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.

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.

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.