Optimizing optimization: A six-year quality improvement project focused on students' APPE preferences.

PROBLEM DESCRIPTION: The advanced pharmacy practice experience (APPE) component of the entry-level doctor of pharmacy degree program is essential in contributing to student pharmacists' education. Establishing an optimization process to assist students in matching to their highest preferred clinical sites is extremely important. QUALITY IMPROVEMENT METHODS: The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences uses a fourth year APPE match process designed to yield the best possible matches for the entire class while being perceived as fair and relatively easy to navigate. This article describes the evolution of this process. RESULTS OF CQI INQUIRY: Across six years of data, satisfaction with the match process has been rated consistently high by students. Fairness with the process is also rated highly. Changes to the process have resulted in students receiving higher ranked preferences in more recent years. This was achieved while still following institution requirements for rural rotations and pre-matching. INTERPRETATION AND DISCUSSION: The APPE year yields a tremendous amount of learning for students as a culminating experience applying skills and knowledge to actual patients. Improving students' ability to customize their own schedule allows them to optimize these learning opportunities. CONCLUSIONS: A robust match process has been established and refined to meet the needs of the student pharmacists as they approach their fourth year of the curriculum. This process has been perceived as fair and relatively easy to navigate. Achievement of higher overall student rankings has been accomplished.

Allowable room temperature excursions for refrigerated medications: A 20-year review.

PURPOSE: The aim of this review was to build upon previous literature describing the maximum duration for which refrigerated medications can tolerate room temperature excursions while maintaining stability and potency. METHODS: During a 12-month period ending in June 2021, the prescribing information and published monographs from multiple pharmacy compendia were reviewed for all medications and biologic products approved by the US Food and Drug Administration (FDA) for human use since January 2000. Products that were subsequently withdrawn from the US market were excluded. When temperature excursion data was unavailable in published form, product manufacturers were surveyed via telephone and/or email. Acceptable storage information for all products for which storage is recommended at temperatures below room temperature (20-25 °C [68-77 °F]) was compiled and arranged in tabular format. RESULTS: Of the 705 products or formulations approved by FDA during the predefined time period, 246 were identified as requiring storage at temperatures below room temperature. After review of available prescribing information and manufacturer communications, if applicable, acceptable periods of excursion to temperatures at room temperature or higher were identified for 214 products (87%). CONCLUSION: Information related to acceptable periods of room temperature excursion was compiled for a total of 214 products approved for US distribution since 2000. The included tables may increase patient safety and decrease medication loss or related expenditures.

Identification of small-molecule inhibitors of Zika virus infection and induced neural cell death via a drug repurposing screen.

In response to the current global health emergency posed by the Zika virus (ZIKV) outbreak and its link to microcephaly and other neurological conditions, we performed a drug repurposing screen of ∼6,000 compounds that included approved drugs, clinical trial drug candidates and pharmacologically active compounds; we identified compounds that either inhibit ZIKV infection or suppress infection-induced caspase-3 activity in different neural cells. A pan-caspase inhibitor, emricasan, inhibited ZIKV-induced increases in caspase-3 activity and protected human cortical neural progenitors in both monolayer and three-dimensional organoid cultures. Ten structurally unrelated inhibitors of cyclin-dependent kinases inhibited ZIKV replication. Niclosamide, a category B anthelmintic drug approved by the US Food and Drug Administration, also inhibited ZIKV replication. Finally, combination treatments using one compound from each category (neuroprotective and antiviral) further increased protection of human neural progenitors and astrocytes from ZIKV-induced cell death. Our results demonstrate the efficacy of this screening strategy and identify lead compounds for anti-ZIKV drug development.

Growing up with epilepsy: a two-year investigation of cognitive development in children with new onset epilepsy.

PURPOSE: To characterize patterns and determinants of normal and abnormal cognitive development in children with new onset epilepsy compared to healthy controls. METHODS: Longitudinal (2-year) cognitive growth was examined in 100 children, age 8-18 years, including healthy controls (n = 48) and children with new onset epilepsy (n = 52). Cognitive maturation was examined as a function of the presence/absence of two neurobehavioral comorbitiies (attention deficit hyperactivity disorder and/or academic problems) identified at the time of epilepsy diagnosis. Groups were compared across a comprehensive neuropsychological battery assessing intelligence, academic achievement, language, memory, executive function, and psychomotor speed. RESULTS: Children with new onset epilepsy without neurobehavioral comorbidities were comparable to healthy controls at baseline, rate of cognitive development, and follow-up assessment across all neuropsychological domains. In contrast, the presence of neurobehavioral comorbidities was associated with significantly worse baseline and prospective cognitive trajectories across all cognitive domains, especially executive functions. CONCLUSION: The presence of neurobehavioral comorbidities at the time of epilepsy onset is a major marker of abnormal cognitive development both prior to and after the onset of epilepsy.

The frequency, complications and aetiology of ADHD in new onset paediatric epilepsy.

Recent studies suggest that Attention Deficit Hyperactivity Disorder (ADHD) is a common comorbid condition in childhood epilepsy, but little is known regarding the nature, frequency and timing of associated neurobehavioural/cognitive complications or the underlying aetiology of ADHD in epilepsy. This investigation examined: (i) the prevalence of ADHD and its subtypes; (ii) the association of ADHD with abnormalities in academic, neuropsychological, behavioural and psychiatric status and (iii) the aetiology of ADHD in paediatric epilepsy. Seventy-five children (age 8-18) with new/recent onset idiopathic epilepsy and 62 healthy controls underwent structured interview (K-SADS) to identify the presence and type of DSM-IV defined ADHD, neuropsychological assessment, quantitative MR volumetrics, characterization of parent observed executive function, review of academic/educational progress and assessment of risk factors during gestation and delivery. The results indicate that ADHD is significantly more prevalent in new onset epilepsy than healthy controls (31% versus 6%), characterized predominantly by the inattentive variant, with onset antedating the diagnosis of epilepsy in the majority of children. ADHD in childhood epilepsy is associated with significantly increased rates of school based remedial services for academic underachievement, neuropsychological consequences with prominent differences in executive function, and parent-reported dysexecutive behaviours. ADHD in paediatric epilepsy is neither associated with demographic or clinical epilepsy characteristics nor potential risk factors during gestation and birth. Quantitative MRI demonstrates that ADHD in epilepsy is associated with significantly increased gray matter in distributed regions of the frontal lobe and significantly smaller brainstem volume. Overall, ADHD is a prevalent comorbidity of new onset idiopathic epilepsy associated with a diversity of salient educational, cognitive, behavioural and social complications that antedate epilepsy onset in a significant proportion of cases, and appear related to neurodevelopmental abnormalities in brain structure.

The differential effect of epilepsy labels on employer perceptions: report of a pilot study.

A multimethod pilot study is described in which employers' and human resource professionals' perceptions of three labels used for epilepsy -- epilepsy, seizure disorder, and seizure condition -- were explored. Ninety-three participants were presented with a list of 10 chronic conditions or disabilities, including one of these epilepsy labels, and asked to rank-order the likelihood that a person with each condition would be hired for an assembly/production position. The participants also ranked cover letters from fictional applicants for a customer service representative position. The fictional applicants disclosed their condition using one of the three epilepsy labels. The participants then ranked which applicant would most likely be hired. Participants were also asked whether applicants should disclose their disability in a cover letter. Rasch and chi(2) analyses were used to analyze the results. Findings suggest that epilepsy was more positively perceived than the other two labels. Almost all of the participants stated that applicants should not disclose their disability in a cover letter. The results have important implications for employment seeking and disclosure practices.

Life skills and subjective well-being of people with disabilities: a canonical correlation analysis.

This study examined the canonical relationships between a set of life skill variables and a set of subjective well-being variables among a national sample of vocational rehabilitation clients in the USA. Self-direction, work tolerance, general employability, and self-care were related to physical, family and social, and financial well-being. This analysis also found that communication skill is related to family and social well-being, while psychological well-being is not related to any life skills in the set. The results showed that vocational rehabilitation services aimed to improve life functioning will lead to an improvement in subjective quality of life.

The impact of epilepsy on quality of life: a qualitative analysis.

The assessment and understanding of epilepsy's impact on an individual's quality of life (QOL) is increasingly being recognized as an important component of clinical care. Because the impact of epilepsy can span a range of clinically important functional and psychosocial domains, QOL as a model for understanding epilepsy's impact should be inclusive of the many life domains that are important to the individual. In this study a community-based sample of 46 adults with epilepsy were surveyed to identify the QOL domains that are important to persons with epilepsy, the factors that contribute to and detract from QOL, and the ways that epilepsy is perceived to impact QOL. A multidomain structure of quality of life emerged from the qualitative data analysis. Epilepsy was seen as having both a direct and an indirect impact on QOL, by directly affecting QOL domains and by affecting those factors that contribute to QOL.

Employment Concerns of People with Epilepsy and the Question of Disclosure: Report of a Survey of the Epilepsy Foundation.

This article presents the results of a survey of the Epilepsy Foundation affiliates in the United States and Puerto Rico, regarding the employment-related questions and concerns of people with epilepsy. The survey also explored how Epilepsy Foundation affiliates advise people with epilepsy about disclosing epilepsy status in the employment-seeking process. Some of the major employment-related questions and concerns reported by the affiliates included identifying resources to help in finding a job, questions about disclosure of epilepsy status in job applications, questions about job-related discrimination or Americans with Disabilities Act (ADA) violations, questions about the ADA, and questions about how to deal with co-workers or supervisors. Implications and design limitations are discussed.