Feeble, fallen, and forgetting: association of cognitive impairment and falls on outcomes of major intra-abdominal surgeries in older adults.

BACKGROUND: Both cognitive impairment/dementia (CID) and falls occur more commonly in older adults than in younger patients. This study aimed to analyze the association of a history of CID or falls with the postoperative outcomes of older adults undergoing major intra-abdominal surgeries on a national level. METHODS: We retrospectively analyzed the American College of Surgeons-National Surgical Quality Improvement Program 2022 Participant Use Data File. Our primary outcome was postoperative mortality. Statistical analysis was performed using the Chi-square test and multivariate regression analysis. RESULTS: On multivariable regression analyses, a history of both CID (odds ratio [OR] = 1.9; CI: 1.5-2.5; P < .01) and a fall (OR = 1.8; CI: 1.4-2.3; P < .01) were independently associated with higher adjusted odds of mortality. History of CID or falls was also a predictor of overall complications, major complications, and discharge to a care facility. CONCLUSION: A history of CID or falls in older adults before major intra-abdominal surgeries was associated with a high risk of postoperative mortality and morbidity. Further studies are required to establish the causal relation of these factors and the steps to mitigate the risk of associated adverse outcomes.

Roles of Pharmacy Technicians in Preventing Prescription Drug Abuse.

Objective: To provide and identify potential roles and strategies for pharmacy technicians to identify and prevent drug abuse within the pharmacy. Data Sources: Related materials were searched via PubMed and Google Scholar from 2000 to present using search terms: "pharmacy," "technicians," "prescription," "drug," and "abuse." Articles describing statistics, warning signs, and prevention strategies for pharmacies were identified through databases and organizations' sites. Portions of the Ohio Administrative Code on OARRS (Ohio Automated Rx Reporting System), and Pennsylvania prescription drug monitoring program information were also identified. Study Selection and Data Extraction: Relevant sections of the Ohio Administrative Code and OARRS were identified through the Ohio Board of Pharmacy website. Information regarding the Pennsylvania Prescription Drug Monitoring was identified via Pennsylvania's Department of Health website. Sections of the Combat Methamphetamine Act of 2005 were identified through the Drug Enforcement Administration Diversion website. Resources on drug abuse and prevention statistics were obtained from Drug Abuse.gov and American Society of Health System Pharmacists. Information regarding warning signs were identified from the National Association of Boards of Pharmacy. Data Synthesis: The data provided for identification of potential roles for technicians within efforts to prevent prescription drug abuse, including evaluation of warning signs, involvement in the use of prescription monitoring programs, and in efforts to prevent methamphetamine abuse and diversion. Conclusions: After identifying potential roles for pharmacy technician involvement in the prevention of prescription drug abuse, it is evident that there is a need for further education and training on the subject specific to pharmacy technicians.

Exploring the expanded role of the pharmacy technician in medication therapy management service implementation in the community pharmacy.

OBJECTIVES: To explore the current roles of the pharmacy technician in the provision of medication therapy management (MTM) and their relation to organizational behavior at "high-performing" community pharmacies within a nationwide supermarket chain. DESIGN: Qualitative research study using methodologic triangulation with the use of semistructured interviews of key informants, direct observation at "high-performing" pharmacy sites, and respondent journals. SETTING AND PARTICIPANTS: High-performing pharmacy sites within a large supermarket pharmacy chain in Tennessee. A high-performing site was defined as a pharmacy that has successfully implemented MTM into its pharmacy workflow. MAIN OUTCOME MEASURES: Themes related to pharmacy technician roles in the delivery of direct patient care services. RESULTS: A total of 28 key informants were interviewed from May 2015 to May 2016. Key informants included 10 certified technicians, 5 noncertified technicians, and 13 pharmacists across 8 pharmacies in central and eastern Tennessee. Three themes were identified. At high-performing sites, pharmacy technicians were engaged in both clinical support activities as well as nonclinical support activities with the goal of improving clinical service implementation. Several barriers and facilitators were revealed. CONCLUSION: Within high-performing teams, expanded technician roles to support patient care service delivery were associated with successful clinical service implementation. Future studies should further explore these expanded technician duties, as well as the role of organizational culture, climate, and team dynamics, in the delivery of patient care and clinical services across a heterogeneous pharmacy setting.

Role of Approved Ohio High School Training Programs in the Demand for Pharmacy Technicians.

Objective: To provide an overview of Ohio Administrative Code 4729 and to identify the potential role of newly approved Ohio high school training programs in preparation of registration-ready pharmacy technicians. Data Sources: Relevant sections of the Ohio Administrative Code and the Ohio public high school pharmacy technician training program application were identified through the Ohio Board of Pharmacy website. Resources on employee training and pharmacy technician demand were used from the Bureau of Labor Statistics, Forbes magazine, Association for Talent Development, and ExploreGate. Information pertaining to the approved high school training programs was identified from the program-specific websites. Related materials were searched for via PubMed and Google Scholar from 2000 to present. Study Selection and Data Extraction: Portions of the Ohio Administrative Code pertaining to pharmacy technician training and registration. Articles describing the cost of employer-based training and the growth of pharmacy technician demand. Data Synthesis: Training and registration requirements for pharmacy technicians have increased over the past decade. In Ohio, pharmacy technicians must now complete an approved training program and become either a registered or certified technician with the Board of Pharmacy. Technicians may complete either a nationally recognized, employer-based, or public high school training program prior to becoming a registered or certified pharmacy technician. Ohio public high school training programs must be Board approved and must prepare students for national certification. After completing a high school training program, pharmacy technicians are adequately prepared to enter the workforce with minimal training burden to potential employers. Conclusions: Newly approved Ohio high school training programs have the potential to fulfill the increased demand for pharmacy technicians at a decreased cost to both students and employers.

Perspectives of athletes and pharmacists on pharmacist-provided sports supplement counseling: An exploratory study.

OBJECTIVES: To identify athletes' interests in receiving advice about sports supplements from a pharmacist in a supermarket setting and to identify pharmacists' knowledge, confidence, and enthusiasm for providing counseling on various sports supplements. METHODS: Two cross-sectional surveys were developed and administered. One survey was administered to athletes at local northwestern Ohio fitness facilities, and 1 survey was administered to pharmacists in chain pharmacies during mid-February to mid-March 2017. The athlete survey gathered demographic information, information sources, products purchased, including their location and selection factors, and perceptions of pharmacists providing sports supplement counseling. The pharmacist survey gathered demographic information; knowledge, confidence, and enthusiasm for providing sports supplement counseling; perceptions of counseling benefit; and barriers to implementation of providing a sports supplement counseling service. RESULTS: The athlete survey had 129 participants. Athletes primarily reported obtaining sports supplement information from supplement stores, and only 2% indicated using a pharmacist. Although 52% said they would talk to a pharmacist about sports supplements, 66% said their perception of a pharmacist's fitness level would influence whether or not they would approach him or her. The pharmacist survey had 143 participants. On a 5-point Likert-type scale (1 = strongly disagree and 5 = strongly agree), the mean (SD) of their knowledge, confidence, and enthusiasm statements were 2.49 (0.89); 2.61 (0.94); and 3.54 (0.87), respectively. Ninety-two percent (n = 130) of pharmacists thought it would be beneficial to provide counseling on sports supplements. Perceived barriers included lack of knowledge, evidence, and time. CONCLUSION: Pharmacists were not identified as a primary resource for sports supplements, but athletes would be willing to discuss this topic with knowledgeable and physically fit pharmacists. Pharmacists felt that they lacked knowledge and confidence regarding sports supplement products but noted enthusiasm to provide counseling. Sports pharmacy counseling could be a viable expansion of pharmacy services in community pharmacies with proper education and tools.

Contemporary Review of Artificial Urinary Sphincters for Male Stress Urinary Incontinence.

INTRODUCTION: The most common cause of urinary incontinence in men after radical prostatectomy is intrinsic sphincter deficiency, which can affect long-term quality of life. The prevalence of stress urinary incontinence (SUI) after radical prostatectomy has been reported to be 2.5% to 90%. For patients with moderate to severe male SUI, the artificial urinary sphincter (AUS) is considered the gold standard in surgical treatment. AIM: To review the available literature on the development, patient selection, surgical technique, complications, and management of AUS for male SUI. METHODS: A literature review was performed through PubMed from 1947 to 2015 regarding AUS for male SUI. MAIN OUTCOME MEASURES: To assess various surgical techniques related to AUS insertion, outcomes, and complications and to offer recommendations regarding management of complications. RESULTS: The AUS can be placed through a perineal or trans-scrotal incision, particularly in the setting of dual insertion of an AUS and an inflatable penile prosthesis. The most commonly used cuff is 4.0 cm. The efficacy of InhibiZone is debatable. Pressure-regulating balloons can be filled with saline or contrast material and can be placed in an orthotopic or an ectopic location. In a systematic review of the literature, dry or improved continence rates are achieved in 79% of patients, with 90% reporting satisfaction and improved quality-of-life index scores after surgery. The most common AUS complications include a nonfunctioning device, sub-cuff atrophy, erosion, and infection. These complications are managed by strategies such as cuff downsizing, tandem cuff placement, and explantation. Dual AUS and inflatable penile prosthesis insertion is feasible for patients with SUI and erectile dysfunction. CONCLUSION: The AUS is a durable and effective device for the management of SUI. Surgeons should be versed in the different device components, their potential complications, and their management.

Accelerometer Measurement of Head Movement During Laparoscopic Surgery as a Tool to Evaluate Skill Development of Surgeons.

OBJECTIVE: To detect and measure surgeons' head movement during laparoscopic simulator performance to determine whether expert surgeons have economy of motion in their head movement, including change of direction, compared with intermediate and novice surgeons. We investigated head movement as an objective tool for assessment of laparoscopic surgical skill and its potential use for assessing novice surgeons' progress on the learning curve. DESIGN: After obtaining institutional review board approval, medical students, urology residents, and attending staff surgeons from an academic institution were recruited. Participants were grouped by level of experience and performed tasks on the Electronic Data Generation for Evaluation laparoscopic simulator. Surgeons wore a commercially available wireless electroencephalogram monitor as a flexible, adjustable, and lightweight headband with 7 sensors-2 forehead sensors, 2 ear sensors, and 3 reference sensors. The headband incorporates a 3-axis accelerometer enabling head movement quantification. A variance analysis was used to compare the average head movement acceleration data between each group. SETTING: Tulane University Medical Center, New Orleans, LA, an academic medical center and the principal teaching hospital for Tulane University School of Medicine. PARTICIPANTS: A total of following 19 participants were recruited for the study and stratified by surgical experience into novice (n = 6), intermediate (n = 9), and expert (n = 4) laparoscopy groups: 6 medical students, 9 urology residents (postgraduate years 1 to5), and 4 attending urologists, respectively. RESULTS: Analysis of the average acceleration rate of head movement showed statistically significant differences among groups on both the vertical axis (p = 0.006) and horizontal axis (p = 0.018) in the laparoscopic suturing task. This demonstrated the ability to distinguish between experts and novice laparoscopic surgeons. The average acceleration among groups did not demonstrate statistical significance on the vertical axis (p = 0.078) and horizontal axis (p = 0.077) in the peg transfer task. This may be in response to the ease of the task. The analysis of the forward-backward axis or depth perception also showed no significant differences between groups. CONCLUSION: Accelerometer-based motion analysis of head movement appears to be a useful tool to evaluate laparoscopic skill development of surgeons in terms of their economy of motion, and it could potentially be used for ergonomic assessment of training in the future, and progression on the learning curve.

Three-dimensional printing of surgical anatomy.

PURPOSE OF REVIEW: Over the past decade, three-dimensional printing for the medical field has been expanding rapidly throughout all of medicine. This manuscript reviews the current and potential applications for three-dimensional printing, including education, presurgical planning, surgical simulation, bioprinting, and printed surgical equipment. RECENT FINDINGS: Three-dimensional printing has proved most relevant in the fields of craniofacial, plastic, orthopedics, and especially, urologic surgery. This review focuses on several examples of how three-dimensional printing can be utilized, with emphasis on renal models for renal cell carcinoma, ureteral stents, and staghorn calculus. From an education standpoint, both patients and residents can benefit from the use of three-dimensional printed models, and even skilled surgeons report better understanding of complex procedures by using printed models. SUMMARY: Three-dimensional printing in the field of medicine is growing quickly, and will soon be incorporated into the way residents are taught and patients are educated. For surgical simulation in a variety of disease processes, this will be particularly useful for urologic surgery.

Crowdsourcing Assessment of Surgeon Dissection of Renal Artery and Vein During Robotic Partial Nephrectomy: A Novel Approach for Quantitative Assessment of Surgical Performance.

INTRODUCTION: We sought to describe a methodology of crowdsourcing for obtaining quantitative performance ratings of surgeons performing renal artery and vein dissection of robotic partial nephrectomy (RPN). We sought to compare assessment of technical performance obtained from the crowdsourcers with that of surgical content experts (CE). Our hypothesis is that the crowd can score performances of renal hilar dissection comparably to surgical CE using the Global Evaluative Assessment of Robotic Skills (GEARS). METHODS: A group of resident and attending robotic surgeons submitted a total of 14 video clips of RPN during hilar dissection. These videos were rated by both crowd and CE for technical skills performance using GEARS. A minimum of 3 CE and 30 Amazon Mechanical Turk crowdworkers evaluated each video with the GEARS scale. RESULTS: Within 13 days, we received ratings of all videos from all CE, and within 11.5 hours, we received 548 GEARS ratings from crowdworkers. Even though CE were exposed to a training module, internal consistency across videos of CE GEARS ratings remained low (ICC = 0.38). Despite this, we found that crowdworker GEARS ratings of videos were highly correlated with CE ratings at both the video level (R = 0.82, p < 0.001) and surgeon level (R = 0.84, p < 0.001). Similarly, crowdworker ratings of the renal artery dissection were highly correlated with expert assessments (R = 0.83, p < 0.001) for the unique surgery-specific assessment question. CONCLUSIONS: We conclude that crowdsourced assessment of qualitative performance ratings may be an alternative and/or adjunct to surgical experts' ratings and would provide a rapid scalable solution to triage technical skills.

Penile Priapism, Clitoral Priapism, and Persistent Genital Arousal Disorder: A Contemporary Review.

INTRODUCTION: Priapism is a persistent erection that arises from a dysfunction of the normal regulatory mechanisms of penile tumescence, rigidity, and flaccidity. It is defined as an erection lasting longer than 6 hours that is not related to sexual stimulation. There are three types of priapism: ischemic, non-ischemic, and stuttering. Similarly, clitoral priapism may occur in females manifested by symptoms such as engorgement with pain and swelling of the clitoris and surrounding tissue. Persistent genital arousal disorder (PGAD) is uncontrollable genital arousal in females, with or without orgasms, that occurs spontaneously and without any sexual feelings. AIM: The aim of this article is to review the available literature on priapism, clitoral priapism, and PGAD. METHODS: A literature review was performed through PubMed regarding priapism, clitoral priapism, and PGAD. MAIN OUTCOME MEASURES: The main outcome is an assessment of the potential etiologies, pathophysiology, diagnostic tools, and management options (medical and surgical) for these conditions. RESULTS: Initial workup of priapism should include a thorough history, physical examination, and cavernous arterial blood gas measurement. Findings should guide further management depending on the etiology of priapism (ischemic vs. non-ischemic). For ischemic priapism, a widely used therapeutic algorithm has been described. For patients with stuttering priapism, multiple oral therapies are currently available. Most reported cases of clitoral priapism appear to be drug-induced, and the primary treatment is stopping the offending agent. Medications like phenylpropanolamine and phenylephrine can also be utilized. PGAD may be associated with anatomical abnormalities, such as Tarlov cysts for which an epidural anesthesia block may be considered. CONCLUSIONS: Early recognition and diagnosis of priapism is paramount to preserving erectile function. Current treatment regimens for ischemic priapism have room for innovation in both pharmacological and surgical therapies. Further investigation into the etiologies and treatment options for clitoral priapism and PGAD are required. Yafi FA, April D, Powers MK, Sangkum P, and Hellstrom WJG. Penile priapism, clitoral priapism, and persistent genital arousal disorder: A contemporary review. Sex Med Rev 2015;3:145-159.

Trends in Toilet Training and Voiding Habits among Children with Down Syndrome.

PURPOSE: Children with Down syndrome are at risk for lower urinary tract dysfunction and delayed toilet training. Comparative studies regarding voiding function in the Down syndrome population are lacking. We assessed urinary continence and voiding function in patients with Down syndrome and a control group. MATERIALS AND METHODS: A questionnaire designed to assess toilet training, continence status, symptoms of lower urinary tract dysfunction and prior evaluation of urological complaints was sent to parents of 326 children with Down syndrome who had been seen at our institution previously. The same survey was administered to parents of patients without Down syndrome. Data were compiled, and descriptive and comparative statistical analyses were performed. RESULTS: A total of 77 patients comprised the Down syndrome group and 78 patients without Down syndrome comprised the control group. Average age of reported toilet training completion was 5.5 years in children with Down syndrome and 2.2 years in controls. Of children 5 years or older 79% with Down syndrome were toilet trained, compared to 100% of those without Down syndrome. Incontinence was reported in 46% of previously toilet trained children with Down syndrome and 24.5% of controls. These findings were statistically significant. No significant difference was observed in the rate of urinary tract infection, symptoms of lower urinary tract dysfunction or evaluation for urological complaints. CONCLUSIONS: Children with Down syndrome can experience marked delay in toilet training and are more likely to suffer incontinence afterward. This study was ineffective in determining whether symptoms of lower urinary tract dysfunction could be related to decreased continence rates.

Impact of a Transitions of Care Training Module on Community Pharmacists' Knowledge and Attitudes.

Background: Community pharmacists' accessibility to patient histories and personal patient relationships situates them to have a potentially significant impact on transitions of care. Recent literature has demonstrated that improved patient outcomes and an overall reduction in health care costs occur when pharmacists are involved in medication reconciliation during transitions of care. Objective: To develop a transitions of care training module for community pharmacists. To assess the training module's impact on pharmacists' transition of care knowledge and their attitude toward actively participating in the transitions of care for their patients. Methods: Community pharmacists practicing in a supermarket pharmacy chain participated in this study. A pretest and posttest were administered around a 30-minute transitions of care training module. The attitude assessment consisted of a 5-point Likert-type scale, while the knowledge-based assessment consisted of true/false and multiple-choice questions. SPSS version 21.0 was used to generate descriptive and nonparametric statistical analyses. The study was approved by the University of Toledo Social, Behavioral, and Educational Institutional Review Board. Results: Thirty-six pharmacists (72%) successfully completed the pre-post survey. The average pharmacist posttest knowledge survey score improved from the pretest score, 73% to 99%. A paired Student's t test demonstrated the posttest percentage of correct questions on the knowledge-based survey improved from the baseline knowledge. Pharmacists' average posttest attitudes regarding participation in patients' transitions of care statistically improved compared to their pretest attitudes. Conclusion: Community pharmacists' transitions of care knowledge and attitudes can be improved through a training module.

Neoadjuvant Tyrosine Kinase Downstaging of T2 Renal Cell Carcinoma in Solitary Kidney Before Robotic Partial Nephrectomy.

We highlight the use of a tyrosine kinase inhibitor, pazopanib, for neoadjuvant downstaging a 7.4 cm right biopsy-proven clear cell renal-cell carcinoma in a solitary kidney before surgical intervention of robotic partial nephrectomy with retrograde cooling to induce cold ischemia in a 79-year-old male.

Outcomes of intralesional interferon-α2B for the treatment of Peyronie disease.

PURPOSE: We evaluated the efficacy of intralesional interferon-α2b for Peyronie disease, reviewed the impact of the timing of therapy from disease onset and identified variables predictive of a response. MATERIALS AND METHODS: We retrospectively reviewed the charts of patients treated with intralesional interferon-α2b from 2001 to 2012. Demographic information, disease characteristics, pretreatment and posttreatment penile duplex ultrasound findings, and objective measures were analyzed. Response was defined as a 20% or greater improvement in curvature. Statistical analysis was done to identify significant changes in variables and identify predictive factors. RESULTS: A total of 127 patients with a mean age of 55 years (range 25 to 76) and a mean±SD pretreatment curvature of 42.4±18.6 degrees underwent a median of 12 biweekly interferon-α2b injections (range 6 to 24). The median history of Peyronie disease was 2.0 years (range 0.5 to 23). Of the patients 54% responded to therapy with an overall mean improvement of 9.0 degrees (p<0.001). Patients with less than 30-degree curvature were most likely to experience a 20% or greater improvement with interferon-α2b (86% response, p<0.001). However, similar overall improvement in pretreatment curvature was noted in all cases. No statistically significant improvement was observed in penile vascular status or ultrasound parameters. The duration of Peyronie disease did not impact the change in curvature. Age, pretreatment curvature, vascular status, penile ultrasound findings, curvature site and International Index of Erectile Function (IIEF) score did not predict the response to therapy. CONCLUSIONS: Intralesional therapy with interferon-α2b resulted in significantly improved curvature without impacting penile vascular parameters. The absolute improvement in curvature was independent of pretreatment curvature or Peyronie disease duration.

Student pharmacists' perceptions of barriers to medication adherence counseling.

PURPOSE: To identify the barriers perceived by student pharmacists to counseling on medication adherence in a supermarket community pharmacy chain. METHODS: Online surveys were made available to 65 student pharmacists. Subjects completed the survey anonymously and indicated their opinions and perceptions on topics related to medication adherence through the use of a 5-point Likert-type scale. RESULTS: Of the surveyed student pharmacists, 26 completed the survey (40%). All participants (100%) agreed that they have knowledge on the importance of medication adherence. Student pharmacists stated that they did not have the time to cover adherence in a counseling session (72.7%) nor did they have time to perform follow-up phone calls with the patient (54.5%). The majority of student pharmacists (81.8%) were comfortable bringing up the topic of adherence with the patient but thought that they did not have access to resources on adherence to provide to the patient (59%). CONCLUSIONS: Surveyed students indicated they were constrained for time to counsel patients on adherence and to perform continued follow-up with patients afterward. Factors cited as barriers to counseling patients on medication adherence include time, lack of specific training in adherence management, lack of resources to provide to the patient, and patient disinterest in the subject.

Current and emerging treatment options for Peyronie's disease.

Peyronie's disease (PD) is a condition of the penis, characterized by the presence of localized fibrotic plaque in the tunica albuginea. PD is not an uncommon disorder, with recent epidemiologic studies documenting a prevalence of 3-9% of adult men affected. The actual prevalence of PD may be even higher. It is often associated with penile pain, anatomical deformities in the erect penis, and difficulty with intromission. As the definitive pathophysiology of PD has not been completely elucidated, further basic research is required to make progress in the understanding of this enigmatic condition. Similarly, research on effective therapies is limited. Currently, nonsurgical treatments are used for those men who are in the acute stage of PD, whereas surgical options are reserved for men with established PD who cannot successfully penetrate. Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD. A surgical approach should be considered when men with PD do not respond to conservative, medical, or minimally invasive therapies for approximately 1 year and cannot have satisfactory sexual intercourse. As scientific breakthroughs in the understanding of the mechanisms of this disease process evolve, novel treatments for the many men suffering with PD are anticipated.

Lessons learned from an accelerated post-master's nurse educator certificate program: teaching the practicum course.

Nursing faces current and future shortages in the practice arena. The nurse educator shortage exacerbates the nursing shortage.This article describes an innovative and collaborative approach developed to increase the supply of nurse educators. An overview of the initial offering of this post-master's nurse educator certificate program, a grant-funded, cohort-based program, delivered online in an accelerated format, is provided. Particular attention is given to the nursing education practicum, a precepted teaching experience. This course is viewed as a culminating course, wherein the role transition from expert practitioner to novice educator occurs as students connect the experiential aspects of the practicum with knowledge gained in didactic courses and enter a new community of practice. Lessons learned and recommendations for future cohorts are discussed.

Staphylococcus aureus biofilms: properties, regulation, and roles in human disease.

Increasing attention has been focused on understanding bacterial biofilms and this growth modality's relation to human disease. In this review we explore the genetic regulation and molecular components involved in biofilm formation and maturation in the context of the Gram-positive cocci, Staphylococcus aureus. In addition, we discuss diseases and host immune responses, along with current therapies associated with S. aureus biofilm infections and prevention strategies.

Comparison of patient assistance program software.

PURPOSE: The capabilities of available software programs for the management of applications to patient assistance programs (PAPs) and associated administrative tasks are reported. SUMMARY: Fifteen PAP software programs available at the time of data collection (July-September 2010) were identified through an Internet search and from e-mailed responses to a listserv request. To supplement and confirm the information obtained online, the software makers were contacted; additional data were collected through follow-up correspondence. The survey was restricted to standalone programs; all manufacturer-provided information was assumed to be accurate, and the products were not tested. The 15 software products evaluated (11 Web-based and 4 Windows-based programs) offered a wide range of capabilities to streamline the PAP application process, such as storage of patient and physician profiles, automatic completion of forms with stored data, application status tracking, and customized report generation. The Web-based programs offered some advantages over the Windows-based programs, including greater user accessibility and automatic updates. Product pricing varied widely, depending on the specific licensing terms. Some manufacturers offered discounts to health care organizations participating in the 340B Prime Vendor Program; some offered volume discounts. In addition, grant support may be available to help pay software licensing costs. CONCLUSION: There are at least 15 software programs for streamlining and enhancing the process of PAP application management. No single program can meet the needs of every organization; selecting the right product demands a close look at the needs of an organization and the features and logistics of each program.

Cultural competence knowledge and confidence after classroom activities.

OBJECTIVES: To determine change in cultural competency knowledge and perceived confidence of second-year pharmacy students to deliver culturally competent care after completing a required cultural competency curriculum. DESIGN: Cultural competence material was covered in the second-year PharmD curriculum through lectures, laboratories, and an experiential/out-of-class assignment. ASSESSMENT: Eighty-five second-year (P2) pharmacy students completed a survey which assessed influence of classroom activities related to cultural competence. Mean values for knowledge and perceived confidence were significantly higher for posttest compared to pretest (p < 0.01), after cultural competency activities. Focus groups were used to solicit students' opinions on instructional effectiveness, relevance of activities, and areas for enhancement. CONCLUSION: The cultural competency curriculum increased pharmacy students' awareness of and confidence in addressing cultural diversity issues that affect pharmaceutical care delivery.