Unlocking the future of patient Education: ChatGPT vs. LexiComp® as sources of patient education materials.

BACKGROUND: ChatGPT is a conversational artificial intelligence technology that has shown application in various facets of healthcare. With the increased use of AI, it is imperative to assess the accuracy and comprehensibility of AI platforms. OBJECTIVE: This pilot project aimed to assess the understandability, readability, and accuracy of ChatGPT as a source of medication-related patient education as compared with an evidence-based medicine tertiary reference resource, LexiComp®. METHODS: Patient education materials (PEMs) were obtained from ChatGPT and LexiComp® for 8 common medications (albuterol, apixaban, atorvastatin, hydrocodone/acetaminophen, insulin glargine, levofloxacin, omeprazole, and sacubitril/valsartan). PEMs were extracted, blinded, and assessed by 2 investigators independently. The primary outcome was a comparison of the Patient Education Materials Assessment Tool-printable (PEMAT-P). Secondary outcomes included Flesch reading ease, Flesch Kincaid grade level, percent passive sentences, word count, and accuracy. A 7-item accuracy checklist for each medication was generated by expert consensus among pharmacist investigators, with LexiComp® PEMs serving as the control. PEMAT-P interrater reliability was determined via intraclass correlation coefficient (ICC). Flesch reading ease, Flesch Kincaid grade level, percent passive sentences, and word count were calculated by Microsoft® Word®. Continuous data were assessed using the Student's t-test via SPSS (version 20.0). RESULTS: No difference was found in the PEMAT-P understandability score of PEMs produced by ChatGPT versus LexiComp® [77.9% (11.0) vs. 72.5% (2.4), P=0.193]. Reading level was higher with ChatGPT [8.6 (1.2) vs. 5.6 (0.3), P < 0.001). ChatGPT PEMs had a lower percentage of passive sentences and lower word count. The average accuracy score of ChatGPT PEMs was 4.25/7 (61%), with scores ranging from 29% to 86%. CONCLUSION: Despite comparable PEMAT-P scores, ChatGPT PEMs did not meet grade level targets. Lower word count and passive text with ChatGPT PEMs could benefit patients, but the variable accuracy scores prevent routine use of ChatGPT to produce medication-related PEMs at this time.

Finding the sweet spot: Managing parenteral nutrition-related glycemic complications in hospitalized adults.

Parenteral nutrition (PN) remains an important aspect of treating hospitalized adult patients who are otherwise unable to achieve adequate nutrition intake. PN is highly individualized and requires careful adjustment of macronutrients and micronutrients to minimize complications. One frequent complication associated with PN involves blood glucose (BG) derangements including both hypoglycemia and hyperglycemia. PN-related glycemic complications are complex and multifactorial. Close BG monitoring is required for selecting and evaluating therapeutic interventions. BG goals for patients treated with PN may vary depending on patient-specific characteristics. Since dextrose provides the carbohydrate source in PN prescriptions, hyperglycemia may be expected, but nondextrose causes must also be considered. Insulin is a mainstay of therapy for managing glycemic complications related to PN, and the regimen chosen depends on patient-specific factors. However, insulin therapy also places the patient at an increased risk of hypoglycemia. Similarly, insulin is not the sole cause of hypoglycemia in these patients. The aim of this review is to describe the factors associated with dysglycemia during PN therapy and provide recommendations for minimizing and managing these complications, which is paramount to providing high-quality patient care and improving clinical outcomes.

Identifying future pharmacists: Development and implementation of a pharmacy camp experience.

INTRODUCTION: Hands-on learning continues to serve as a positive mechanism for gaining interest and increasing recruitment in the health professions. This paper explores the Harrison School of Pharmacy's (HSOP) development and implementation of a week-long pharmacy camp designed to engage learners through active learning experiences to provide early exposure to the pharmacy profession. METHODS: The planning committee was formed in fall 2016, with the inaugural camp occurring summer 2017. A partnership with Auburn University Youth Programs allowed the committee to utilize existing university infrastructure and resources. Designed to expose campers to a variety of practice settings, the curriculum immersed participants in active learning experiences that allowed them to learn more about the clinical skills and knowledge needed for practice. To create diverse and learner-centric experiences, the planning committee recruited current second- and third-year student pharmacists to serve as counselors and peer instructors for all camp activities. RESULTS: Over two years, the camp hosted 40 campers representing nine states. Campers were predominantly female (65.3%), an average age of 16.8 years, and 16% were from diverse backgrounds. Camper feedback found overall satisfaction with the camp was high, with most indicating they attended camp to learn more about the pharmacy profession, specifically the school. As of spring 2019, 20% of total campers had applied and been accepted into the HSOP's Early Assurance Program. CONCLUSIONS: While early findings are good, the true value of the camp will be found over time as the committee explores if more students are choosing pharmacy as a career.

Frequency of ß-Blocker Use Following Exacerbations of COPD in Patients with Compelling Indication for Use.

OBJECTIVE: To assess the current use of ß-blockers in patients with compelling indications for use, following the acute exacerbation of chronic obstructive pulmonary disease (COPD). METHODS: We performed a multicenter retrospective observational study using data from all of the patients admitted to five institutions for an acute exacerbation of COPD. Patients were included if they were admitted for an acute exacerbation of COPD and had a compelling indication for the use of a ß-blocker, defined as previous myocardial infarction or heart failure with left ventricular ejection fraction ≤40%. RESULTS: There were 396 patients meeting the criteria for inclusion in the study. The population was predominantly white men with myocardial infarction as the most prevalent compelling indication. On admission, 267 (67.4%) patients were receiving ß-blockers, which increased to 278 (70.2%) at discharge. There were 118 (29.8%) patients discharged without ß-blockers. Of the predictors tested, none were significantly predictive of a patient not receiving ß-blockers upon discharge; however, home and in-hospital ß-blockers reduced the likelihood of being discharged without a ß-blocker. Of the 129 patients not receiving ß-blockers prehospitalization, 23 (17.8%) were discharged with a new prescription for a ß-blocker. CONCLUSIONS: Nearly one-third of patients with compelling indications for ß-blockers were not prescribed the therapy at discharge.

Incorporating age-related special populations into a pharmacy skills laboratory course sequence.

BACKGROUND AND PURPOSE: The purpose was this study was to evaluate the incorporation of geriatric and pediatric therapeutic concepts into a pharmacy skills laboratory (PSL) course sequence. Secondary outcomes were to describe the incorporation and evaluate the assessment effectiveness of these topics. Educational activity and setting Teaching materials and assessment data from the PSL course were evaluated for inclusion of content regarding age-related special populations. FINDINGS: Materials reviewed from 205 PSL sessions held over four years demonstrated 89 (41.5%) sessions incorporated age-related topics using a variety of methods. Quiz and exam item performance was acceptable with an average difficulty index of 77.2% ± 21.3 and 85.8% ± 12.8, respectively. The average objective structured clinical exam (OSCE) score was also satisfactory at 83.2% ± 3. DISCUSSION AND CONCLUSIONS: Age-related topics were included in several PSL sessions. These incorporation strategies were deemed to be effective as students performed well on written assessments and OSCEs. Additional PSL sessions were identified as potential targets for incorporating age-related special populations into future PSL offerings.

Predisposition for Empathy, Intercultural Sensitivity, and Intentions for Using Motivational Interviewing in First Year Pharmacy Students.

Objective. To assess first-year pharmacy (P1) students' predispositions (eg, perceptions for empathy, intercultural sensitivity, and motivational interviewing (MI) as a patient-centered communication skillset) and identify potential curricula content/communication skills training needs. Methods. A cross-sectional survey was used to collect students' self-reported perceptions for empathy, intercultural sensitivity, counseling contexts, and projected future MI use. Relationships between variables were explored and logistic regression was used to evaluate intention for using MI in future patient encounters. Results. There were 134 students who participated. Higher predisposition for empathy and for intercultural sensitivity were significantly correlated. Significant predictors for applying MI in future patient encounters were sex, confidence with counseling skills, and current use of MI. Conclusion. Results suggest the need to incorporate innovative training strategies in communication skills curricula. Potential areas include empathy, intercultural sensitivity and significant predictor variables for future MI use. Further investigation in other schools is needed.

Allometric versus consensus guideline dosing in achieving target vancomycin trough concentrations.

PURPOSE: Results of a study comparing the performance of allometric versus consensus guideline-recommended vancomycin dosing in achieving initial trough concentrations within the desired range are reported. METHODS: A retrospective study was conducted to compare selected outcomes with 2 vancomycin dosing methods: (1) dosing by total body weight, as recommended in current consensus guidelines, and (2) a new empirical vancomycin dosing strategy grounded in allometry (the study of the relationship between body size and physiology). The primary outcome was attainment of an initial vancomycin trough concentration within the target range (10-20 mg/L). Rates of nephrotoxicity associated with the 2 dosing methods were compared. RESULTS: Allometric dosing resulted in 77% of the evaluated patient sample (n = 81) achieving vancomycin trough concentration targets at the initial measurement, as compared with a target attainment rate of 57% (n = 81) with guideline-recommended dosing (p = 0.0121); the rate of target attainment in obese patients was also improved with allometric dosing (73% versus 46%, p = 0.0327). Nephrotoxicity rates did not differ significantly between the 2 groups, but a lower rate was observed with allometric versus guideline-based dosing (1.2% versus 7.4%, p = 0.0584). CONCLUSION: In hospitalized adults, allometric vancomycin dosing achieved a higher frequency of initial vancomycin trough concentrations within the target range of 10-20 mg/L, compared with dosing as recommended by consensus guidelines. The difference between methods in the percentage of troughs within the target range was most pronounced in obese patients.

Potential problems and solutions with inhaler use in elderly COPD patients.

With the number of elderly people increasing each year, the potential problems of treating chronic obstructive pulmonary disease (COPD) in elderly patients is likely to become more prevalent. Naturally occurring changes during aging may lead to a change in treatment needs. Mental and dexterity decline can lead to increased difficulty operating the inhalers that are a staple of COPD treatment. Decreased respiratory strength can make it difficult for patients to achieve an adequate peak inspiratory force, which may prevent maximum benefit from inhaler use. Pharmacists have the unique opportunity of interacting with patients at the point of care and can make a significant impact by ensuring that these barriers are not affecting their patients.

Statin use and cognitive changes in elderly patients with dementia.

HMG-CoA reductase inhibitors ("statins") are commonly prescribed for the treatment of dyslipidemia and prevention of any complications arising from this disease. The Food and Drug Administration recently published enhanced warnings for statin use, including the possible relationship between statins and cognitive impairment, especially in the elderly. Significant cognitive decline associated with statin use in elderly patients with Alzheimer's disease has also been reported recently. However, the 2013 American College of Cardiology/American Heart Association blood cholesterol guidelines stated that no evidence is available supporting the conclusion that statins cause an adverse effect on cognition or risk of dementia. Because of the increasing number of elderly patients with dementia, this relationship needs to be examined. This article will review cognitive changes associated with statin use in elderly patients with dementia and offer clinical recommendations.

Tapentadol-ER for the treatment of diabetic peripheral neuropathy.

With the prevalence of diabetes mellitus (DM) increasing, pathologic complications such as diabetic peripheral neuropathy (DPN) are also becoming more common. Of those diagnosed with DM, 10% to 20% of patients suffer from painful DPN. Until recently, only pregabalin and duloxetine possessed Food and Drug Administration (FDA) approval for this condition. However, FDA recently approved tapentadol-ER [extended release] (Nucynta ER) for painful DPN. Tapentadol-ER is an opioid analgesic commonly used for the treatment of moderate-to-severe chronic pain that contains a unique dual mechanism acting as both a weak mu-opiod receptor agonist and norepinephine-reuptake inhibitor. It is by way of this unique dual mechanism that allows for effective analgesic effects with increased tolerability. This new FDA approval provides an additional therapeutic option to treat DPN in symptomatic patients.

Fentanyl pectin nasal spray: a novel intranasal delivery method for the treatment of breakthrough cancer pain.

Fentanyl pectin nasal spray is a novel intranasal formulation for the management of breakthrough cancer pain in patients taking and tolerant to opioids for persistent cancer pain. The pectin-based delivery modulates the product's transmucosal absorption. Nasal delivery allows fentanyl pectin nasal spray to achieve a greater maximum plasma concentration than oral transmucosal fentanyl products and at a much faster rate. Compared with intranasal fentanyl compounded with aqueous solutions, the pectin-based system decreases the maximum plasma concentration and prolongs exposure to more closely match the time course of a typical breakthrough cancer pain episode. Throughout all phases of clinical studies, it was shown to be safe and effective in doses between 100 and 800 µg per breakthrough pain episode. Fentanyl pectin nasal spray is the only proprietary intranasal fentanyl formulation in the USA and one of two in Europe. Owing to the medication's delivery system, the pharmacokinetics and subsequent dosing are unique to this product and should not be interchanged with any other proprietary or compounded fentanyl product.