Using simulation to introduce students and healthcare professionals to losses experienced by older adults: a pre-post analysis.

BACKGROUND: To introduce students and healthcare professionals to losses experienced by older adults and instill compassion among interprofessional learners, an interactive narrative simulation activity was developed and incorporated in clinical staff orientation and student professional course work. Narrative simulation allows learners to incorporate skills of examination, exploration, sharing, and reflection applied to simulated losses and lived experience of the older adult to promote empathy and understanding. METHODS: A pre-post analysis was conducted to evaluate changes in self-reported empathy scores among nurses, pharmacists, student nurses and student pharmacists using the 20-item Jefferson Scale of Empathy©, Health Professional and Health Professional Student versions. The instrument was administered prior to and after narrative simulation participation. RESULTS: A total of 152 students and 107 health care professionals completed both assessments. Median (interquartile range, IQR) post-simulation scores were significantly higher among nursing professionals [118.5 (112.25, 126.75) versus 126 (117, 132); P < 0.001; effect size 0.81] and nursing students [116 (107, 121) versus 119 (109, 126); P < 0.001; effect size 0.28], as well as pharmacy students [111 (101, 117) versus 116 (107.5, 125); P < 0.001; effect size 0.47]. Although a moderate effect size of 0.7 was observed for pharmacy professionals, there was no difference between pre- and post-activity empathy scores [117 (98, 137) versus 116 (101, 137); P = 0.16] for pharmacists participating in the narrative simulation exercise. CONCLUSIONS: A statistically significant change in self-reported levels of empathy, particularly for nurses, nursing students, and pharmacy students, was observed; results of this activity did not suggest a change in pharmacist self-reported empathy levels. This activity could be implemented by educators seeking to increase awareness of losses experienced by the older adult.

Impact of an Educational Intervention on Hospital Pharmacists' Knowledge and Application of Substance Withdrawal Management.

Background: Patients with substance use disorders are often encountered in an acute care setting and withdrawal management is important. Available literature reveals inadequate acute management of substance withdrawal due to lack of experience and knowledge of medications. Methods: A quality improvement project was implemented to improve hospital pharmacists' knowledge, application, and practice of inpatient opioid and alcohol withdrawal management through provision of didactic and case-based education and implementation of practice based prospective drug utilization review (PDUR). Pharmacists' knowledge of the management of alcohol and opioid withdrawal was assessed by a 10-item survey pre-and post-intervention. Results: Twenty-one pharmacists completed the education and pre- and post-surveys. Scores for the 21 pharmacists improved significantly, with pre- and post-intervention scores of 7.33 ± 1.98 and 8.86 ± 0.91, respectively (P = .0035). Most pharmacists completed their required PDUR submission, and several pharmacist interventions were made and accepted post-education. Pharmacists indicated that the education increased their confidence and enabled them to learn new information that could be directly applied to their pharmacy practice. Conclusion: Providing education and requiring a PDUR improved pharmacists' knowledge, application, and practice of inpatient opioid and alcohol withdrawal management. Re-education or expanded education may be warranted to further increase pharmacists' competence.

New Jersey Pharmacists' Perceptions on Performing COVID-19 Testing in Community Pharmacy Practice Sites.

BackgroundPoint of care testing (POCT) for Coronavirus Disease 2019 (COVID-19) is a major source of its control. On May 13, 2020, NJ pharmacists were authorized to order and perform COVID-19 testing, expanding their role in the response to the COVID-19 pandemic. Objective: The purpose of this study was to evaluate NJ pharmacists' perceptions on the safety and potential consequences of performing COVID-19 testing within their community pharmacy practice sites. Methods: An electronic survey was distributed to NJ-registered pharmacists approximately 3 months after the administrative order was issued. Results: The survey was completed by 523 recipients (3.39% response rate) and responses from 311 NJ pharmacists practicing in community pharmacy were analyzed. The majority of respondents (83.8%) were not providing testing, while 16.2% were testing at the time of survey distribution. Most testing pharmacists were staff pharmacists with one to five years of experience, working in a pharmacy chain approximately 30-40 hours per week. Those not testing identified lack of a pharmacy drive-through, insufficient staff, and potential workflow disruption as reasons for not testing. Increased workload and fear of spreading the virus to others were concerns noted by both testers and non-testers. Conclusion: Overall, NJ pharmacists reported mixed perceptions regarding performing COVID-19 testing. Challenges and barriers to pharmacist COVID-19 testing, including inadequate staffing and space, and concerns about reimbursement and disruption to workflow were identified. Findings may serve as a guide to design and implement strategies to overcome barriers.

Management of chimeric antigen receptor T-cell induced cytokine release syndrome: Current and emerging approaches.

The most common adverse event associated with chimeric antigen receptor T-cell therapy is cytokine release syndrome, which is characterized by fever, hypoxia, and hypotension in varying degrees of severity. In severe cases, cytokine release syndrome can result in life-threatening symptoms such as multi-organ failure. The widely accepted first-line therapy for cytokine release syndrome management is tocilizumab with or without corticosteroids, but there is very limited guidance on the proper management of patients unresponsive to this regimen. There are emerging strategies that target cytokine release syndrome through novel mechanisms, showing promise in treating or preventing severe cytokine release syndrome. Although further clinical investigation is necessary to assess the applicability of the emerging approaches, these exploratory therapies may shape the future landscape of chimeric antigen receptor T-cell induced cytokine release syndrome management. This review article provides a comprehensive overview of the current and emerging therapies for the management of chimeric antigen receptor T-cell induced cytokine release syndrome, especially cases that are refractory to tocilizumab and steroids.

Observational Study of Drug Formulation Manipulation in Pediatric Versus Adult Inpatients.

OBJECTIVES: Medications often require manipulations to measure and administer the correct dose for pediatric patients. These manipulations pose medication safety risks. The objective of this study was to determine the frequency of drug formulation manipulations in the pediatric inpatient population and compare the findings to a parallel adult inpatient population. METHODS: Observations were conducted at four sites with 1 day of data collection per week by a randomized schedule for 5 weeks. All pediatric inpatients at each study site were included as well as an equivalent number of medication orders from adult inpatients with similar levels of care. The percentage of medication orders requiring a manipulation were evaluated and compared between pediatric and adult patients. RESULTS: A total of 15,722 medication orders were analyzed. Drug formulation manipulation was required in 3925 (49.9%) of 7861 pediatric orders versus 1301 of 7861 adult orders (16.6%) (P < 0.05). By pediatric service, drug manipulations were required most frequently (71.5% of orders) in the neonatal intensive care unit. The most common dosage forms requiring manipulation for pediatric patients were oral liquids (45.7% of orders) and intravenous medications (44.6% of orders). By pediatric patient age, drug manipulation was required most often in patients aged 1 to 12 months (69.8% of orders). CONCLUSIONS: Drug formulation manipulation was three times more common in pediatric inpatient practice compared with adult inpatient practice in this study. This study demonstrated a statistically significant difference in the prevalence of drug formulation manipulation between pediatric and adult inpatients.

Pediatric COVID-19 and Appendicitis: A Gut Reaction to SARS-CoV-2?

BACKGROUND: We describe the temporal pattern of COVID-19 admissions to a tertiary care children's hospital in central New Jersey during the SARS-CoV-2 surge, covering the time period from March 29 to July 26, 2020. METHODS: Medical charts were reviewed for the date of admission, past medical history, and demographic variables, presenting signs and symptoms, admitting laboratory values, diagnostic imaging, diagnosis, treatment modalities, and outcomes including length of stay and disease severity. RESULTS: Patients with symptomatic SARS-CoV-2 infection tended to present with pneumonia early during the study period, which coincided with the early surge in New Jersey cases. Approximately 2 weeks after the peak in reported SARS-CoV-2 cases in New Jersey, we began to see fewer pneumonia cases and an increase in admissions for Multi-Inflammatory Syndrome in Children and cases of acute appendicitis in association with a diagnosis of SARS-CoV-2 infection. CONCLUSIONS: We present a novel association of acute appendicitis in children infected with SARS-CoV-2 and postulate that it may represent a postinfectious hyperinflammatory complication of SARS-CoV-2 infection occurring 2 weeks after the early manifestation of acute pneumonia disease in children.

Situation, background, assessment, recommendation (SBAR) technique education enhances pharmacy student communication ability and confidence.

BACKGROUND AND PURPOSE: The Situation, Background, Assessment, Recommendation (SBAR) technique is a method that can be incorporated into a professional healthcare curriculum to enhance students' ability to communicate information logically and concisely. This educational research activity was designed to assess the impact of SBAR training on pharmacy students' ability to communicate pharmacotherapy recommendations during a simulated telephone intervention with a prescriber. Secondary objectives were to evaluate the impact of the activity on student self-perception of confidence, potential correlations between prior experience and both performance and confidence, and the activity's overall quality and value. EDUCATIONAL ACTIVITY AND SETTING: Third professional year pharmacy students enrolled in a required communications course completed the simulated telephone intervention both before and after SBAR training. The teaching and learning activity was evaluated by comparing pre- and post-activity intervention scores, and a post-activity survey measuring secondary study objectives. FINDINGS: Of the 198 students enrolled in the course, 197 consented to participate in the study (99% response rate). Median scores on pre- and post-activity interventions were 12/20 and 18/20 points, respectively (p < 0.001). Student-perceived confidence in the ability to deliver a pharmacotherapy-related intervention improved (p < 0.001) and most students (92%) indicated that the activity enhanced their communication skills. There was a significant positive correlation between previous pharmacy-related experience and student confidence, both before and after SBAR training. SUMMARY: SBAR training is a valuable component of pharmacy education. Training will be introduced earlier in the curriculum and incorporated into a variety of activities and courses, including interprofessional educational activities.

Incorporation of a multi-modal interactive exercise on student pharmacists' perceptions of lifestyle modification in weight loss promotion.

BACKGROUND AND PURPOSE: The purpose of this project was to evaluate the impact of a calorie tracking and dietary modification activity on students' perceptions of the challenges associated with weight loss. EDUCATIONAL ACTIVITY AND SETTING: Students maintained a two-day paper calorie log, then received a weight management lecture, followed by four additional days of calorie tracking using a mobile application. Demographics, self-evaluation of obesity-related knowledge, perceptions on weight loss difficulties, utility of mobile technology, and overall program value were evaluated. FINDINGS: A total of 79% of students completed all three surveys (n = 150). Students' perceptions regarding their knowledge and comfort with respect to weight loss counseling and dietary modification strategies increased following the lecture and mobile technology-based calorie counting activity. Seventy-eight percent of students either agreed or strongly agreed that this activity was valuable to their professional development while 86% of students agreed or strongly agreed this activity helped them understand the challenges faced by patients trying to lose weight. DISCUSSION: Student attitudes regarding weight loss, including nutritional tracking, and comfort in establishing a weight loss goal, as well as student's perceived knowledge of the types of dietary fats and empathy, all significantly improved over the course of activity participation. SUMMARY: This activity improved student pharmacists' understanding of lifestyle modifications necessary for weight loss, exposed them to novel technologies available to help support patient's weight loss attempts, and provided them with first-hand experience in tracking calories.

Impact of an interprofessional medication error workshop on healthcare student perceptions.

BACKGROUND: The integration of interprofessional education (IPE) into health professional curricula is critical to ensuring safe and efficient delivery of patient care. The intent of this manuscript is to describe the results of a pilot study designed to evaluate the impact of a large-scale interprofessional medication error prevention workshop on student perceptions of team-based patient care in the prevention of medication errors. INTERPROFESSIONAL EDUCATION ACTIVITY: Pharmacy, medical, and physician assistant students' perceptions of the role of multidisciplinary patient care teams in preventing medication errors were evaluated before and after participating in a three-hour interprofessional medication errors prevention workshop utilizing a modified version of the validated Attitudes Towards Health Care Teams Scale. DISCUSSION: When comparing student attitudes among the three schools, statistically significant differences in student perceptions across the items and subscales (e.g., quality of care/process and physician centrality) captured in the instrument utilized were identified. Additionally, differences in the responses of pharmacy, medical, and physician-assistant students were found, highlighting the areas where healthcare education can be targeted to bridge the gap in opinion. IMPLICATIONS: We demonstrated an overall positive impact of an interprofessional medication errors prevention-themed workshop on the attitudes of the participating healthcare students. Future directions and research initiatives focusing on the role of IPE and the influence of IPE workshops on team-based performance are indicated to validate the influence of this method of education on the attitudes of post-graduate healthcare trainees and healthcare practitioners.

Extracellular dopamine, acetylcholine, and activation of dopamine D1 and D2 receptors after selective breeding for cocaine self-administration in rats.

RATIONALE: The low self-administration (LS)/Kgras (LS) and high self-administration (HS)/Kgras (HS) rat lines were generated by selective breeding for low- and high-intravenous cocaine self-administration, respectively, from a common outbred Wistar stock (Crl:WI). This trait has remained stable after 13 generations of breeding. OBJECTIVE: The objective of the present study is to compare cocaine preference, neurotransmitter release, and dopamine receptor activation in LS and HS rats. METHODS: Levels of dopamine, acetylcholine, and cocaine were measured in the nucleus accumbens (NA) shell of HS and LS rats by tandem mass spectrometry of microdialysates. Cocaine-induced locomotor activity and conditioned-place preference were compared between LS and HS rats. RESULTS: HS rats displayed greater conditioned-place preference scores compared to LS and reduced basal extracellular concentrations of dopamine and acetylcholine. However, patterns of neurotransmitter release did not differ between strains. Low-dose cocaine increased locomotor activity in LS rats, but not in HS animals, while high-dose cocaine augmented activity only in HS rats. Either dose of cocaine increased immunoreactivity for c-Fos in the NA shell of both strains, with greater elevations observed in HS rats. Activation identified by cells expressing both c-Fos and dopamine receptors was generally greater in the HS strain, with a similar pattern for both D1 and D2 dopamine receptors. CONCLUSIONS: Diminished levels of dopamine and acetylcholine in the NA shell, with enhanced cocaine-induced expression of D1 and D2 receptors, are associated with greater rewarding effects of cocaine in HS rats and an altered dose-effect relationship for cocaine-induced locomotor activity.

2018 American Society of Consultant Pharmacists Annual Meeting & Exhibition.

Poster abstracts are evaluated based on the following criteria: significance of the problem to healthy aging or medication management; innovativeness of ideas, methods, and/or approach; methodological rigor of methods and approach; presentation of finding; implications identified for future research, practice, and/or policy; and clarity of writing. Submissions are not evaluated through the peer-reviewed process used by The Consultant Pharmacist. Industry support is indicated, where applicable. Presenting author is in italics. The poster abstract presentation is supported by the ASCP Foundation.

Cocaine cardiovascular effects and pharmacokinetics after treatment with the acetylcholinesterase inhibitor donepezil.

BACKGROUND: In rodents, cholinesterase inhibitors can cause sustained decreases in the reinforcing effects of cocaine. Nonetheless, cocaine is metabolized by butyrylcholinesterase (BuChE), raising concerns that cholinesterase inhibition could increase its peripheral concentrations, perhaps augmenting toxicity. Although donepezil is approved for use in patients and selective for inhibiting acetylcholinesterase over BuChE, no studies have reported cocaine bioavailability in human subjects receiving donepezil. METHODS: Twelve cocaine-dependent veterans received three days of treatment with either oral placebo or 5 mg daily of donepezil, followed by cross-over to the opposite treatment. During both oral treatments, double-blind intravenous cocaine was administered at .0, .18, and .36 mg/kg in a laboratory setting, followed by determinations of heart rate, blood pressure, and plasma concentrations of cocaine and major metabolites. RESULTS: Intravenous cocaine produced dose-related increases in systolic blood pressure that were most pronounced over the initial 30 minutes after treatment. Oral donepezil attenuated drug-induced elevations of systolic blood pressure following low-dose cocaine (.18 mg/kg). No significant difference in blood pressure following treatment with placebo or donepezil after high-dose cocaine (.36 mg/kg). Peak values of blood pressure and heart rate were unaffected by donepezil. Plasma concentrations of cocaine and metabolites did not differ in donepezil- and placebo-treated participants. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: We conclude that donepezil can attenuate drug-induced increases in systolic blood pressure following low-dose cocaine, but does not otherwise modify the cardiovascular effects of intravenous cocaine. Clinically significant changes in cocaine bioavailability and cardiovascular effects do not occur following this dose of donepezil. (Am J Addict 2016;25:392-399).

Achievement of Therapeutic Vancomycin Trough Serum Concentrations with Empiric Dosing in Neonatal Intensive Care Unit Patients.

BACKGROUND: The recommended goal serum trough concentration for vancomycin has increased to 10 to 20 mcg/mL, with a higher range of 15 to 20 mcg/mL for serious infections due to methicillin-resistant Staphylococcus aureus in children and adults. Although neonatal references have also recommended these higher target concentrations, dosing recommendations remained unchanged. The objective of this study was to assess the percentage of neonates and young infants achieving a serum trough concentration between 10 and 20 mcg/mL with empiric vancomycin dosing based on Neofax® in a neonatal intensive care unit (NICU) population. METHODS: A multi-institutional retrospective chart review was conducted to identify NICU patients who received a minimum of three doses of intravenous vancomycin and had at least one appropriately drawn trough. Additional outcomes included the duration of vancomycin therapy, number of dose adjustments required to attain goal trough concentrations, time to goal trough, and incidence of nephrotoxicity and ototoxicity. RESULTS: Of the 171 vancomycin serum trough concentrations included in the primary outcome, only 25.1% achieved a goal trough of 10 to 20 mcg/mL with empiric dosing. Only 44.6% of patients achieved the goal trough of 10 to 20 mcg/mL at any time during their vancomycin therapy. The average gestational age was 28.2 ± 4.1 weeks, average postnatal age at start of vancomycin was 34.1 ± 34.6 days, and average weight of the patients at start of vancomycin was 1602 ± 1014.5 g. The average and median total daily dose in those patients who achieved an initial vancomycin trough of 10-20 mcg/mL were 32.4 mg/kg/day and 30 mg/kg/day, respectively. CONCLUSION: Dosing of vancomycin based on Neofax® in NICU patients is insufficient in yielding serum trough concentrations of 10 to 20 mcg/mL. Further studies are needed to evaluate the optimal dosing regimen to achieve higher trough concentrations in this patient population.

An Academic Multihealth System PGY2 Pediatric Pharmacy Residency Program.

We describe a novel multihealth system pediatric pharmacy residency program through the Ernest Mario School of Pharmacy at Rutgers University. Pediatric clinical pharmacy is a growing field that has seen an increase in demand for practitioners. Practice sites include freestanding children's hospitals, children's hospitals within adult hospitals, and pediatric units within adult hospitals. To accommodate a residency program in a region with no freestanding children's hospital, the pediatric faculty members at the Ernest Mario School of Pharmacy at Rutgers University developed a multihealth system postgraduate year 2 (PGY2) pediatric pharmacy residency program with 6 pediatric faculty members functioning as preceptors at their 5 respective practice sites. The multihealth system setup of the program provides the resident exposure to a multitude of patient populations, pediatric specialties, and pediatric pharmacy practices. In addition, the affiliation with Rutgers University allows an emphasis on academia with opportunities for the resident to lecture in small and large classrooms, facilitate discussion periods, assist with clinical laboratory classes, and precept pharmacy students. The resident has the unique opportunity to develop a research project with a large and diverse patient population owing to the multihealth system rotation sites. A multihealth system PGY2 residency in pediatric pharmacy provides the resident a well-rounded experience in pediatric clinical practice, research, and academia that will enhance the resident's ability to build his or her own pediatric pharmacy practice.

Epigallocatechin-3-gallate is absorbed but extensively glucuronidated following oral administration to mice.

Epigallocatechin-3-gallate (EGCG), the most abundant catechin in green tea (Camellia sinensis), has shown cancer preventive activity in animal models. The bioavailability of EGCG in the most commonly used animal species, mice, is poorly understood. Moreover, the pharmacokinetic parameters of EGCG have not been reported previously in mice. Here we report that after administration of EGCG intravenously at 21.8 micro mol/kg or intragastrically at 163.8 micro mol/kg, the peak plasma levels of EGCG in male CF-1 mice were 2.7 +/- 0.7 and 0.28 +/- 0.08 micro mol/L, respectively. EGCG was present mainly (50-90%) as the glucuronide. The plasma bioavailability of EGCG after intragastric administration was higher than previously reported in rats (26.5 +/- 7.5% vs. 1.6 +/- 0.6%). The conjugated EGCG displayed a shorter t(1/2) (82.8-211.5 vs 804.9-1102.3 min) than unconjugated EGCG (P < 0.01, Student's t test). EGCG was present in the unconjugated form in the lung, prostate and other tissues at levels of 0.31-3.56 nmol/g after intravenous administration. Although intragastric administration resulted in lower levels in most tissues compared with intravenous administration (e.g., 0.006 +/- 0.004 vs. 2.66 +/- 1.0 nmol/g in the lung), the levels in the small intestine and colon were high at 45.2 +/- 13.5 and 7.86 +/- 2.4 nmol/g, respectively. This is the first report of the pharmacokinetic parameters of EGCG in mice. Such information provides a basis for understanding the bioavailability of EGCG in mice and should aid in understanding the cancer preventive activity of EGCG.