Development and Assessment of Targeted, Live, and Interactive Continuing Pharmacy Education Workshops in Dementia Care for North Dakota Pharmacists.

Background With the growing US aging population, need for a health care workforce able to provide dementia care will increase. Objective To develop, deliver, and assess interactive live workshops for licensed North Dakota pharmacists in dementia care. Methods Prospective interventional study of impact of free-of-charge, interactive, five-hour workshops for pharmacists providing advanced training in Alzheimer's disease, vascular and Parkinson's disease dementia, dementia with Lewy bodies, and common reversible causes of cognitive impairment. The workshop was offered three times across two different locations in ND: Fargo and Bismarck. Online pre- and postworkshop questionnaires were administered to collect demographics, attendance rationale, perceived ability to provide dementia care, and workshop quality/satisfaction. A 16-item assessment instrument/ test (1 point/item) was developed to assess pre- and postworkshop competency in dementia-related care (ie, knowledge, comprehension, application, and analysis). Descriptive statistics and paired t-test were performed using Stata 10.1. Results Sixty-nine pharmacists were trained and completed the competency test assessments; 95.7% ND pharmacists completed pre-and postworkshop questionnaires. The overall competency test scores improved from 5.7 ± 2.2 to 13.0 ± 2.8 (P < 0.001) and individual scores for each disease/problem also improved significantly (P < 0.001). Increases corresponded with increased self-reported perceived ability to provide dementia care; 95.4 to 100% of participants agreed/strongly agreed learning needs were met, teaching was effective, were satisfied with content and educational material usefulness, and would recommend workshop. Conclusion Workshop had measurable, immediate benefit on knowledge and ability to apply learned information. Structured, interactive workshops are valuable for improving pharmacists' competency in dementia care.

Quality Improvement for Rapid Development and Scale-Up of COVID-19-Related Screening Processes.

BACKGROUND: In March 2020, Ohio strongly recommended temperature and health screening for coronavirus disease 2019 symptoms in all businesses to reduce the spread of infection. METHODS: We used multiple plan-do-study-act cycles and workplace efficiency techniques iteratively to develop 12 intervention components required to effectively screen employees and visitors across all locations. We used run and control charts to summarize our performance over time. RESULTS: Over the course of 20 days of rapid testing, we increased from 0% to 100% of locations successfully screening. The volume of people undergoing screening peaked during employee shift change. Employee positive screen results decreased by >50% after the first 7 days of screening, whereas family positive screen results remained stable throughout the study period. CONCLUSIONS: An empowered, multidepartmental steering team, disciplined use of rapid cycle quality improvement processes, and explicit, standardized training processes enabled rapid successful scale-up of standard screening and masking process for employees and patients during the coronavirus disease 2019 pandemic. This approach can assist hospitals in adapting screening processes to evolving evidence.

Basic Disaster Preparedness of Rural Community Pharmacies in 5 States.

OBJECTIVES: The aim of this study was to investigate the basic preparedness of rural community pharmacies to continue operations during and immediately following a disaster. METHODS: In 2014, we conducted a telephone survey (N = 990) of community pharmacies in 3 rural areas: North Dakota/South Dakota, West Virginia, Southern Oregon/Northern California regarding whether they had a formal disaster/continuity plan, offsite data backup, emergency power generation, and/or had a certified pharmacy immunizer on staff. Logistic regression and chi square were performed using Stata 11.1. FINDINGS: Community pharmacies in rural areas (≤50.0 persons/mile2) were less likely to have emergency power (odds ratio [OR] = 0.59; 95% confidence interval [CI]: 0.32-1.07) or certified pharmacy immunizer on staff (OR = 0.47; 95% CI: 0.34-0.64). Pharmacies in lower income areas were less likely to have emergency power and offsite data backup or a formal disaster plan (OR = 0.70; 95% CI: 0.49-0.99) compared with pharmacies in higher income areas. Community pharmacies in areas of higher percent elderly population were less likely to have emergency power (OR = 0.54; 95% CI: 0.39-0.73), or certified pharmacy immunizer on staff (OR = 0.65; 95% CI: 0.47-0.91) compared with chain pharmacies in areas with lower percent elderly population. CONCLUSIONS: Being in a rural, low-income, or high-elderly area was associated with lower likelihood of basic preparedness of community pharmacies.

Pharmacists' Utilization of Information Sources Related to Community and Population Needs in the Upper Midwest and Associations with Continuing Professional Education.

BACKGROUND: To investigate information sources utilized in pharmacists' assessment of population-based health needs and/or community changes; and the association between information sources utilized and reported completion of continuing professional education topics. METHODS: In 2017; licensed pharmacists (n = 1124) in North Dakota; South Dakota; Minnesota; Iowa; and Nebraska completed a questionnaire on continuing professional education and information sources on population-based health needs and community changes. Data were entered; cleaned and imported into Stata 11.1. Census Bureau county-level population density data were used to classify local area characteristics. Descriptive statistics and multivariate logistic regression analyses were performed. RESULTS: Most sources of primary; county-level data on population-based health needs or community changes were minimally utilized. Pharmacists in more rural areas were statistically more likely to use local health professionals; local non-health professionals; and/or the state health department compared to pharmacists in less rural areas. Pharmacists reporting higher use of population-based information sources were more likely to have completed continuing education in the past 12 months for all 21 surveyed topics; 13 significantly so. CONCLUSIONS: There is a reliance of pharmacists on information from local health and non-health professionals for information on population-based health needs and/or community changes. Utilization of health departments and other primary information sources was associated with increased rates of completion of an array of continuing professional education topics. Expanding utilization of evidence-driven information sources would improve pharmacists' ability to better identify and respond to population-based health needs and/or community changes through programs and services offered; and tailor continuing professional education to population-based health needs.

A Pharmacist-Led Stroke Education and Screening Program for Community-Dwelling Older Adults.

OBJECTIVES: To deliver a pharmacist-led education and screening for community-dwelling residents, assess the effect of this initiative on knowledge of stroke risk factors and warning signs, and evaluate the stroke-knowledge and risk-assessment questionnaire as a tool to identify stroke-related health status and identify need(s) for specific clinical intervention(s) to decrease risk.
DESIGN: The 70-minute-long event comprised: brief introduction/informed consent, baseline assessment of stroke knowledge, completion of study questionnaire, single blood pressure and heart rate readings, presentation, question-and-answer session, postsurvey questionnaire items.
SETTING: Four faith-based institutions in the Midwest.
PARTICIPANTS: Independent community-dwelling adults 18 years of age and older (N = 97), 89.7% 60 years of age and older.
INTERVENTIONS: Thirty-minute presentation followed by question-and-answer session on ischemic stroke. Screening for primary and secondary stroke-prevention status using study questionnaire and vital signs.
MAIN OUTCOME MEASURE(S): Stroke knowledge regarding modifiable stroke-risk factors and acute stroke-warning signs, individual primary/secondary stroke-prevention status.
RESULTS: Postintervention, mean number of modifiable stroke risk factors (2.6 ± 0.8) and warning signs (2.6 ± 0.8) named improved from preintervention (P < 0.001) including for most subgroups (i.e., self-reported hypertension, atrial fibrillation [AF], or high number of personal risk factors). Needs for improved primary/secondary prevention were identified for blood-measure control and antilipidemic therapy. No disparity was observed regarding thrombotic therapy in participants with AF.
CONCLUSION: The program was resource-efficient, involved student pharmacists, improved immediate stroke-related knowledge of participants including those with increased risk(s) of stroke, and demonstrated value for evaluating stroke-related health status and identifying need for primary and secondary stroke prevention.

Continuing pharmacy education practices in geriatric care among pharmacists in the Upper Midwest.

OBJECTIVES: To summarize select continuing pharmacy education (CPE) topics and hours related to geriatric care completed by community, hospital/clinic, and long-term care (LTC)/consultant pharmacists in the previous 12 months, whether pharmacy workplace influenced topic selection or completion, and to describe CPE sources used by community versus hospital/clinic pharmacists. DESIGN: Cross-sectional survey (2017). SETTING AND PARTICIPANTS: Licensed pharmacists in North Dakota, South Dakota, Minnesota, Iowa, and Nebraska with primary practice settings in community pharmacies, hospitals, or clinics or those practicing as consultant pharmacists. MAIN OUTCOME MEASURES: CPE on geriatric-related topics and hours completed in the previous 12 months, CPE providers and sources used, and differences in CPE topic completion and CPE providers and sources by primary pharmacy practice setting. RESULTS: Pharmacists' response rates for states ranged from 10.5% to 17.1%. Pharmacists (n = 1082) reported limited completion of geriatric-related topics. Almost one-third completed CPE credit in Alzheimer disease (AD) but fewer than 20% of pharmacists in selected age-related chronic diseases (e.g., Parkinson disease, dementia with Lewy bodies, epilepsy, vascular dementia, geriatric syndrome). LTC/consultant pharmacists completed significantly more hours in geriatric-related topics compared with other pharmacists. In contrast, diabetes mellitus, hypertension, asthma, and heart failure were completed by 34% to 64% of the pharmacists. Pharmacist's Letter (57.2%), Power-Pak CE (42.4%), conferences, conventions, and symposia (32.5%), and Pharmacy Times (21.8%), were the most used CPE sources. Other sources were used by fewer than 18% of the pharmacists. Online CPE providers used by high numbers of study participants offered limited AD- or dementia-related topics and hours. CONCLUSION: Findings revealed modest to minimal CPE completion in select geriatric care topics among pharmacists in the Upper Midwest. Completion rates were higher for LTC pharmacists compared with hospital, clinic, and community pharmacists. Only a few CPE sources were heavily used, and those offered minimal CPE in AD/dementia-related care. Given current findings and previous research, current CPE use habits and CPE offerings from major providers and sources seem insufficient for ensuring continued high-quality patient-centered care for growing U.S. aging populations.

Diamond Stress View Radiograph for Thumb Metacarpophalangeal Hyperextension.

BACKGROUND: Successful surgical management of thumb carpometacarpal (CMC) arthritis requires treatment of coexisting metacarpophalangeal (MCP) hyperextension deformity when present. The surgeon's decision to offer thumb CMC arthritis patients the option of no additional treatment, MCP capsulodesis, or MCP arthrodesis relies on the severity of the MCP deformity measured in clinic. The authors present a novel patient-performed radiographic stress view to measure MCP hyperextension. METHODS: Fifty-seven thumbs in 30 consecutive patients offered thumb CMC arthroplasty were enrolled. Clinic goniometer measurements, patient-performed stress view radiographs, and intraoperative manual stress views of each MCP joint were documented for study. Paired samples t test was used to compare the differences between the preoperative measurements and intraoperative measurements of the right and left thumb groups. RESULTS: The clinic goniometer measurements were significantly different ( P = .0001) than the MCP stress view obtained while the patient was under anesthesia. The difference in the new patient-derived x-ray stress view was not statistically significant compared with the stress view under anesthesia in the left ( P = .91) or right ( P = .53) groups. CONCLUSIONS: This new patient-performed stress view of the MCP joint allows accurate, objective measurement of hyperextension to aide in the decision making and patient education for the need of additional MCP joint surgery when addressing thumb CMC arthritis.

Design, implementation, and evaluation of educational workshop on management of Parkinson's and Alzheimer's disease patients for third-year pharmacy students.

BACKGROUND AND PURPOSE: Increasing aging populations in the United States means an increasing number of persons with Parkinson's disease (PD) and Alzheimer's disease (AD) requiring competent pharmaceutical care. The workshop was designed and implemented to integrate pharmacology and therapeutics in management of PD and AD, and evaluate efficacy of students' high-cognitive thinking, and self-rated knowledge improvement, confidence, and interest in the subject. EDUCATION ACTIVITY AND SETTING: Third-year pharmacy students participated in a three-hour workshop comprised of a foundational knowledge quiz from pathophysiology, pharmacology and therapeutics, performance on high-cognitive thinking in clinical scenarios, and hands-on activities in pharmacology and therapeutics related to PD and AD care. Pre- and post-education, Likert-style questions assessed students' self-rated confidence, interest and knowledge improvement. Descriptive statistics, paired t-test, and chi-square analyses were performed using Stata 10.1 statistical software (College Station, TX: Stata Corp LP). FINDINGS: Eighty-four of 93 students (90.3%) completed all workshop activities. Students' ability to apply knowledge in complex case mediation problems was not associated with performance on baseline quiz questions (Pearson r: 0.03-0.17). Completion of structured, hands-on active learning integrating clinical pharmacology and therapeutics had measurable immediate benefit solving high-cognitive order problems in clinical scenarios (p < 0.05). Hands-on activity also increased mean self-rated confidence (p < 0.01). Students (85.6%) reported knowledge improved "somewhat" or "very much" after the activity. Mean scores before and after hands-on activity were not associated with interest in the topic. SUMMARY: Structured, hands-on workshops can aid comprehension of taught/lectured material and its application to PD and AD, and is a way for instructors to close gaps between didactic lecture and clinical practice.

Maintaining Vitality: Pharmacists' Continuing Professional Education Decision-Making in the Upper Midwest.

Continuing professional education (CPE) plays an important role in continuing professional development of pharmacists for providing quality pharmaceutical care but also to maintain professional and organizational vitality and meet changing community/population needs. The study objective was to describe and understand factors of importance in selection of CPE credit hours among Upper Midwest pharmacists. A cross-sectional study of licensed pharmacists (n = 1239) in Iowa, Minnesota, Nebraska, North Dakota, and South Dakota included completion of a questionnaire on demographics and CPE decision-making. Factor analysis, t-test, and multivariate analyses were performed using Stata 10.1. Pharmacists placed greatest importance on maintaining licensure (mean = 2.72/3.00), personal interest (mean = 2.57), and self-improvement (mean = 2.42). Community/population need (mean = 1.83) was rated as slightly more important (p < 0.01) by retail/community pharmacists, females, and those with a Doctor of Pharmacy degree or pharmacy residency while business growth/development (mean = 1.33) was rated slightly more important (p < 0.01) by retail/community pharmacists. Despite findings that neither community/population need nor business development were among the most important factors in pharmacists' CPE selection, there exists significant potential for pharmacists to utilize CPE to maintain professional and organizational vitality in the labor market, but more importantly to ensure continued provision of quality pharmaceutical care and patient education.

Collaborating on medication errors in nursing.

BACKGROUND: Nurse educators are faced with changing roles and expanding responsibilities for medication administration and monitoring in pursuit of improved patient safety. The aims of this study were to develop, implement and evaluate clinical simulation experiences that included, along with nursing faculty members, a pharmacist educator for the teaching of preventable medication errors in undergraduate nursing education. METHODS: Four clinical simulation scenarios using high-fidelity patient simulators were developed focusing on select medication problems in nursing practice. Post-simulation evaluation of perceptions and experiences of undergraduate nursing students (n = 69) were assessed using a questionnaire of Likert-type items, including: (1) an evaluation of the simulation experience; and (2) self-reported perceived benefits for clinical ability and confidence in recognising, managing and reporting medication errors. RESULTS: Four hospital-based simulations on select preventable medication errors were piloted with 72 undergraduate nursing students. The majority of students (60.8-84.1%) evaluated the experience positively with regards to time pressure, type/severity of events, challenges, and benefits for critical thinking and decision making regarding patient safety and medication errors. Four clinical simulation scenarios using high-fidelity patient simulators were developed focusing on select medication problems DISCUSSION: The use of a pharmacy educator as a medication expert and member of the interprofessional health care teaching team in nursing education can be beneficial for training on medication safety, and on adverse effects, in a nursing programme in order to enhance nursing students' education.

Rural Disparities in Alzheimer's Disease-Related Community Pharmacy Care in the United States.

PURPOSE: To examine the relationship between area population density and community pharmacy-based Alzheimer's Disease (AD)-related services: pharmacists' medication knowledge and counseling, immunizations, and in-stock cognitive enhancers in 3 predominantly rural regions of the United States. METHODS: A standardized interview was administered by telephone to a 100% sample of community pharmacies in 3 areas: Northern California/Southern Oregon (n = 206), North and South Dakota (n = 278), and West Virginia (n = 420). Key study outcomes included: pharmacists' medication knowledge, availability of immunization services, and cognitive enhancers in stock. Respondents were classified by population density (persons/mi2 ) by pharmacy location to evaluate the relationship between rurality and AD-related pharmacy services. Chi-squared and logistic regression analyses were performed using Stata 10.1. FINDINGS: Pharmacies in more rural areas (50.1-100.0, 25.1-50.0, and ≤25.0 persons/mi2 ) were about 50% less likely to offer immunizations (95% CI: 0.32-0.91; 0.32-0.76; 0.28-0.80, respectively) compared to the least rural areas (>100.0 persons/mi2 ). Compared to the least rural areas, pharmacists in the most rural areas (≤25.0 persons/mi2 ) were less likely to name ≥2 gastrointestinal adverse effects of donepezil (OR = 0.50, 95% CI: 0.31-0.82) or have memantine XR 28 mg (OR = 0.61, 95% CI: 0.41-0.89) and other surveyed medications (OR = 0.57, 95% CI: 0.39-0.82) in stock. CONCLUSIONS: We found disparities in AD-related services in community pharmacies located in more rural counties, wherein individuals with AD and their caregivers may face barriers to obtaining quality pharmaceutical care. There is a need to strengthen pharmacists' knowledge and improve pharmacy services to reduce disparities.

Community Pharmacists' Knowledge Regarding Donepezil Averse Effects and Self-Care Recommendations for Insomnia for Persons with AD.

Alzheimer's disease (AD) impacts millions of individuals worldwide. Since no cure is currently available, acetylcholinesterase inhibitors are symptomatic therapy. This study assessed community pharmacists' knowledge regarding donepezil adverse effects (AEs) and self-care recommendations for insomnia management for persons with AD treated with rivastigmine. This is a cross-sectional, standardized telephone survey of community pharmacists (n = 862) in three study areas: West Virginia, North Dakota/South Dakota, and Southern Oregon/Northern California. Pharmacists' degree, sex, and pharmacists' AD-related knowledge were assessed. In-stock availability of donepezil and rivastigmine formulations was assessed. Analyses were performed using Stata 10.1. Only 31.4% pharmacists were able to name ≥2 donepezil AEs. Only four donepezil AEs were named by at least 13% of pharmacists: nausea (36.1%), dizziness (25.1%), diarrhea (15.0%), and vomiting (13.9%). All other AEs were named by fewer than 7% of respondents. Only 62.9% of pharmacists (n = 542) provided appropriate recommendations: melatonin (40.3%), referral to physician (22.0%), or sleep hygiene (0.6%). Over 12% of pharmacists (n = 107) provided inappropriate recommendations (anticholinergic agent or valerian root) and 21.5% of pharmacists were unable to provide any recommendation. We identified significant gaps in community pharmacists' knowledge regarding donepezil AEs and non-prescription insomnia recommendation needing significant improvement to ensure high-quality AD-related care.

Community pharmacists' knowledge of Alzheimer disease care in high- and low-income Chicago.

OBJECTIVES: This pilot study examined community pharmacists' knowledge to provide care and services for persons with Alzheimer disease (AD) and area income-based disparities in knowledge and availability of cognitive enhancers. METHODS: A cross-sectional telephone survey of pharmacies (n = 137) in high- and low-income areas in Chicago was conducted on pharmacists' degree, experience, and continuing education, as well as knowledge of AD disease and treatment expectations, adverse effects (AEs) of donepezil, and self-care recommendations for insomnia. Pharmacies were selected from highest- and lowest-income zip code areas, defined using household area median incomes from the 2008-2012 American Community Survey 5-Year Estimates. In-stock availability of select cognitive enhancers was obtained. Chi-square, Fisher exact test, and simple and multiple logistic regression analyses were performed with the use of Stata 10.1. RESULTS: Odds were 70% lower that pharmacists in low-income areas would say there was nothing to reverse the course of AD (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.13-0.70) and 7 times greater that they would recommend a medication to reverse the course of AD (OR 7.04, 95% CI 2.19-22.62) compared with pharmacists in high-income areas. Odds were more than 50% lower that pharmacists in low-income areas would name at least 1 adverse effect for donepezil (OR 0.42, 95% CI 0.19-0.92) compared with peers in high-income areas. Pharmacies in low-income areas had lower odds of having 4 of the 5 surveyed formulations of cognitive enhancers in stock. CONCLUSION: It is concerning that 20%-30% of pharmacists recommended a medication to "reverse" the course of AD, about one-half of pharmacists could not mention a single adverse effect of donepezil, and more than one-fourth of pharmacists made an inappropriate self-care sleep aid recommendation for a person with AD who was using rivastigmine patch. Although overall results regarding pharmacists' knowledge were poor, performance was significantly poorer in low-income areas. As our AD population increases, we need to strengthen pharmacists' knowledge on and competencies important for pharmacy-related AD care.

2018 American Society of Consultant Pharmacists Annual Meeting & Exhibition.

Poster abstracts are evaluated based on the following criteria: significance of the problem to healthy aging or medication management; innovativeness of ideas, methods, and/or approach; methodological rigor of methods and approach; presentation of finding; implications identified for future research, practice, and/or policy; and clarity of writing. Submissions are not evaluated through the peer-reviewed process used by The Consultant Pharmacist. Industry support is indicated, where applicable. Presenting author is in italics. The poster abstract presentation is supported by the ASCP Foundation.

Endogenous RGS proteins attenuate Galpha(i)-mediated lysophosphatidic acid signaling pathways in ovarian cancer cells.

Lysophosphatidic acid is a bioactive phospholipid that is produced by and stimulates ovarian cancer cells, promoting proliferation, migration, invasion, and survival. Effects of LPA are mediated by cell surface G-protein coupled receptors (GPCRs) that activate multiple heterotrimeric G-proteins. G-proteins are deactivated by Regulator of G-protein Signaling (RGS) proteins. This led us to hypothesize that RGS proteins may regulate G-protein signaling pathways initiated by LPA in ovarian cancer cells. To determine the effect of endogenous RGS proteins on LPA signaling in ovarian cancer cells, we compared LPA activity in SKOV-3 ovarian cancer cells expressing G(i) subunit constructs that are either insensitive to RGS protein regulation (RGSi) or their RGS wild-type (RGSwt) counterparts. Both forms of the G-protein contained a point mutation rendering them insensitive to inhibition with pertussis toxin, and cells were treated with pertussis toxin prior to experiments to eliminate endogenous G(i/o) signaling. The potency and efficacy of LPA-mediated inhibition of forskolin-stimulated adenylyl cyclase activity was enhanced in cells expressing RGSi G(i) proteins as compared to RGSwt G(i). We further showed that LPA signaling that is subject to RGS regulation terminates much faster than signaling thru RGS insensitive G-proteins. Finally, LPA-stimulated SKOV-3 cell migration, as measured in a wound-induced migration assay, was enhanced in cells expressing Galpha(i2) RGSi as compared to cells expressing Galpha(i2) RGSwt, suggesting that endogenous RGS proteins in ovarian cancer cells normally attenuate this LPA effect. These data establish RGS proteins as novel regulators of LPA signaling in ovarian cancer cells.