Current state of APPE-readiness assessments in schools or colleges of pharmacy.

Objective: To determine components and assessments included in Advanced Pharmacy Practice Experience (APPE) readiness plans in United States Doctor of Pharmacy (PharmD) programs.

Methods: An electronic survey was emailed to the American Association of Colleges of Pharmacy Laboratory Instructors Special Interest Group. Survey items included demographic information about the program, APPE-readiness plan implementation status and components.

How did we get here? Evolution of specifications grading in a required skills-based course series.

Background And Purpose: Specifications grading is a mastery-based grading approach to unlock student potential and empower students to focus on learning goals while receiving and acting on meaningful feedback. Within specifications grading, bundles are created to group assignments and assessments. Based on student achievement within each bundle, overall course grade is determined.

Incorporation of Innovative Strategies for Patient Education in Pharmacist-Led Transition of Care Initiatives.

As patients transition between health care settings, they are at an increased risk of adverse events and medication errors as a result of medication changes and miscommunication. Pharmacists have traditionally provided transitions of care (TOC) services, including patient education, in a face-to-face manner with the goal of reducing medication errors and enhancing patient safety and understanding. However, changes in care delivery models, a burdened health care workforce, and diminishing resources necessitate innovative approaches for the provision of patient education within TOC.

A Scoping Review of Student Pharmacist-Led Transitions-of-Care Initiatives.

Objectives: To identify and evaluate the current literature pertaining to student pharmacist-led transitions-of-care (TOC) initiatives and to inform pharmacy educators regarding the current and future roles of pharmacy learners in TOC.

Findings: A total of 14 articles were identified describing student-led initiatives in care transitions to the inpatient setting and from the inpatient to the outpatient setting. In most studies, student pharmacists involved in delivering TOC services were completing either an advanced pharmacy practice experience or an introductory pharmacy practice experience and were most commonly performing services such as admission medication history and reconciliation.

Teaching pharmacy students a systematic approach to medication order verification.

Background And Purpose: Inpatient medication order verification is an important skill for pharmacy students to learn for patient safety. This article describes a systematic approach to order verification that enables students to apply didactic knowledge and determine the presence of drug therapy problems during verification decisions.

Educational Activity And Setting: At two different colleges of pharmacy, an order verification module for second-year pharmacy students introduced a checklist for reviewing medication orders in a patient chart and identifying the presence of drug therapy problems.

Low-Density Lipoproteins, High-Density Lipoproteins (HDL), and HDL-Associated Proteins Differentially Modulate Chronic Myelogenous Leukemia Cell Viability.

Cellular lipid metabolism, lipoprotein interactions, and liver X receptor (LXR) activation have been implicated in the pathophysiology and treatment of cancer, although findings vary across cancer models and by lipoprotein profiles. In this study, we investigated the effects of human-derived low-density lipoproteins (LDL), high-density lipoproteins (HDL), and HDL-associated proteins apolipoprotein A1 (apoA1) and serum amyloid A (SAA) on markers of viability, cholesterol flux, and differentiation in K562 cells-a bone marrow-derived, stem-like erythroleukemia cell model of chronic myelogenous leukemia (CML). We further evaluated whether lipoprotein-mediated effects were altered by concomitant LXR activation.

Evaluation of the protective effects of β-blockers in the management of acute exacerbations of chronic obstructive pulmonary disease.

What Is Known And Objective: The purpose of this study was to evaluate the association between early β-blocker continuation and major inpatient events in patients hospitalized for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods: This single centre, retrospective, investigational review board approved cohort study evaluated patients admitted for a primary diagnosis of AECOPD. Patients were evaluated based on early continuation of a β-blocker whether a β-blocker was initiated within 24 hours of admission and continued for at least 72 hours.

Evaluation of Adherence to Guideline-Directed Antithrombotic Therapy for Atrial Fibrillation at Hospital Discharge.

Background: Risk stratification for stroke in patients with atrial fibrillation is a vital step in identifying whether antithrombotic therapy is indicated for stroke prevention in this common arrhythmia.

Purpose: The aim of this study was to determine adherence to guideline-directed antithrombotic therapy based on Congestive Heart Failure (1 point), Hypertension (1 point), Age (≥75 years old is 2 points and 65-74 is 1 point), Diabetes (1 point), prior Stroke (2 points), Vascular Disease (1 point), and Sex Category (1 point if female; CHADS-VASc) score in patients with atrial fibrillation (AF) on hospital discharge.

Methods: A total of 293 patients discharged from this academic medical center with a history of atrial fibrillation from June 2014 to June 2016 were enrolled.

Failure of chemical thromboprophylaxis in critically ill medical and surgical patients with sepsis.

Purpose: Critically ill patients who develop sepsis may be at a higher risk of venous thromboembolism (VTE) prophylaxis failure; however, studies in this population are limited. The objective of this study was to identify the incidence of VTE prophylaxis failure in this population.

Methods: This retrospective review of patients admitted to the intensive care unit between February 2013 and September 2015 included patients who were diagnosed with sepsis and received heparin or enoxaparin VTE prophylaxis.

The pharmacological challenges of treating tuberculosis and HIV coinfections.

Tuberculosis (TB) is the most prevalent opportunistic infection among HIV patients, and the leading cause of death among HIV patients worldwide. Simultaneous treatment of both diseases is recommended by current guidelines, but can be challenging due to the potential for drug-drug interactions, overlapping toxicities, difficulty adhering to medications, and an increased risk for immune reconstitution inflammatory syndrome (IRIS). Clinical manifestations of TB can also vary between HIV-infected patients and uninfected patients, which can increase the risk for delayed diagnosis.

Impact of an antimicrobial stewardship initiative to evaluate β-lactam allergy in patients ordered aztreonam.

Purpose: An evaluation of the clinical and economic impact of an antimicrobial stewardship quality initiative (ASQI) focusing on allergy assessment in patients with a documented β-lactam allergy prescribed aztreonam was conducted.

Methods: This retrospective study was executed at a hospital with an interdisciplinary antimicrobial stewardship program (ASP). A total of 186 patients with self-reported β-lactam allergies who were prescribed aztreonam while admitted during a 36-month time period surrounding the ASQI implementation were included.

Practical Approach to VTE Management in Hospitalized Patients.

Venous thromboembolism (VTE) is a commonly feared life-threatening complication in hospitalized patients. Physicians are frequently consulted to diagnose and manage VTE in obstetrics, neurology, and surgical services. VTE should be treated irrespective of the presentation (incidental or symptomatic), etiology (provoked vs.

Approach to Antihypertensive Therapy.

Antihypertensive agents are commonly prescribed by physicians to prevent the long-term mortality from chronic hypertension. They are also given to improve survival in a number of conditions (eg, heart failure, coronary artery disease), independent of the effect on blood pressure. Several classes of antihypertensives are available with unique pharmacologic characteristics and adverse effects.

Use of rivaroxaban in a patient with history of nephrotic syndrome and hypercoagulability.

Objective: Hypercoagulability, resulting in thromboembolic events, can be a life-threatening complication of nephrotic syndrome (NS). Conventional anticoagulants, such as warfarin, have been the standard of care for more than 50 years; however, the availability of target-specific oral anticoagulants (TSOACs) have provided additional options for the treatment and prevention of thromboembolic events. Documented use of the TSOACs in patients with NS and hypercoagulability is currently limited.

Comparison of acute kidney injury during treatment with vancomycin in combination with piperacillin-tazobactam or cefepime.

Study Objective: To evaluate the observed incidence of acute kidney injury (AKI) in adult patients receiving either piperacillin-tazobactam and vancomycin or cefepime-vancomycin for more than 48 hours.

Design: Retrospective matched cohort.

Setting: Large academic medical center.

Evaluation of appropriate serologic testing for suspected heparin-induced thrombocytopenia.

Purpose: The predictive value of clinical "4-T's" scoring in patient selection for serologic testing to confirm suspected heparin-induced thrombocytopenia (HIT) was evaluated.

Methods: In a chart review-based study at a large hospital, all adult inpatients who underwent enzyme-linked immunosorbent assay (ELISA) testing for HIT-antibody detection during a two-year period were identified. Scoring of the 4 T's (degree of thrombocytopenia, timing of symptom onset, presence of thrombosis or other sequelae, and other potential causes) was retrospectively performed on a random sample of cases (n = 70) by three pharmacist investigators.

Performance improvement in practice: managing urinary incontinence in home health patients with the use of an evidence-based guideline.

Urinary incontinence (UI) has a far-reaching impact on the medical, social, and psychological well-being of older adults. This article describes the steps taken to develop and implement a UI evidence-based guideline that achieved success in enhancing the Outcome and Assessment Information Set urinary outcome scores. It describes a process of putting evidence into practice, how it is related to the performance improvement process, specific barriers the authors faced in their performance improvement efforts, lessons learned, and the Home Health Compare outcomes data that ultimately proved the success of the efforts and challenges encountered after implementation.

Diagnosis of Trichomonas vaginalis in female children and adolescents evaluated for possible sexual abuse: a comparison of the InPouch TV culture method and wet mount microscopy.

Study Objective: To compare the performance of wet mount microscopy and the InPouch TV culture method in diagnosing Trichomonas vaginalis in a cohort of female children and adolescents evaluated for possible sexual abuse.

Design: A prospective study in which samples for both wet mount and InPouch TV were collected from the vaginal vault of each participant. The wet mount was examined microscopically for the presence of motile trichomonads, and the InPouch TV was analyzed in accordance with manufacturer specifications.

Geropsychology post-doctoral training in public sector service delivery: the USF/Tampa VA fellowship model.

There is a growing need for geropsychologists who are specialists in practice, research, education, and advocacy for older adults. The combined USF/Tampa VA geropsychology fellowship program focuses on the training of three post-doctoral Fellows each year in public sector service delivery across diverse long term care (LTC) and primary care settings. Addressing the bio-psycho-social needs of frail, poor, and minority older adults within an interdisciplinary framework exposes geropsychology Fellows to the complex nature of mental health problems of older adults and the need for collaborative efforts across professional lines.

Cognitive-behavioral treatment of older veterans with substance abuse problems.

The authors describe the initial cohort of participants in the GET SMART program, an age-specific, outpatient program for older veterans with substance abuse problems. Chief among the program's services is a relapse-prevention intervention consisting of 16 weekly group sessions using cognitive-behavioral (CB) and self-management approaches. Group sessions begin with analysis of substance use behavior to determine high-risk situations for alcohol or drug use, followed by a series of modules to teach coping skills for coping with social pressure, being at home and alone, feelings of depression and loneliness, anxiety and tension, anger and frustration, cues for substance use, urges (self-statements), and slips or relapses.

Treatment approaches for older problem drinkers.

Recent research suggests that older adults with alcohol problems often drink in response to loneliness, depression, and poor social support networks. Although a variety of approaches such as psychodynamic, Twelve Step, social support, behavioral, and cognitive-behavioral, have been suggested, only those studies involving behavioral and cognitive-behavioral interventions have provided empirical support for treatment effectiveness. Some research also suggests that age-specific group treatment produces better outcomes than when older adults are placed in treatment with younger alcoholics.

Antecedents of drinking for early- and late-onset elderly alcohol abusers.

The present study compared antecedents to recent drinking for two groups of elderly alcohol abusers admitted for treatment. Twenty-three early-onset alcohol abusers were matched with 23 late-onset alcohol abusers according to age and sex. Depression, loneliness and lack of social support were the most frequently reported antecedents to preadmission drinking behavior for both groups.

Older adult users of outpatient mental health services.

Descriptive demographic, clinical and interview data from clients of an outpatient mental health clinic for older adults are presented. These clients are better educated and have a more frequent history of marital difficulties than older adults in general. Although a significant minority received V code and Adjustment Disorder diagnoses, the majority were depressed and had histories of prior mental health services.

Comparison of three case-finding strategies relative to elderly alcohol abusers.

The effectiveness of three case-finding strategies for locating elderly alcohol abusers and linking them with an alcohol treatment program was explored. The three approaches emphasized the formal caregiver (CARN), the general public (PAC), and community health clinics (CBO). The CARN and PAC approaches appeared to be most cost-effective.