Using the HyFlex model to deliver a capstone seminar course.

INTRODUCTION: The HyFlex course structure allows students to attend class in-person or via synchronous videoconferencing technology. This model has been described, but no data are available in pharmacy curricula. METHODS: Students enrolled in Grand Rounds (GR) were eligible. The GR Engagement Assessment Tool (GREAT) measured engagement three times during the semester. Eighteen statements across four domains were rated using a five-point Likert scale (1 = not true at all and 5 = completely true). Free-text responses were collected for qualitative analysis. The primary outcome was the difference in GR engagement between students attending in-person vs. remotely. Descriptive statistics were used for demographic information. Wilcoxon rank-sum tests compared Likert-scale responses between in-person and remote attendance. RESULTS: Surveys included 128 responses from 88 unique students. There were no differences between remote and in-person attendance for the boredom and elaboration domains. In-person students reported listening more intently (median 4, IQR [3,4]; P = .03). In-person students felt the material was more practical (median 4, IQR [4,5]) than remote students (median 4, IQR [3,4]; P = .002) and more applicable to other situations (median 3, IQR [3,5]) than remote students (median 3, IQR [2,4]; P = .04). Qualitative analysis of the entire cohort demonstrated five themes for satisfaction: safety, flexibility, convenience, technology, and professionalism. CONCLUSIONS: There were subtle differences in student engagement or satisfaction using the HyFlex model. This study supports the expansion of this methodology to similar courses where remote instruction is needed.

"Death Over Dessert" - A conversation with pharmacy students about what really matters in the end.

BACKGROUND AND PURPOSE: Pharmacists will encounter the death of patients and loved ones throughout their career. Though this is a part of our profession as health care providers, many pharmacy students express discomfort and even fear of discussing death and dying with their patients. "Death Over Dessert" has been developed as a loosely structured discussion held during a required geriatrics advanced pharmacy practice experience (APPE). EDUCATIONAL ACTIVITY AND SETTING: "Death Over Dessert: uses principles of "Death Over Dinner," a free online program, "Where I Stand" scales from The Conversation Project, and a series of written reflection questions for after the activity. The discussion is led by two faculty members and ranges from two to six APPE students per offering. A mixed-methods approach was used to assess participant responses to reflection questions. FINDINGS: Of the 19 participants, all (n = 19, 100%) found the activity to be beneficial despite many mentioning the topic can be uncomfortable. There were five overall themes identified that broached personal and professional views: significance of end-of-life discussion with family, important aspects of personal wishes at end-of-life, the definition of living, approaches to end-of-life discussion, and the role of end-of-life in the pharmacy curriculum. SUMMARY: "Death Over Dessert" is a new teaching modality for faculty and preceptors to consider using in their classrooms or rotation activities.

ABH Gel: Comforting Cure or Pricey Placebo?

Despite a lack of evidence of benefit, the compounded product ABH gel (lorazepam, diphenhydramine, and haloperidol) continues to be prescribed for individuals in hospice and palliative care settings for the treatment of nausea and vomiting and terminal delirium. More effective and reliable pharmacological and nonpharmacological strategies exist for the treatment of these conditions in the palliative care and hospice settings. We discuss the pharmacokinetic and clinical evidence for the individual components of ABH gel, as well as the compounded product, and attempt to understand the mechanism of effect that some purport to see, as well as why the compound continues to enjoy such a cult following. Truly, the continued use of ABH gel makes for a pricey placebo and delays the treatment of end-of-life symptoms with modalities that work.

A review of citalopram dose restrictions in the treatment of neuropsychiatric disorders in older adults.

INTRODUCTION: Neuropsychiatric disorders affect millions of older adults. Despite this, there are relatively few older adults included in clinical trials evaluating treatments for psychiatric disorders. Citalopram has been evaluated in older adults with neuropsychiatric disorders and has largely been found beneficial, making the 2011 US Food and Drug Administration (FDA) safety advisory on citalopram extremely impactful. METHODS: A literature search was completed using the PubMed database. Results were limited to clinical trials conducted in older adults that were published in English. RESULTS: Review of the literature confirms the efficacy of citalopram in depression, anxiety, depression associated with Parkinson disease, and behavioral and psychological symptoms of dementia. Additionally, no adverse cardiac outcomes have been described related to citalopram. DISCUSSION: The FDA's evidence for applying this safety advisory to citalopram is minimal and largely based on surrogate markers, such as the QTc interval rather than clinical and safety outcomes. Citalopram is known to increase the QTc, but this increase has not been linked to adverse cardiac outcomes. The evidence for efficacy and against adverse outcomes suggests that a reevaluation of the dosing restrictions in older adults with neuropsychiatric disorders is needed.

Safety and Efficacy of Lithium for Treating Bipolar Disorder In the Older Adult.

The population of older adults with bipolar disorder is growing, not only because of the increase in the percentage of the population 65 years of age and older, but also because of an increase in awareness about mental health issues in this population. For years, lithium has been one of the first-line options for treating bipolar disorder, but data in the older population have mostly been inconclusive or extrapolated from younger populations. Questions of tolerability and safety in the older adult have also arisen, as well as its efficacy in comparison to newer agents on the market. This manuscript aims to examine the evidence of lithium use in the older adult and whether or not this drug should still be recommended for use in this population.

Atypical Antipsychotics in Late-Life and Treatment-Resistant Depression.

As persons age, their risk of developing late-life depression increases. Older adults not only have an increased risk of late-life depression, but they also have an increased risk of suicidal ideation. Because of these increased risks, it is vital that clinicians be aware of the options available to assist these persons to achieve remission of their symptoms, as well as prevent relapse. Atypical antipsychotics have been considered an augmentation option in younger adults with depression. However, because of the black box warning associated with atypical antipsychotics in older adults with dementia, clinicians often exercise caution when using these agents to help treat late-life depression. This article explores the various studies conducted for the use of atypical antipsychotics in older adults and their safety and efficacy in this population.

Drug Therapy for Gender Transitions and Health Screenings in Transgender Older Adults.

Transgender medicine is a relatively new field in health care, with only a small amount of evidence-based literature available for reference. This is especially true for the older adult population, for whom most information must be extrapolated from younger adults. Be it a newly transitioned older adult or a transgendered individual who has been undergoing hormonal therapy for many years, it is important that healthcare professionals be aware of the significant effects that transgender pharmacotherapy can have on older adults. Healthcare providers must also recommend appropriate preventative screenings to transgendered persons.

Perceptions of Direct-to-Consumer Advertising and the Older Adult Population.

Direct-to-consumer advertising (DTCA) has become a prominent feature of our society and reaches many consumers through their televisions, radios, and computer screens. In 2004, the average United States citizen was exposed to more than 16 hours of DTCA per year, and the number of hours has steadily increased. Drug advertising is a multi-billion dollar business for pharmaceutical manufacturers and affects public perception of medications, both prescription and over-the counter. Studies have shown advertisements can have both positive and negative effects, including educating consumers, but can harm the patient-physician relationship. This article addresses the perceptions older adults have toward DTCA and discusses how pharmacists can play a role in helping older adults understand and effectively use DTCA.

Sodium-glucose co-transporter 2 inhibitors: evidence and place in therapy.

Type 2 diabetes effects millions of people yet remains difficult to treat with oral pharmacotherapy. Metformin is the first line recommended therapy, and current guidelines suggest individualized therapy for second line selection. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are the newest class of agents in treating type 2 diabetes via an insulin independent mechanism to lower blood glucose. Currently marketed agents, including canagliflozin, dapagliflozin, empagliflozin, and luseogliflozin, reduce hemoglobin A1c (HbA1c) ~0.8-1%, reduce fasting and post prandial glucose, and have little hypoglycemia associated with them when added to therapies including metformin, a sulfonylurea, pioglitazone, or insulin. Patients receiving SGLT-2 inhibitors have reduced weight and blood pressure, but are more susceptible to urinary tract infections and genital mycotic infections. This review summarizes current literature regarding the SGLT-2 inhibitors.

Identifying solutions to medication adherence in the visually impaired elderly.

Adults older than 65 years of age with vision impairment are more likely to have difficulty managing medications compared with people having normal vision. This patient population has difficulty reading medication information and may take the wrong medication or incorrect doses of medication, resulting in serious consequences, including overdose or inadequate treatment of health problems. Visually impaired patients report increased anxiety related to medication management and must rely on others to obtain necessary drug information. Pharmacists have a unique opportunity to pursue accurate medication adherence in this special population. This article reviews literature illustrating how severe medication mismanagement can occur in the visually impaired elderly and presents resources and solutions for pharmacists to take a larger role in adherence management in this population.