Using the YRBSS to Assess the Health Behaviors of Bi/Multiracial Adolescents.

Numerous research articles are published yearly that focus on the health status of minorities, but what is lacking is a dedicated section for those who identify as bi/multiracial (B/MR). This research attempted to add to the limited but growing body of literature dedicated to the B/MR community. Using the Youth Risk Behavioral Surveillance System (YRBSS), three behaviors were assessed: tobacco and alcohol use and adolescent sexual practices. The composite scores were then evaluated by racial status (Black, B/MR, and White adolescents) and sex. Aggregate results for these three behaviors varied across all three racial categories and, to a lesser extent, by sex. The implications for these results indicate a need for more specific and targeted approaches for the prevention or risk-reducing programs based on racial identity group.

Student pharmacist opioid consultations with standardized limited English proficiency patients: A pre-post educational intervention study.

BACKGROUND AND PURPOSE: This study explored the effect of a structured educational intervention for student pharmacists to counsel limited English proficiency (LEP) patients on risks and safety of opioid medications for chronic pain. Specific aims were to compare 2018 pre-intervention versus 2019 post-intervention groups regarding: (1) dose and side effects discussed, (2) opioid risks and safety measures covered, and (3) LEP specific communication practices. EDUCATIONAL ACTIVITY AND SETTING: Third-year student pharmacists (P3s) in a required communications course consulted LEP standardized patients (SPs) on opioid medications in 2018 and 2019. An educational intervention for the 2019 P3s consisted of a 50-min lecture, pre-lab instructions about techniques for communication about opioid risks and safety, and for LEP specific communication stressing teach-back. All consultations in the pre- and post-intervention phases were video recorded and quantitatively coded for verbal and non-verbal communication skills. Descriptive statistics and Fisher's exact tests were conducted on data. FINDINGS: Twenty-three consultations were recorded in 2018 for the pre-intervention phase and 49 consultations were recorded in 2019 for the post-intervention phase. Only 17% of students in the pre- intervention phase called the medication an "opioid" or "narcotic" in the consultation as compared to 84% in the post-intervention phase. While 100% of students in the post-intervention phase used teach-back, only 61% did so in the pre-intervention group. Significant differences between the two groups were observed for minimizing dependency and overdose, offering naloxone, teach-back, integrating a patient handout into the consultation, and discussing use of alternate pain medications.

Communication between patients and health care professionals about opioid medications.

Prescription opioids contribute to 40% of opioid overdose deaths in the United States. Healthcare professionals (HCPs) play an important role in mitigating the prescription opioid epidemic by appropriate opioid prescribing and patient education. Yet, little empirical literature addresses pharmacist (and other HCP) communication with patients related to risks of opioid use associated with dependence, misuse, and overdose. Nor is there much research on the barriers and facilitators which affect whether and how much opioid-related information is discussed. This commentary, based on an extensive literature search, seeks to inform future communication, education, and research agendas by describing (1) topics commonly discussed or excluded from opioid medication counseling, (2) patient and HCP perceptions regarding opioid medication communication, and (3) barriers and facilitators to opioid risk communication. Based on this literature, recommendations are provided for opioid counseling practices, pharmacist education, and research agendas.

Pharmacy Student Opioid Consultations with Standardized Limited English Proficiency Patients.

INTRODUCTION: Limited healthcare studies have analyzed communication practices with limited English proficiency (LEP) patients. Empirical literature lacks evidence about LEP patient-pharmacist communication about opioid risks. This study aimed to (1) explore topics discussed in opioid medication consults, (2) assess if students inform patients about dependency and overdose risks associated with opioid use and the manner in which those risks were introduced and discussed, and (3) assess LEP specific communication practices. METHODS: Third-year pharmacy students in a required communications course consulted LEP standardized patients (SPs) who spoke 30% English and 70% non-English language. The SP followed a script simulating an encounter between a pharmacist and patient picking up a new, month long prescription of oxycodone. All consultations were video recorded and quantitatively coded for verbal and non-verbal communication skills. RESULTS: Twenty-three pharmacy students conducted consultations with LEP SPs. The majority of students discussed common side effects, but only a few discussed severe side effects. Four of 23 students named the medication as an "opioid" or "narcotic" and described dependency, overdose, or other opioid specific risks. Students used several filler words, long sentences, and a fast pace. A majority of students used teach back methods to identify patient understanding. Students expressed the need for more structured education and training in providing patient counseling for opioids and communicating with LEP patients. CONCLUSIONS: Pharmacy students lack confidence and skills in communicating with LEP patients regarding opioid-specific risks, suggesting structured training is needed.

Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review.

OBJECTIVES: Pharmacists are well positioned to identify patients at risk of overdose, dispense naloxone, and counsel patients on appropriate use. In response to growing numbers of opioid-related deaths, many states have issued standing orders allowing pharmacists to dispense naloxone without a prescription. This systematic review examines the current state of naloxone use and dispensing regarding (1) roles for pharmacists dispensing naloxone, (2) barriers to their dispensing naloxone, and (3) pharmacist training to dispense naloxone. DATA SOURCES: PubMed, Cinahl Plus, and Cochrane review databases were searched with the use of the terms "pharmacist OR pharmacy" AND "naloxone." Included for review were peer-reviewed original research studies conducted in the U.S. in the past 5 years. STUDY SELECTION: The preliminary search generated 155 studies, including 50 duplicate studies which were removed. From the remaining 105 studies, 33 were included that addressed pharmacist naloxone dispensing roles, barriers and facilitators to dispensing, or training for pharmacists. DATA EXTRACTION: Authors, publication year, study title, study objective, method, outcomes, and conclusions were extracted for all studies. RESULTS: Out of 33 studies, 14 focused on pharmacists' roles in naloxone dispensing, 9 on barriers, and 10 on training pharmacists for dispensing naloxone. The review found that most states permit major naloxone dispensing roles for pharmacists, but pharmacists are often underutilized without programs to support their roles. A key barrier to pharmacist naloxone dispensing is limited pharmacist training to identify and educate patients at risk of overdose. CONCLUSION: Although pharmacists have the legal opportunity to educate patients and dispense naloxone, barriers have limited their addressing naloxone with patients. There is a need for more intervention studies and in-depth understanding of pharmacist perspectives on barriers, training, and professional roles to facilitate tailored approaches for increasing pharmacist confidence in naloxone dispensing and consultation.

What We Know, Are Still Getting Wrong, and Have Yet to Learn about the Relationships among the SAT, Intelligence and Achievement.

Fifteen years ago, Frey and Detterman established that the SAT (and later, with Koenig, the ACT) was substantially correlated with measures of general cognitive ability and could be used as a proxy measure for intelligence (Frey and Detterman, 2004; Koenig, Frey, and Detterman, 2008). Since that finding, replicated many times and cited extensively in the literature, myths about the SAT, intelligence, and academic achievement continue to spread in popular domains, online, and in some academic administrators. This paper reviews the available evidence about the relationships among the SAT, intelligence, and academic achievement, dispels common myths about the SAT, and points to promising future directions for research in the prediction of academic achievement.

Pharmacist Services in the Opioid Crisis: Current Practices and Scope in the United States.

Introduction: Pharmacist roles promoting safe opioid use are recognized in literature and practice. Pharmacists can offer services such as counseling on opioid risks, naloxone dispensing, education on opioid storage and disposal, prescription drug monitoring program (PDMP) utilization, opioid deprescribing, and providing resources for addiction treatment to help mitigate the opioid crisis. Objective: This commentary seeks to describe current and potential roles for pharmacists to combat the United States opioid crisis and identify key factors affecting service provision. Methods: The paper summarizes evidence-based studies describing current pharmacist roles and services, factors affecting service implementation, and strategies to further improve pharmacist roles and services related to promoting safe opioid use for patients. Results: Pharmacists recognize their roles and responsibilities to counsel patients on opioid risks, dispense naloxone, educate on opioid storage and disposal, utilize prescription drug monitoring programs (PDMPs), offer opioid deprescribing, and provide resources for addiction treatment. However, pharmacists express low confidence, time, and training as barriers to service provision. This suggests a need for structured training, resources, and organizational support for pharmacists to improve confidence and participation in such services. Conclusions: Although pharmacists are aware of roles and responsibilities to help reduce the opioid crisis, more training, education, organizational support and resources are needed to increase their ability to embody these roles.

Pharmacist-reported practice change as a result of a statewide community pharmacy accreditation program.

OBJECTIVES: To assess pharmacist-reported practice change as a result of participation in a community pharmacy accreditation program. SETTING: Community pharmacy practice in Wisconsin. PRACTICE INNOVATION: The Wisconsin Pharmacy Quality Collaborative (WPQC) is a network of pharmacies and pharmacists who provide standardized pharmacy services. WPQC is based on a unique set of quality-based best practices designed to improve patient safety in the medication use process. WPQC is supported by the statewide pharmacy organization, the Pharmacy Society of Wisconsin (PSW), which provides resources focused on implementation and engagement to support the success of WPQC-accredited pharmacies. PROGRAM EVALUATION: PSW used a 24-question online survey to evaluate the degree of pharmacist-reported practice change as a result of the WPQC quality-based best practices. RESULTS: Pharmacist-reported frequency and consistency of all quality-based best practices and services increased after WPQC accreditation (P < 0.05), with the exception of robotic dispensing systems, holding regular staff meetings for team communication, and providing incentives for recording quality-related events. In addition, quality-based best practices and WPQC services had a positive impact on pharmacist perceptions of their quality of patient care, patient safety, patient satisfaction, and patient relationships in WPQC-accredited pharmacies. The majority of pharmacies valued WPQC accreditation and shared positive comments about their experiences. CONCLUSION: A community pharmacy accreditation program using standardized quality-based best practices can create and reinforce behavior change in the community pharmacy setting to positively affect patient care and medication safety. Research is needed to determine if there are actual behavior changes as a result of WPQC accreditation compared with pharmacies that have elected not to participate.

Evaluating Pharmacy Student Consultations with Standardized Patients on Opioid Medication Use and Opioid-Specific Risks.

Objective. To assess third-year pharmacy students' entry-level verbal and nonverbal communication skills when addressing sensitive topics during opioid consultations with standardized patients. Methods. Seventy-one students were video-taped while consulting with standardized patients who were receiving a one-month supply of oxycodone for lower back pain. Consults were coded quantitatively for the topics students discussed with the patient, terms used, eye contact, and filler words. Results. The majority of pharmacy students discussed common and severe opioid side effects, such as respiratory depression. However, only 30% explained that the medication being dispensed was an opioid or narcotic, and only 23% of students initiated a conversation regarding dependence, addiction, or overdose risk. Students used more filler words when discussing dependence, addiction, or overdose risk as compared to the rest of the consult. Afterwards, students expressed discomfort and the need for additional training and resources for communicating with patients about opioids. Conclusion. Many students lacked confidence with regards to educating patients about opioid-specific risks. This necessitates expanding education regarding discussing sensitive information about opioids at this school of pharmacy. Other schools of pharmacy would benefit from an evaluation of their curriculum to assess the necessity for additional education and training.

Music Listening Among Postoperative Patients in the Intensive Care Unit: A Randomized Controlled Trial with Mixed-Methods Analysis.

BACKGROUND: Music listening may reduce the physiological, emotional, and mental effects of distress and anxiety. It is unclear whether music listening may reduce the amount of opioids used for pain management in critical care, postoperative patients or whether music may improve patient experience in the intensive care unit (ICU). METHODS: A total of 41 surgical patients were randomized to either music listening or controlled non-music listening groups on ICU admission. Approximately 50-minute music listening interventions were offered 4 times per day (every 4-6 hours) during the 48 hours of patients' ICU stays. Pain, distress, and anxiety scores were measured immediately before and after music listening or controlled resting periods. Total opioid intake was recorded every 24 hours and during each intervention. RESULTS: There was no significant difference in pain, opioid intake, distress, or anxiety scores between the control and music listening groups during the first 4 time points of the study. However, a mixed modeling analysis examining the pre- and post-intervention scores at the first time point revealed a significant interaction in the Numeric Rating Scale (NRS) for pain between the music and the control groups (P = .037). The Numeric Rating Score decreased in the music group but remained stable in the control group. Following discharge from the ICU, the music group's interviews were analyzed for themes. CONCLUSIONS: Despite the limited sample size, this study identified music listening as an appropriate intervention that improved patients' post-intervention experience, according to patients' self-report. Future mixed methods studies are needed to examine both qualitative patient perspectives and methodology to improve music listening in critical care units.

Measuring Sustained Attention and Perceived Workload.

OBJECTIVE: We examined the effects of spatial uncertainty, field dependence/independence (FD/I), and sex on vigilance performance and perceived workload in elementary school children. BACKGROUND: Building on previous work in which children demonstrated their ability to evaluate workload, we tested whether spatial-uncertainty manipulations in a vigilance task would elicit in children the same deleterious effects on performance and workload as it does with adults. We also examined individual difference effects associated with FD/I and sex to determine their influence on both performance and workload. METHOD: In the low-uncertainty task, stimuli appeared in the center of the computer screen; in the high-uncertainty task, they appeared in one of the four quadrants of the screen. Neutral events consisted of uppercase letter strings. Critical signals consisted of a single lowercase letter among uppercase letters. Following each vigil, children completed a workload assessment via a modified version of the NASA Task Load Index. RESULTS: Children showed lower perceptual sensitivity, greater response latency variability (RTSD), and a higher response criterion in the uncertain display condition. Workload scores reflected these performance differences. Field-dependent children showed lower perceptual sensitivity and greater RTSD than did field-independent children. The two groups exhibited differing workload profiles. Despite no objective performance differences, boys reported greater workload than girls. CONCLUSION: The scale demonstrated sensitivity and diagnosticity with regard to both the task variable and individual differences. APPLICATION: These findings contribute to the emerging field of "educational ergonomics" and indicate that appropriate assessment tools might identify children who are experiencing increased workload.

Effects of Memory Load and Test Position on Short-Duration Sustained Attention Tasks.

The current study applies a dual-task working memory and vigilance task to examine sustained attention performance and perceived workload in a multi-instrument battery. In Experiment 1 we modified a task developed by Helton and Russell (2011) to examine declines in performance and to assess the effects of its position within a larger battery. Experiment 1 failed to reveal a sensitivity decrement, and test position revealed only spurious influence. Workload scores derived from the NASA-TLX fell at the high end of the scale, with mental and temporal demand receiving the highest ratings. In Experiment 2, we modified the dual task to place more emphasis on attention rather than working memory. Results revealed a significant decline in performance across the vigil for the perceptual sensitivity index A'. Test position (early vs. late) effects appeared with the reaction time variability measure, with performance becoming more variable when the task appeared in the latter half of the battery. Workload scores varied according to position in the battery: Workload scores were higher when the vigilance task appeared in the latter half of the battery. Practical and theoretical implications are discussed.

Measuring perceived mental workload in children.

Little is known about the mental workload, or psychological costs, associated with information processing tasks in children. We adapted the highly regarded NASA Task Load Index (NASA-TLX) multidimensional workload scale (Hart & Staveland, 1988) to test its efficacy for use with elementary school children. We developed 2 types of tasks, each with 2 levels of demand, to draw differentially on resources from the separate subscales of workload. In Experiment 1, our participants were both typical and school-labeled gifted children recruited from 4th and 5th grades. Results revealed that task type elicited different workload profiles, and task demand directly affected the children's experience of workload. In general, gifted children experienced less workload than typical children. Objective response time and accuracy measures provide evidence for the criterion validity of the workload ratings. In Experiment 2, we applied the same method with 1st- and 2nd-grade children. Findings from Experiment 2 paralleled those of Experiment 1 and support the use of NASA-TLX with even the youngest elementary school children. These findings contribute to the fledgling field of educational ergonomics and attest to the innovative application of workload research. Such research may optimize instructional techniques and identify children at risk for experiencing overload.

The Relationship between Performance in Near Match-to-Sample Tasks and Fluid Intelligence.

Match-to-sample is a timed task in which a subject is presented with a visual stimulus (the probe) and must select a match to that stimulus (the target) from among an array of distractors. These tasks are frequently employed as tests of basic cognitive abilities and demonstrate consistent correlations with measures of intelligence. In the current study, a match-to-sample task was modified to produce near-match conditions (trials for which no exact match existed). Two factors were manipulated: type of discrepancy between the target and probe (additive or subtractive) and degree of discrepancy between target and probe (1 element or 2 elements). It was hypothesized that introducing near-match conditions would change the processing demands of the task, resulting in increased correlations between decision time and fluid intelligence. Degree and type of discrepancy affected decision times: participants required more time for 2 element discrepancies and additive type discrepancies. Contrary to expectations, increased decision time on a task did not correspond to higher correlations with fluid intelligence. For type, correlations were larger when participants needed to mentally subtract elements from the target in order to make it match the probe (mean r(additive) = .399; mean r(subtractive) = .451). For degree, correlations were larger for trials where the probe and target differed by one element (mean r = .470) than for trials where the probe and target differed by two elements (mean r = .380). These results seem to indicate that the relationship between the complexity of a task and general intelligence is not as straightforward as has been commonly believed.

Scholastic Assessment or g? The relationship between the Scholastic Assessment Test and general cognitive ability.

There is little evidence showing the relationship between the Scholastic Assessment Test (SAT) and g (general intelligence). This research established the relationship between SAT and g, as well as the appropriateness of the SAT as a measure of g, and examined the SAT as a premorbid measure of intelligence. In Study 1, we used the National Longitudinal Survey of Youth 1979. Measures of g were extracted from the Armed Services Vocational Aptitude Battery and correlated with SAT scores of 917 participants. The resulting correlation was.82 (.86 corrected for nonlinearity). Study 2 investigated the correlation between revised and recentered SAT scores and scores on the Raven's Advanced Progressive Matrices among 104 undergraduates. The resulting correlation was.483 (.72 corrected for restricted range). These studies indicate that the SAT is mainly a test of g. We provide equations for converting SAT scores to estimated IQs; such conversion could be useful for estimating premorbid IQ or conducting individual difference research with college students.