Initiation of Buprenorphine/Naloxone on Rates of Discharge Against Medical Advice.

Objective: Evidence shows that patients with opioid use disorder (OUD) have an increased rate of discharge against medical advice (DAMA) as well as higher rates of hospital readmission. Therefore, the objective of this study was to determine if inpatient initiation of buprenorphine/naloxone in patients with OUD is associated with decreased rates of DAMA. Methods: This was a single center retrospective cohort study conducted at a level 1, academic medical center. The study included patients with OUD admitted to the Internal Medicine service from January through May of both 2018 and 2019 for an admitting diagnosis other than opioid withdrawal. The primary endpoint was rate of DAMA among OUD patients not initiated on opioid agonist therapy compared to those initiated on buprenorphine/naloxone. The secondary endpoint was the association between factors of the initiation process on rates of DAMA. Patients were excluded if they were discharged in less than 24 hours or received intermittent administration of buprenorphine/naloxone. Results: The rate of DAMA in OUD patients not initiated on buprenorphine/naloxone was 13.85% compared to 2.56% in those initiated on buprenorphine/naloxone (P = .048). Conclusion: In OUD patients initiated on buprenorphine/naloxone, the rate of DAMA was significantly lower than those who were not. This data supports the importance of optimizing the opportunity to initiate buprenorphine/naloxone in the acute care setting to minimize withdrawal symptoms therefore reducing the rate of DAMA. Ultimately increasing the ability to adequately treat the primary reason for admission and potentially decreasing readmission rates. Further studies are needed to evaluate this impact as this study is limited to a small sample size therefore lacking adequate power.

Evaluation of cure rate in patients with hepatitis C virus completing shortened courses of treatment.

BACKGROUND: Guidelines recommend treatment with direct-acting antivirals for a minimum duration of 8 weeks in all patients with hepatitis C virus. Minimizing treatment duration is desirable because of decreased cost and increased adherence. Studies with treatment durations of less than 8 weeks have conflicting data. OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of hepatitis C treatment in patients who did not complete the guideline-recommended duration of therapy. METHODS: This was a retrospective, observational case series of patients with hepatitis C virus treated with 7 weeks or less of direct-acting antivirals between November 1, 2017 and July 31, 2019 at a large, academic medical center. The primary end point was cure, defined as sustained virologic response at 12 weeks after the end of treatment. Secondary end points included average duration of therapy, direct-acting antiviral used, and reason for early discontinuation. RESULTS: Of the 472 patients treated, 13 met criteria for inclusion. Sustained virologic response was achieved in 61.5% of the patients. Two patients (15.3%) were not cured, and 3 patients (23.1%) were lost to follow-up. Median duration of therapy was 4 weeks. All patients who received at least 4 weeks of therapy and remained in care were cured. CONCLUSION: In situations in which patients inadvertently stop hepatitis C treatment early, there is still the possibility of cure. Further studies are needed to determine which patient population may benefit from a shorter duration of therapy.

Faculty Doing More with Less: A Technology Initiative Realized Through a Structured Process.

Introduction: Many barriers exist when implementing new educational technologies. Some institutions without specialty support staff or offices may struggle with the necessary steps. In a climate that increasingly asks faculty to do more with less, empowering faculty-driven processes may prove important. Innovation: When the need for an academic electronic health record (EHR) was identified, a faculty champion followed a structured approach to research available options, garner faculty interest, bring forth a proposal to the administration, implement the academic EHR technology, and perform continuous quality improvement thereby paving the pathway for future faculty-led initiatives. Findings: A single faculty member followed a structured approach that could be carried out by others to bring meaningful academic technology to multiple programs. This process was subsequently successfully used by another faculty member and the technology implemented was well-received by administration, faculty, and students. Conclusion: Despite few resources to support or compel technological adaptation or change, faculty can follow steps to introduce these projects and moreover, spark a cultural shift and momentum to embolden faculty to follow a process to bring forth change or initiatives in the future.

The Evolution of the Physical Work Capacity at the Fatigue Threshold Test: Past, Present, and Future.

ABSTRACT: Feldpausch, JE, Blok, AL, Frederick, EL, Coburn, JW, and Malek, MH. The evolution of the physical work capacity at the fatigue threshold test: past, present, and future. J Strength Cond Res 35(12): 3529-3536, 2021-The assessment of neuromuscular fatigue using surface electromyography has evolved over the past 40 years while maintaining some of the original key features. In this mini-review article, the goal will be to briefly present a history and systems of the physical working capacity at the fatigue threshold (PWCFT). In addition, we will discuss studies that have investigated the effect of different interventions such as supplementation, exercise, and cognitive fatigue to examine what stimuli influence the PWCFT. The latter section of this mini-review will discuss future studies that may provide additional information related to the underlying physiological mechanism(s) that influences the PWCFT. We will conclude with the practical application of PWCFT in health and sports settings.

An Exploratory Assessment of Epistemic Curiosity in Students at Three Doctor of Pharmacy Programs.

Objective. To determine the level of epistemic curiosity in a sample of student pharmacists from three Doctor of Pharmacy (PharmD) programs as well as any differences in epistemic curiosity levels that exist between programs and with regard to professional year. Methods. Litman's Epistemic Curiosity Scale (ECS) was administered to student pharmacists at three different PharmD programs. Descriptive statistics were calculated, and overall mean ECS scores as well as mean scores on epistemic curiosity motivated by intellectual interest (I-type) and informational deprivation (D-type) were compared among student pharmacists at the three institutions using analysis of variance. Reliability analyses were also performed on the data. Results. A total of 569 out of 1143 eligible students responded to the survey, for an overall response rate of 49.8%. The mean overall ECS score was 27.6 (SD=4.9). Mean I-type epistemic curiosity was 14.9 (SD=2.8) overall, but was statistically different among the schools. Mean D-type epistemic curiosity was 12.7 (SD=3.2) overall, but was statistically similar among the programs. Overall, the data demonstrated good internal consistency, with a Cronbach's alpha of .81. Conclusion. This study was the first to characterize epistemic curiosity in student pharmacists and included data from multiple years and multiple programs. Future analyses should investigate associations between epistemic curiosity and other factors of interest to help elucidate how better understanding epistemic curiosity or enhancing it in student pharmacists may help facilitate student success.

The Write Stuff: The Development of a Medical Writing Pharmacy Residency Elective.

THE PROBLEM: Effective medical writing requires a mastery of many skills including those of data interpretation, literature evaluation, written communication, and leadership. A number of these skills are considered educational goals and objectives for residents by the American Society of Health-System Pharmacists, yet preceptors and residents oftentimes face challenges in gaining competency, confidence, and success in medical writing. INNOVATION: A structured yet individualized plan for medical writing, including idea creation, peer reviewing, manuscript preparation, and team management for post-graduate year two pharmacy residents was implemented as an elective learning experience. RESULTS: Feedback from residents participating in the elective was positive. Each of the two residents who participated produced a manuscript that was subsequently published. CONCLUSION: Though data is limited by number of residents that have completed this learning experience, this longitudinally designed elective has potential benefits and barriers to execution that should be considered, but may be an excellent opportunity to develop critical skills in scholarly endeavors for residents and preceptors alike.

Lofexidine versus clonidine for mitigation of opioid withdrawal symptoms: A systematic review.

OBJECTIVES: The U.S. Food and Drug Administration recently approved lofexidine, an α-2-adrenergic agonist, as the first non-opioid medication for mitigation of opioid withdrawal symptoms. Clonidine, an α-2-adrenergic agonist, historically was used off-label for this indication. This review aimed to evaluate the effectiveness of lofexidine versus clonidine for mitigation of opioid withdrawal symptoms and to discuss the current role of lofexidine in the management of patients at risk of experiencing opioid withdrawal. DATA SOURCES: MEDLINE/PubMed, EBSCO, and CENTRAL were searched using the terms "lofexidine," "clonidine," and "opioid withdrawal." STUDY SELECTION: The literature search included English-language studies involving administration and prescription of lofexidine and clonidine for the management of opioid withdrawal symptoms in adults. Data sources were searched to include articles published between October 1993 and May 2019. DATA EXTRACTION: Three independent reviewers analyzed the title and abstract of studies to identify studies involving comparisons of lofexidine with clonidine for mitigation of opioid withdrawal symptoms. Reviewers were initially blinded to the individual determinations. Results were then unblinded and discussed among reviewers. RESULTS: Of the 110 citations screened, 5 articles were included. One study demonstrated a statistically significant reduction in opioid withdrawal symptom severity with lofexidine compared with clonidine, whereas the other 4 studies showed no significant difference. Three studies reported the completion of opioid detoxification treatment, with no significant differences seen. In 1 study that compared lofexidine with placebo, lofexidine caused significant hypotension, bradycardia, and pupillary constriction. Three studies showed significant adverse effects of hypotension and symptoms of feeling unwell with clonidine compared with lofexidine. CONCLUSION: Lofexidine appears equivalent in efficacy to clonidine, with fewer adverse effects, and it may have a limited role in the management of opioid withdrawal symptoms. However, cost, detoxification venue, and value of other preferred treatment modalities may affect the comparative efficacy of lofexidine to other agents.

Impact of a Journal Club Elective Course on Student Learning Measures.

Objective. To assess the impact of a journal club elective course on measures of student's longitudinal performance throughout an accelerated three-year Doctor of Pharmacy (PharmD) curriculum. Methods. Students were separated into two groups (those who did and did not complete a journal club elective). The following primary and secondary student outcomes were assessed using hierarchical linear regression analysis: score on the Pharmacy Curriculum Outcomes Assessment (PCOA), overall course grade in the Pharmacotherapeutics IV course, overall course grade in the Research Design and Literature Evaluation II course, and average grade on acute/ambulatory care advanced pharmacy practice experiences (APPEs). Results. One hundred ninety-seven students were included in the study (73 students who completed the journal club elective and 124 students who did not). After controlling for baseline confounders, enrollment in the journal club elective was associated with students scoring 24.5 points higher on their overall scaled score on the PCOA. Enrollment in the journal club elective also appeared to add 2% to a student's overall grade in each of the courses and APPEs. All results were statistically significant. Conclusion. An elective journal club course can significantly improve multiple objective measures of pharmacy student learning. Components of this course, such as reading primary literature, presenting a journal club, learning from peers, and scaffolding of pharmacotherapeutic concepts are important elements to consider when designing a journal club curriculum.

Models for pharmacist-delivered tobacco cessation services: a systematic review.

OBJECTIVES: To summarize delivery models of pharmacist-led tobacco cessation services. DATA SOURCES: Studies published from July 1, 2003, to April 1, 2019, describing pharmacist-led tobacco cessation services in the United States were identified via PubMed/MEDLINE and EBSCO searches. STUDY SELECTION: Studies were considered for inclusion if they met the following criteria: population, patients 18 years of age and older using tobacco products; intervention, pharmacist-led tobacco cessation services; comparator, not required; and outcome, tobacco cessation. We used a web-based tool, Rayyan QCRI, to assist with study selection. DATA EXTRACTION: We used a data extraction tool to collect article reference, study design, primary and secondary objectives, brief description of intervention, pharmacologic interventions, service model, business model, method to measure tobacco cessation, tobacco cessation rates, and other comments. RESULTS: A total of 16 articles were incorporated into this review. Most studies included were observational (87.5%). The pharmacy settings included ambulatory care (68.8%), community (25%), and managed care (6.3%). Service models described most frequently followed an appointment-based, individual, face-to-face session between the patient and pharmacist. Business models included grant funding (12.5%), fee-for-service (6.3%), value-based (6.3%), and free services (6.3%), but most studies (56.3%) did not address reimbursement. Cessation rates ranged from 3.98% to 77.14% and were predominantly measured through self-report (62.5%). The timing of follow-up varied from 1 to 6 months after program completion, but in some articles was not reported (37.5%). CONCLUSION: Pharmacists currently manage tobacco cessation services via an assortment of methods and can successfully assist patients in achieving abstinence. Gaps in the literature necessitate further guidance on consistent outcomes reporting, impact of service model on tobacco cessation, and economic data of business models. The profession will benefit from such information to further expand the pharmacists' role within tobacco cessation services.