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The Evolving Role of Long-Term Pharmacotherapy for Opioid-Induced Constipation in Patients Being Treated for Noncancer Pain
No full textNationally, the prescription of opioids for acute and chronic pain is increasing. As opioid use continues to expand and become of increased concern for health-care practitioners, so do the adverse effects and long-term management of those effects. Opioid-induced constipation (OIC) presents a unique challenge because tolerance does not develop to this particular adverse effect, making chronic pain management a delicate balance between relieving pain and preventing long-term adverse effects such as constipation and dependence. Several agents have been developed for the treatment of OIC in patients with chronic noncancer pain on the basis of short-term studies of 12 weeks or less. However, chronic pain management often extends beyond this 12-week boundary, resulting in health-care professionals questioning the safety and efficacy of continued treatment with OIC agents. This review evaluates available literature on long-term treatment of OIC in patients with chronic noncancer pain with lubiprostone, naloxegol, and methylnaltrexone as well as preliminary results of the recently completed naldemedine long-term trial, COMPOSE-3
Pharmacokinetic Models for Active Learning of Differential Equations
No full textWe present adaptable activities for models of drug movement in the human body–pharmacokinetics–that motivate the learning of ordinary differential equations with an interdisciplinary topic. Specifically, we model aspirin, caffeine, and digoxin. We discuss the pedagogy of guiding students to understand, develop, and analyze models, progressing in complexity to a system of differential equations. We investigate the effects of parameter values that distinguish various health levels, and dosing that may have toxic effects. Our assignments include modeling in a student-centered, active, and increasingly inquiry-oriented setting through which the mathematics and biology inform and reinforce each other. We include supplemental information regarding inquiry methods, student learning outcomes, a student’s commentary about our activities, and support through mathematical communities such as POGIL and SIMIODE
Student pharmacists’ experiences of teamwork in a quality improvement course
No full textIntroduction: Student pharmacists need to work in teams in the educational and practice settings, but there is limited information on their teamwork experiences in the published literature. The study objective was to assess second-year (P2) student pharmacists’ teamwork experiences in an experiential quality improvement (QI) course. Methods: A retrospective pre-post survey was conducted with P2 students to assess teamwork experience attitudes. Students reported their agreement with 17 statements about teamwork, first after the project was planned and again after the project was complete. A Kuder-Richardson 20 score was calculated to assess internal consistency. Differences between pre- and post- groups for each teamwork item were assessed using McNemar\u27s test. An alpha level of 0.05 was used, and a Bonferroni correction was applied for multiple comparisons. Results: Sixty P2 students (50%) responded to the survey. After the project was complete, the majority indicated agreement with good teamwork qualities and disagreement with poor teamwork qualities for most items. More than 60% of respondents indicated they would like to do collaborative work again while 20% of respondents indicated imbalances in member contributions caused conflict within the team. Conclusions: The majority of student pharmacists in this investigation had positive experiences working in teams, but new important findings from this study indicate that further work is needed to prevent imbalances in team-member contributions and to encourage students to work on future collaborative projects in some cases
Quality improvement and safety in US pharmacy schools
No full textTo catalog the methods in which quality improvement (QI) and safety are taught in schools and colleges of pharmacy in the United States and showcase exemplar QI programs. Methods. This descriptive, multi-phase study included an online questionnaire, syllabi review, and phone interviews. The study was approved by the University of Arizona Institutional Review Board (IRB). One representative from each US pharmacy school accredited by the Accreditation Council for Pharmacy Education (ACPE) was invited to participate. Participants indicated the type of QI education their school provided via online questionnaire. Following questionnaire completion, syllabi were requested from the schools and phone interviews were scheduled with a school representative to obtain additional information. From the data, exemplars were chosen using a predetermined, evidenced-based rubric. Results. Of the 136 schools contacted, 56 (41.2%) completed the survey. Of the responding schools reporting their QI and safety offerings, 41 (73.2%) had a required session/module; 24 (42.9%) had a required course; 21 (37.5%) had an elective course; 21 (37.5%) had an introductory pharmacy practice experience (IPPE), advanced pharmacy practice experience (APPE), or internship; 17 (30.4%) had a required project; 17 (30.4%) had interprofessional education integrated into their course; 15 (26.8%) had an error laboratory; and 11 (19.6%) offered postgraduate training. Conclusion. Many of the responding US schools of pharmacy expose students to some aspect of QI and/or safety, most often via class session or module. The exemplar programs serve as examples of how QI can be further integrated into pharmacy curricula
Ceftolozane–tazobactam for the treatment of osteomyelitis caused by multidrug-resistant pathogens: a case series
No full textCeftolozane–tazobactam (CT) is a recently approved novel cephalosporin and β-lactamase inhibitor combination agent with in vitro activity against various Gram-positive and Gram-negative pathogens, including several multidrug-resistant (MDR) Gram-negative organisms. CT is currently approved by the US Food and Drug Administration for the treatment of complicated intrabdominal infection and complicated urinary tract infection at a dose of 1.5 g intravenously every 8 h. This agent is an attractive option for MDR osteomyelitis (OM) treatment, but clinical data is limited to case reports and series. Here we report a series of five patients with MDR OM who were treated with CT. Pathogens involved in these infections were MDR Acinetobacter baumannii (two isolates) and MDR Pseudomonas aeruginosa (four isolates). Two patients were disease free 6 months after therapy was discontinued, one required an additional curative surgical procedure, and two (both on high-dose therapy) developed adverse reactions likely related to CT that necessitated early antibiotic discontinuation
Competencies for improving diagnosis: An interprofessional framework for education and training in health care
No full textGiven an unacceptably high incidence of diagnostic errors, we sought to identify the key competencies that should be considered for inclusion in health professions education programs to improve the quality and safety of diagnosis in clinical practice. An interprofessional group reviewed existing competency expectations for multiple health professions, and conducted a search that explored quality, safety, and competency in diagnosis. An iterative series of group discussions and concept prioritization was used to derive a final set of competencies. Twelve competencies were identified: Six of these are individual competencies: The first four (#1-#4) focus on acquiring the key information needed for diagnosis and formulating an appropriate, prioritized differential diagnosis; individual competency #5 is taking advantage of second opinions, decision support, and checklists; and #6 is using reflection and critical thinking to improve diagnostic performance. Three competencies focus on teamwork: Involving the patient and family (#1) and all relevant health professionals (#2) in the diagnostic process; and (#3) ensuring safe transitions of care and handoffs, and closing the loop on test result communication. The final three competencies emphasize system-related aspects of care: (#1) Understanding how human-factor elements influence the diagnostic process; (#2) developing a supportive culture; and (#3) reporting and disclosing diagnostic errors that are recognized, and learning from both successful diagnosis and from diagnostic errors. These newly defined competencies are relevant to all health professions education programs and should be incorporated into educational programs
Glucagon-like peptide 1 receptor agonists in type 1 diabetes mellitus
No full textThe role of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in the treatment of type 1 diabetes mellitus (T1DM), including efficacy and safety evidence, is reviewed. Summary: Currently approved treatment options for glycemic control in T1DM include insulin, which combats insulin deficiency but does not effectively target disease progression or alpha cell dysfunction; and pramlintide, whose use requires multiple daily doses and involves a high likelihood of gastrointestinal side effects. GLP-1 RAs have a unique mechanism of action in T1DM, addressing alpha cell dysfunction and thereby suppressing inappropriate glucagon secretion. GLP-1 RA dosing varies from once weekly to twice daily, and the class is well tolerated in patients with type 2 diabetes. Among the GLP-1 RAs, exenatide and liraglutide have been studied in patients with T1DM, with published evidence consistently demonstrating weight loss, decreases in total daily insulin requirements, and modest improvements in glycemic control. GLP-1 RA therapy appears to be well tolerated in patients with T1DM and is associated with nonsignificant increases in hypoglycemia risk. Conclusion: GLP-1 RA therapy represents an important add-on therapy option for achieving decreased insulin doses, weight loss, and modest improvements in HbA1c levels without significantly increasing hypoglycemia risk in patients with T1DM. Patients who have detectable C-peptide and/or are overweight or cannot achieve glycemic goals without hypoglycemia have been found to benefit the most from GLP-1 RA therapy. Further studies are warranted to evaluate these agents\u27 potential impact on clinical outcomes such as microvascular and macrovascular complications
Key and Card Access Management Policy
No full textThe purpose of the key and card access management policy is to provide reasonable security and privacy to the University community. This policy will provide individuals assigned to use University facilities with the guidance and regulation of the issuance, accounting, control and return of all keys/access cards used to control access to University facilities and/or property.
Applies to all faculty, staff, students, contractors, visitors and persons having and/or requesting access to campus either by key or card access. This policy applies to all locking devices securing University facilities and those individuals authorized to use them
Missing Persons Reporting Policy
No full textConsistent with the Clery Act, The University of Health Sciences and Pharmacy in St. Louis Office of Public Safety has established the following missing person’s policy. Any individual who believes a currently enrolled UHSP student is missing shall notify the Office of Public Safety. Following notification, public safety will commence an investigation along with the Office of Student Affairs as soon as reasonably possible. Should the investigation result in the conclusion that the student is missing, the Office of Public Safety will notify the Saint Louis Metropolitan Police and/or the appropriate local law enforcement agency immediately, as well as the student’s missing person contact within a span of time not to exceed 24 hours from the time the student was determined to be missing. If the missing student is under the age of 18, and not an emancipated individual, public safety or student affairs will notify the student’s parent or legal guardian immediately after the University determines that the student is missing, in addition to notifying the contact person designated by the student.
This policy applies to students who reside in on-campus housing and who is determined to have been missing for 24 hours
Te wero tonu—the challenge continues: Māori access to medicines 2006/07–2012/13 update
No full textAIM: Analysis of dispensings of prescription medicines in New Zealand in 2006/07 reported large inequities between Māori and non-Māori. This present study has now updated the earlier work by describing variations in disease burden-adjusted medicines access by ethnicity in 2012/13, and changes over time. METHOD: The update has linked prescription medicine data with burden of disease estimates by ethnicity for 2012/13 and comparing with 2006/07. This has re-examined the shortfall in prescriptions for Māori vs non-Māori adjusting for age, population and burden of disease (ie, health loss, in disability-adjusted life years (DALYs)). RESULTS: Aft er adjusting for age, population and burden of disease, large inequalities still existed for Māori compared with non-Māori, with generally no improvement over the six years. In 2012/13, Māori had 41% lower dispensings overall than non-Māori; this was nominally worse compared with the 37% relative gap in 2006/07, but the trend was not statistically significant. Many complexities and limitations hamper valid interpretation, but large inequities in access and persistence, across many therapeutic groups, remain. The full University of Auckland report details these inequities. CONCLUSION: Large inequities in medicines access for Māori continue. Inequities in access are unacceptable, their causes likely complex and entrenched; we believe they need deeper understanding of systems and barriers, pragmatic ways to monitor outcomes, and an all-of-sector approach and beyond. PHARMAC has committed to strategic action to eliminate inequities in access to medicines by 2025, recognising it needs partners to drive the necessary change. Kei a tātou tonu katoa te wero kia mahikaha, kia mahi tino mōhio, me te mahitahi (The challenge continues for us to work harder, work smarter, and work together); everyone in the health sector has a role