral and psychological symptoms of Alzheimer's disease. BPSD can include hallucinations, agitation, delusions, anxiety, apathy, abnormal body movements, irritability, depression, disinhibition, and sleep or appetite changes. Pharmacologic therapies used in the treatment of BPSD include antidepressants, antipsychotics, anxiolytics, and anticonvulsants. Treatment can be tailored to the specific noncognitive symptoms that are experienced. The use of these agents may be limited based on recommendations from the Beers Criteria®, STOPP criteria, treatment guidelines, and FDA warnings.

The Divergence between Self- and Preceptor-Assessments of Student Performance during Advanced Pharmacy Practice Experiences.

(1) Objectives: A divergence in self- and preceptor-evaluations of clinical skills has been noted during Advanced Pharmacy Practice Experiences (APPEs). The goal of this study was to determine the domains of overestimation of clinical skills by students during their APPE rotations. (2) Methods: Preceptor-assigned grades for APPE rotations from 2017-2022 were analyzed to identify instances of letter grade B or lower. The self- and preceptor-evaluations of APPE rotation were compared to determine the domains of divergence in evaluation between students and preceptors. (3) Results: Between 2017 and 2022, 305 student APPE rotations were graded as B or lower (~14%) by the preceptors. A statistically significant difference was noted between self- and preceptor-assigned letter grades across all practice settings including ambulatory patient care, community pharmacy, general medicine patient care, hospital/health system pharmacy, and special population patient care APPE rotations. In addition, examining the self- and preceptor evaluation rubric for these rotations revealed a statistically significant overestimation of clinical skills by students in all 9 domains of APPE evaluation. Finally, the divergence in the rating of clinical skills between student- and preceptor evaluation was found to be highest in the domains of planning and follow-up of patient care, disease knowledge, and communication with patients. (4) Conclusions: Students who fail to exhibit exemplary practice readiness during APPEs tend to overestimate their clinical skills in all domains of APPE evaluation. The results from our study support the need for additional avenues to assist in the identification of deficits in student learning before APPEs to increase their self-awareness (metacognition).

Predictors of student preparedness for advanced pharmacy practice experiences.

BACKGROUND: A capstone course often serves as the final checkpoint of student readiness before the commencement of experiential training. The purpose of this study was to determine if the assessment components from the capstone course can serve as predictors of student performance during their Advanced Pharmacy Practice Experiences (APPEs). METHODS: Student data was analyzed to observe the correlation between performance in the Pharmacy Curriculum Outcomes Assessment (PCOA), student performance in the capstone course, and the overall grade point average (GPA) earned during APPEs. Spearman rank correlation analysis, multiple linear regression, and Mann-Whitney U test were used for statistical analysis. RESULTS: A statistically significant positive correlation was observed between the overall APPE GPA and students' capstone course grade, top drug competency exam score, pharmacy calculation competency exam score, and PCOA exam score. A significant regression equation was obtained during the analysis: (F(5, 97) = 5.62, p < 0.001), with an R2 = 0.225 (adjusted R2 = 0.185). In the linear regression model, capstone GPA emerged as a significant predictor (ß = 0.155; p = 0.019) of APPE GPA amongst the tested variables. Additionally, students scoring < 73% on the top drug competency exam in the capstone course or less than the reference group in the PCOA exam were found to have significantly lower GPA during their APPEs compared to other students. CONCLUSION: Performance on the top drug competency exam and the PCOA exam can serve as potential predictors of success during APPEs.

Drug Information Quizzes as Predictors of Student Success in Integrated Pharmacotherapy Courses.

OBJECTIVE: To determine if drug quizzes (DQs) can serve as predictors of student success in pharmacy coursework. METHODS: De-identified student exam and DQ data from 2 courses of the pharmacy curriculum were evaluated over 3 years. One-way analysis of variance, Spearman's rank correlation analysis, and Mann-Whitney U test were utilized to determine significant changes in student performance on exams and DQs over 3 years. RESULTS: Over 3 years, significant changes in exam performance were accompanied by significant changes in student performance on the respective DQ. A significant positive correlation was observed between student performance on DQ and their scores on respective major examinations in 22 of 24 datasets. Finally, students failing an exam had significantly lower DQ scores compared to students passing an exam in most analyzed datasets across 3 years. CONCLUSION: Drug quizzes can serve as a predictor of student success or failure in pharmacy courses.

Pharmacy Students' Perceptions of Remote versus Face-to-Face Learning Experience.

During the COVID-19 pandemic, there was a large shift from face-to-face (FTF) to remote learning. Evaluating students' perceptions of remote learning provides educators with opportunity to inform their instructional methods. This study sought to evaluate pharmacy students' self-perceived (1) confidence, (2) preparedness, (3) satisfaction, and (4) motivation following remote vs. FTF classes. An electronic survey was distributed to six pharmacy student cohorts enrolled in the University of Findlay College of Pharmacy during April 2021 to measure the objectives. The Kruskal-Wallis, Mann-Whitney U, and Spearman's rank correlation tests were used to analyze the data (alpha = 0.05). A total of 151 students completed the survey. While the responses differed among the cohorts, first-professional year students reported lower motivation to study (p = 0.008), engage (p = 0.008), satisfaction with content presentation (p = 0.05), preparedness for exams (p < 0.001), and confidence to communicate (p = 0.008) and succeed in a career (p < 0.001) when studying remotely vs. taking FTF classes compared to fourth-professional year students. Positive correlations were observed between students who felt motivated to engage and study (ρ = 0.501, p < 0.001), motivated to study and exam preparedness (ρ = 0.511, p < 0.001), satisfied with course material presentation and professor accessibility (ρ = 0.688, p < 0.001), and exam preparedness (ρ = 0.521, p < 0.001), and felt prepared for exams and able to succeed in a pharmacy career (ρ = 0.573, p < 0.001). Taking the above results into consideration, pharmacy educators may designate more time and instructional support to first-professional year students in an effort to improve students' perceptions of motivation, satisfaction, confidence, and preparedness.

Trends of Opioid Usage in Surgical Patients in a Small Community Hospital: Analysis of Patient Data Between 2017 and 2021.

Purpose: The purpose of our study was to quantify and analyze the annual opioid usage in surgical patients at Wood County Hospital (WCH) between 2017 and 2021. Methods: In this retrospective study, patient data between 2017 and 2021 was analyzed to determine the oral morphine milligram equivalent (MME) of opioids used in surgical patients at WCH. Annual MME prescribed per admission was compared each year using one-way ANOVA followed by Tukey post hoc test. Similarly, the annual use of intravenous (IV) acetaminophen for surgical patients per admission was also calculated and analyzed using the one-way ANOVA followed by Tukey post hoc test. Results: Compared to the year 2017 (42.0 ± 3.6), a statistically significant decrease in opioid usage per surgical admission (mean±SEM of MME) was observed during the years 2018 (32.6 ± 1.4; P = .04), 2019 (30.4 ± 1.2; P = .01), and 2021 (30.8 ± 1.9; P = .01). An analysis of individual opioid use revealed a trend toward lower fentanyl and hydromorphone usage each year since 2017. A significant decrease in the annual morphine usage (mean±SEM of MME) for surgical patients was observed during both 2020 (14.4 ± 0.9; P = .05) and 2021 (14.0 ± 0.7; P = .05) compared to the year 2017 (22.1 ± 2.4). Finally, compared to the year 2017, a statistically significant decrease (P < .05) in the annual use of oxycodone (MME) and IV acetaminophen (mg) for pain management in surgical patients was observed from 2018 to 2021. Conclusion: Our analysis reveals a significant decrease in opioid usage per surgical admission at WCH over 2017 to 2021 indicating a positive impact of the various opioid stewardship measures implemented at the hospital.