Predictors of stool deoxyribonucleic acid test use in the United States: Implications for outreach to under-resourced populations.

Objective: Although colorectal cancer screening (CRCS) is a public health priority, uptake is suboptimal in under-resourced groups. Noninvasive modalities, including stool deoxyribonucleic acid (sDNA) testing, may mitigate economic, geographic, cultural, or impairment-related barriers to CRCS. We assessed use of sDNA testing and other CRCS modalities in U.

Finding our Voice: Evaluation of Goal Setting Using the Habits of Preceptors Rubric in Terms of Focus, "SMARTness," and Impact.

Introduction: Effective leadership propels teams from effectiveness to greatness and is accomplished when everyone achieves and contributes their full potential, or "voice." The Clinician Educators Program Teaching and Learning Curriculum fosters preceptor development using the Habits of Preceptors Rubric (HOP-R) to guide participants in finding their precepting "voice." After the HOP-R self-assessment, participants select a habit of focus (HOF) and craft a SMART (specific/measurable/achievable/relevant/time-bound) goal.

Association of Cardiovascular Disease and Military Veteran Status With Impairments in Physical and Psychological Functioning: Retrospective Cross-Sectional Analysis of US National Survey Data.

Introduction: The Veterans Health Administration (VHA) provides multidisciplinary team-based care with peer-to-peer support for diabetes and obesity, but not for most heart diseases.

Objective: To inform disease-care models, assess physical and psychological functioning in veterans with, or at high risk of, heart disease.

Methods: Retrospective, cross-sectional cohort analysis of data from the National Survey on Drug Use and Health, 2015-2019, based on standard measures of functioning: self-rated health, serious psychological distress, and high-risk substance use.

Association of Asthma Exacerbation Risk and Physician Time Expenditure With Provision of Asthma Action Plans and Education for Pediatric Patients.

Objective: To provide information about factors underlying provision of asthma action plans (AAPs) to a minority of pediatric patients with asthma, assess whether risk of exacerbation acts on provision of AAP and asthma education directly, suggesting targeting to highest-risk patients, or indirectly by influencing physician-patient interaction time.

Methods: This study was a retrospective cross-sectional analysis of a nationally representative sample of physician office visits that consisted of patients aged 2 to 18 years with asthma. Exacerbation risk comprised proxy indicators of control and severity.

Outcomes of Pharmacist-Conducted Admission Medication-Regimen Reviews in Long-term Care Facilities.

To assess the outcomes of pharmacist-completed aMRRs. The 2018 installation of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act requires medication regimen reviews (aMRR) upon admission to long-term care (LTC) hospitals, nursing facilities, and inpatient-rehabilitation facilities. While the legislation does not require that pharmacists perform the reviews, pharmacists are aptly suited to add value to this practice.

Pandemics, policy, and the power of paradigm: will COVID-19 lead to a new scientific revolution?

Critical historical analysis of the 19th-century cholera and 21st-century coronavirus-19 (COVID-19) pandemics suggests that in conflicts over pandemic-mitigation policies, the professional backgrounds of principal opponents reveal dominant and minority scientific paradigms, presaging possible epistemological shifts. Epistemic conflict over cholera helped spur biomedical expertise as the dominant paradigm for U.S.

A "Virtual Pharmacy Shelf" to Enhance the Rigor and Efficiency of Standardized-Patient OSCEs for Over-the-Counter Medication Advice.

Background: Realistic simulation in health professional education can be costly or cumbersome.

Activity: A low-cost, tablet-based simulated "virtual shelf" of over-the-counter (OTC) medications, hyperlinked to Drug Facts labels, eliminated use of physical product boxes or printed drug lists in objective structured clinical examinations (OSCE) for Doctor of Pharmacy students learning to provide OTC advice.

Results And Discussion: The application reduced instructor preparation and OSCE administration time by allowing students to tap product options instead of thumbing through medication lists.

Unexplained mortality during the US COVID-19 pandemic: retrospective analysis of death certificate data and critical assessment of excess death calculations.

Objectives: Cause-of-death discrepancies are common in respiratory illness-related mortality. A standard epidemiological metric, excess all-cause death, is unaffected by these discrepancies but provides no actionable policy information when increased all-cause mortality is unexplained by reported specific causes. To assess the contribution of unexplained mortality to the excess death metric, we parsed excess deaths in the COVID-19 pandemic into changes in explained versus unexplained (unreported or unspecified) causes.

Modest Association of Long-Term ACE Inhibitor Treatment With Lung Cancer: The Promise and Pitfalls of Epidemiological Drug-Safety Analyses.

Results of the carefully executed Evaluation of Treatment with Angiotensin Converting Enzyme Inhibitors and the Risk of Lung Cancer (ERACER) study, reported in this issue, echo those of several previous observational analyses of the association of long-term angiotensin-converting enzyme (ACE) inhibitor use with incident lung cancer. These epidemiological drug-safety analyses merit cautious interpretation. First, the number needed to harm (NNH) of 6667 reported in ERACER for ACE inhibitors compared with angiotensin-2 receptor blockers (ARBs) after approximately 12 years of follow-up should be balanced against therapeutic benefits.

Rates and Predictors of Physician-Recommended and Self-Reported Aspirin Use in 2015.

This study assesses the rate of providerrecommended aspirin use through the National Ambulatory Medical Care Survey (NAMCS) database versus self-reported aspirin use through the Behavioral Risk Factor Surveillance System (BRFSS) database and identifies factors that predict initiation of aspirin. This study provides insight into the rate of providerrecommended aspirin use versus self-reported aspirin use prior to the 2016 United States Preventive Service Task Force primary prevention recommendation update.
Retrospective, cross-sectional analysis of US population data obtained from medical records (NAMCS) and community-dwelling residents in four states (BRFSS) in 2015.

Physical and psychological functioning in veterans with diabetes: Disease-related versus service-related effects.

Objective: Research on veterans with diabetes (VWD) suggested elevated rates of mental illness and substance use disorder but used samples studied 14-21 years ago without comparator groups. To inform translational research and care-delivery models for diabetes, the purpose of this study was to compare VWD, nonveterans with diabetes (NVWD), and veterans without diabetes (VWOD) on physical and psychological functioning.

Method: The study was a retrospective analysis of cross-sectional data from the National Survey on Drug Use and Health, a population-based household-interview survey, 2015 to 2018.

Changes in PBM Business Practices in 2019: True Innovation or More of the Same?

In 2019, pharmacy benefit managers (PBMs) responded to intense public criticism with business model changes described as movements toward full transparency and innovation to reduce costs for benefit plan sponsors. We critically analyze these changes in light of key challenges in specialty drug management: pharmaceutical manufacturer practices (price increases driven by coverage mandates and lack of price control, intensive and sometimes misleading advertising, patent extensions), FDA changes (increased reliance on manufacturer funding, weakened evidentiary base for drug approvals), and provider prescribing patterns (lag from evidence to routine practice, manufacturer influences on the knowledge base, direct manufacturer payments to frequent prescribers). The persistence of controversial PBM practices suggests that business model changes were mostly cosmetic, without altering key marketplace dysfunctions.

Treatment Needs and Service Utilization in Older U.S. Adults Evidencing High-Risk Substance Use.

Because substance misuse by older adults poses clinical risks and has not been recently assessed, we examined substance use patterns, treatment needs, and service utilization in those evidencing high-risk use. We identified National Survey on Drug Use and Health respondents (2015-2018) aged ≥50 years reporting multiple-occasion binge drinking, illicit drug use, prescription drug misuse, or substance dependence. Past-year psychological symptoms were assessed using validated scales.

Item analysis of emotional exhaustion in pharmacy practice faculty.

Introduction: The primary objective of this study was to identify the single question on the Maslach Burnout Inventory - Educator Survey (MBI-ES) that correlated with high emotional exhaustion (EE) among pharmacy practice faculty.

Methods: We analyzed data collected from the electronic administration of the MBI-ES to faculty at United States (US) colleges and schools of pharmacy in 2014. For our primary outcome, we used Spearman's rho correlation (r) to identify a single question on the MBI-ES that was highly correlated with high EE (one of three subscales of MBI-ES).

Evaluation of an interactive simulated patient educational tool on course performance among current pharmacy students.

Background And Purpose: In an accelerated doctor of pharmacy program, student examination performance on a key knowledge concept, the Cockcroft-Gault equation (CGE) for creatinine clearance estimation, was suboptimal. A scenario-based online tutorial using a virtual patient activity was developed to provide just-in-time access to an active-learning opportunity, consistent with Millennial learning styles. The purposes of this study were to assess the association between tutorial use and CGE examination performance and to explore learner characteristics that may affect this association, including student age group.

Beneficial Agents for Patients With Type 2 Diabetes and Cardiovascular Disease or Obesity: Utilization in an Era of Accumulating Evidence.

This study was an analysis of a national sample of U.S. medical office visits from 2014 to 2016, a period when evidence of effectiveness was emerging for a variety of beneficial type 2 diabetes agents with regard to potential reduction in diabetes comorbidities.

Association of Antibiotic Treatment Duration With Recurrence of Uncomplicated Urinary Tract Infection in Pediatric Patients.

Gaps and inconsistencies in published information about optimal antibiotic treatment duration for uncomplicated urinary tract infection (UTI) in pediatric patients pose a dilemma for antibiotic stewardship. Evaluate the association of antibiotic treatment duration with recurrence rates in children with new-onset cystitis or pyelonephritis. Retrospective cohort analysis of patients aged 2 to 17 years with new-onset cystitis or pyelonephritis and without renal/anatomical abnormality was conducted using Truven Health MarketScan Database for 2013-2015.

Estimated Cardiovascular Risk and Guideline-Concordant Primary Prevention With Statins: Retrospective Cross-Sectional Analyses of US Ambulatory Visits Using Competing Algorithms.

Introduction: The 2013 pooled cohort equations (PCE) may misestimate cardiovascular event (CVE) risk, particularly for black patients. Alternatives to the original PCE (O-PCE) to assess potential statin benefit for primary prevention-a revised PCE (R-PCE) and US Preventive Services Task Force (USPSTF) algorithms-have not been compared in contemporary US patients in routine office-based practice.

Methods: We performed retrospective, cross-sectional analysis of a nationally representative, US sample of office visits made from 2011 to 2014.

Joint effects of advancing age and number of potentially inappropriate medication classes on risk of falls in Medicare enrollees.

Background: Injurious falls among older adults are both common and costly. The prevalence of falls is known to increase with age and with use of fall-risk drugs/potentially inappropriate medications (FRD/PIM). Little is known about the joint effects of these two risk factors.

High-risk opioid prescribing trends in the outpatient setting prior to issuance of federal guidance.

Co-prescription of opioid and benzodiazepine products increases the risk of overdose-related mortality four-fold due to respiratory depression. Accordingly, prevention of high-risk opioid prescribing (HROP) has become a focus over the past two decades and was the subject of a black-box warning (BBW) issued by the U.S.

Pediatric Home Parenteral Nutrition: Indications and Short-Term Outcomes in a Large National Sample of Commercially Insured Children and Adolescents.

Background: To support families managing the complex requirements of home parenteral nutrition (HPN) in pediatric patients, health professionals need information about HPN indications and complications. Nationally representative information is limited.

Methods: A retrospective cohort analysis of the Truven Health MarketScan Commercial Claims and Encounters Database was performed and identified 683 patients aged ≤18 years receiving HPN during dates of service from January 2013 through September 2015.

Use of power-law analysis to predict abuse or diversion of prescribed medications: proof-of-concept mathematical exploration.

Objective: To conduct a proof-of-concept study comparing Lorenz-curve analysis (LCA) with power-law (exponential function) analysis (PLA), by applying segmented regression modeling to 1-year prescription claims data for three medications-alprazolam, opioids, and gabapentin-to predict abuse and/or diversion using power-law zone (PLZ) classification.

Results: In 1-year baseline observation, patients classified into the top PLZ groups (PLGs) were demographically and diagnostically similar to those in Lorenz-1 (top 1% of utilizers) and Lorenz-25 (top 25%). For prediction of follow-up (6-month post-baseline) Lorenz-1 use of alprazolam and opioids (i.