Understanding of pharmacy students' knowledge of cannabis use disorders in recreational vs non-recreational use states.

INTRODUCTION: Currently, the trend of legalizing recreational cannabis across the United States is experiencing rapid expansion. Cannabis Use Disorder (CUD) is a pattern of cannabis use leading to clinically significant impairment, manifested by at least two of the 11 criteria on DSM-5. The objective of this study is to compare the knowledge of CUD among pharmacy students attending pharmacy schools in recreational cannabis-legalized states to nonlegalized states. METHODS: This was a survey-based study using validated questionnaires distributed among students from ACPE-accredited pharmacy schools in the United States. The survey included a CUD knowledge section followed by section on student characteristics. Individual item knowledge scores for each question were assessed as well as the total knowledge score. Adjusted linear regression model was used to evaluate knowledge scores between legalized and nonlegalized states. RESULTS: A total of 513 students initiated the survey and 408 completed responses with 153 from recreational cannabis legalized states and 255 from nonlegalized states. The mean knowledge score in RC-legalized states was higher than nonlegalized states. After adjusting for covariates, the knowledge of pharmacy students in recreational cannabis legalized states were 40% higher than in nonlegalized states. CONCLUSION: For future patient requirements, it may be necessary for students to receive formal education in pharmacy schools regarding CUD so that they can proficiently assist with their patient needs. Given that pharmacy students might relocate to different states, it is essential to ensure that they possess a comprehensive understanding of the specific regulations CUD across the United States.

Understanding racial disparities in health care expenditures for cervical cancer.

BACKGROUND: Cervical cancer demonstrates a notable efficacy in treatment, evidenced by a 92% 5-year survival rate among cases diagnosed at a localized stage. In 2020, the estimated annual national expenditure for cervical cancer care amounted to $2.3 billion in the United States. Limited real-world data are available for racial disparities in health care expenditures for cervical cancer. OBJECTIVE: To evaluate racial disparities associated with annual health care expenditures among patients diagnosed with cervical cancer in the United States. METHODS: A retrospective observational cohort study of annual health care expenditures in patients with cervical cancer diagnosed during 2014-2019 was performed using the Medical Expenditure Panel Survey data. In addition to the descriptive weighted analysis, an unadjusted analysis of the annual health care expenditure was conducted. An adjusted linear regression model with log transformation of the outcome variable was used to evaluate the total annual health care expenditure as well as expenditures by category across the racial groups. RESULTS: Overall, 826 patients with cervical cancer were identified from the Medical Expenditure Panel Survey during 2014-2019. The majority were classified as White patients (81.2%) and in the age group of 45-64 years (44.65%). On average, the total annual health care expenditure was $11,537 (95% CI = $9,887-$13,186) among the White cohort, $10,659 (95% CI = $6,704-$14,614) among the African American cohort, and $8,726 (95% CI = $6,113-$11,340) among the Hispanic cohort. After adjusting for covariates, the average total annual health care expenditure for the Hispanic cohort was 35% of the total health care expenditure of the White cohort (P < 0.001) and 46% of the African American cohort's health care expenditure (P = 0.02). Specifically, adjusted costs of office-based and outpatient visits for the Hispanic cohort were 47% (P = 0.009) and 57% (P = 0.005) lower than for the White cohort, respectively. The total annual home health care expenditure for the African American cohort was 49% lower than White patients (P = 0.03), and the Hispanic cohort's total expenditure, excluding prescription medicines, was 57% lower than African American patients (P = 0.02). CONCLUSIONS: This study provides valuable information regarding the health care disparities that need to be addressed among certain minority races. Reducing the disparities in health care spending across racial groups should be included as a crucial element in tackling well-established health care inequities.

Understanding Pharmacy Students' Preparedness towards Counseling over Cannabis Use Disorder.

The rise in cannabis use prompts significant concerns regarding pharmacy students' abilities to counsel patients over cannabis use disorder. This study aims to understand pharmacy students' preparedness to counsel patients with cannabis use disorder (CUD) and evaluate the relationship between knowledge, attitudes towards medical cannabis (MC) and recreational cannabis (RC), and behavior intention (BI) to counsel over CUD. A cross-sectional survey was administered to pharmacy students. Descriptive analyses of sample characteristics were assessed with the t-test and one-way ANOVA test. Pearson correlation and linear regression were conducted, measuring the strength and direction of relationships. The average scores for knowledge, attitudes towards MC use and RC, and behavioral intention were 81% (SD 16%), 4.13 (SD 0.75), 3.28 (0.80), and 2.74 (1.00). Significant correlations were observed between knowledge-attitudes toward MC, knowledge-attitudes towards RC, and attitudes towards RC-behavioral intentions. Linear regression indicated attitudes towards MC use and RC, academic year, awareness of MC use legality, obtained knowledge, and past patient interaction were significantly associated with behavioral intention on confidence in counseling over CUD. There is a gap in students' behavioral intention to counsel. These findings emphasize the importance of ample preparation that enables student pharmacists to address patient needs related to cannabis use confidently.

Why the increase? Examining the rise in prescription medication expenditures in the United States between 2011 and 2020.

The objective of this cross-sectional analysis was to identify determinants of increasing medicine expenditures in the US between 2011 and 2020. Prescription medication expenditures from the 2011-2020 Medical Expenditures Panel Survey (MEPS) were used to calculate total annual medication expenditures by payer categories (Out-of-pocket, Medicare, Medicaid, TRICARE/Veterans Administration/CHAMPVA (TVAC), Other Government Sources, Private Insurance, and Other Sources). From here, expenditures were stratified by therapeutic category using Multum Lexicon Drug Class to examine trends in expenditures by therapeutic area. Linear regression was used to identify temporal trends in medication expenditures. From 2011 to 2020, total annual prescription medication expenditures rose from $341.49 to $473.12 billion per year with metabolic agents being the most costly category. Among the metabolic agents, antidiabetic agents were the most costly therapeutic area, with an increasing trend observed from $27.15 to $89.17 billion over the same period. Medicare, Medicaid, Private Insurance, TVAC, and Other Sources also saw an increasing trend in antidiabetic agent expenditure, while no trend was observed for Out-of-pocket and Other Government Sources. Insulin had the highest expenditure among antidiabetic agents. Further studies are warranted to explore specific factors contributing to the increasing trend.

Pretracheal tuberculous abcess mimicking a thyroid swelling-A case report.

INTRODUCTION: Pretracheal tubercular abscess is a rare presentation of extra pulmonary tuberculosis even in TB- endemic areas (WHO, 2014 [3]). It usually presents in posterior triangle group of lymph nodes (Baskota et al., 2004 [2]). PRESENTATION OF CASE: We report a case of a lower midline swelling in anterior part of the neck of 6 months duration, with dysphagia of 1 month duration. Radiological diagnosis was established as tuberculous abscess and was drained. Patient was started on anti tuberculous treatment. DISCUSSION: Swellings anatomically located in the area of anterior group of lymph nodes should be dealt with high degree of suspicion for tubercular etiology especially in TB-endemic areas (WHO, 2014 [3]). Anterior group of lymph node involvement is very rare. To differentiate, proper radiological assessment is needed to differentiate between thyroid nodule and lymph node pathology. CONCLUSION: Pre operative assessment is often under estimated. Adequate evaluation will avoid major surgery for a benign pathology like tuberculosis.