To describe and evaluate a novel practice setting for a pharmacist within an occupational health clinic.
Ambulatory care facility.
Implementation and evaluation of a new practice site embedding a ...clinical pharmacist into the workplace to provide ambulatory care services, such as comprehensive medication management, disease state management, and immunizations to a broad diversity of patients.
A clinical pharmacist provides pharmacy services as part of a collaborative occupational health clinic at a large, self-insured company. The pharmacy services are open to employees and family members with any chronic disease states, elevated biometric results, or medication questions, with the goal of improving patient care on a consistent basis. During visits, the pharmacist works to identify and resolve drug-related problems by educating the patient or reaching out to the patient's health care provider and to develop strategies with the patient to achieve desired health care outcomes. The pharmacist assists with patient outreach events and immunizations during the flu clinic.
Identification of drug-related problems, resolution status, patient satisfaction via survey results, immunizations provided.
In 4.3 years of operation, the pharmacist conducted 604 visits with 172 patients. During these visits, the pharmacist identified 611 drug-related problems, of which 49.4% have been confirmed as resolved. All patients who completed the patient satisfaction survey said that they would recommend the pharmacy services to others. For the past 3 years, the pharmacist and pharmacy students immunized approximately 1000 patients each year during the company flu clinic.
An occupational health clinic is a unique and convenient location for a pharmacist to provide ambulatory care services to employees and family members, as long as methods to identify patients and appropriate sources of referral exist. The pharmacist was able to help patients resolve approximately 50% of identified drug-related problems, and patients were highly satisfied with services provided.
Genetic disruption of the vomeronasal organ (VNO), an organ responsible for pheromone processing, drastically alters socio-sexual behavior in mice. However, it is not known whether the VNO has a role ...during the pubertal organizational period when sex-typical socio-sexual behaviors emerge, or if disruption of the organ in adulthood is sufficient to alter socio-sexual behavior. To bypass the lifelong VNO disruption of genetic knockout models, we surgically ablated the VNO of male and female mice either during the peripubertal period postnatal day (PND) 28-30 or adulthood (PND 58-60), with sham controls at both ages. We ruled out anosmia
the buried food test and assessed sexual odor preferences by simultaneously exposing mice to same- and opposite-sex soiled-bedding. We then measured territorial aggression with the resident-intruder paradigm and assessed sexual behavior in response to an encounter with an estrus-induced female. Neural activity approximated by FOS-immunoreactivity along the VNO-accessory olfactory pathway was measured in response to opposite-sex odors. We found that peripubertal VNO ablation decreased sexual odor preferences and neural activity in response to opposite-sex odors, and drastically reduced territorial aggression in male mice. Conversely, adult VNO ablation resulted in subtle differences in sexual odor preferences compared with sham controls. Regardless of the VNO condition, mice displayed sex-typical copulatory behaviors. Together, these results suggest that puberty is a critical period in development whereby the VNO contributes to the sexual differentiation of behavior and neural response to conspecific odors.
The primary objective of this study was to determine sharps disposal practices among people with diabetes in a community care clinic. Secondary objectives were to identify patterns of sharps use and ...barriers to proper use.
Surveys were distributed to patients at a community care clinic in person and via mail. Survey questions focused on how sharps are used and disposed of, the frequency of sharps changes, sharps disposal training, sharps identification, and confidence in sharps disposal. Participant demographics and diabetes profiles were also collected.
Among 89 respondents, mean age was 60 years (range 29-93 years), 61.8% were Caucasian, 88.8% had type 2 diabetes, and 60.7% had had a diabetes diagnosis for ≤10 years, with diverse diabetes management methods; 57.3% did not receive or were unsure of sharps training, 25.8% discarded used sharps without a designated sharps container, and 37.1% properly disposed of sharps containers at sharps disposal facilities. Barriers to proper sharps practices included perceived safety of reusing sharps and waste with single use, cost, and the hassle of disposal. Those with prior sharps training were more likely to properly use and discard sharps; however, gaps in knowledge were still evident in this population.
Results indicate gaps in proper sharps use and disposal knowledge among people with diabetes. Responses revealed sharps practices that are inconsistent with current federal and state regulations and are potentially dangerous for those handling improperly discarded sharps. Targeted sharps usage and disposal education resources are needed for individuals with and without prior sharps training.
Cytomegalovirus (CMV) infections acquired by very-low-birthweight (VLBW) infants are incompletely characterized. To examine CMV transmission in VLBW infants, we evaluated maternal DNAlactia, infant ...DNAemia, and presence of clinical disease in a blinded study in VLBW infants in our newborn intensive care unit (NICU). To examine these issues, 200 VLBW infants were enrolled in a surveillance study, with weekly breast milk and infant whole blood samples collected, as available. Virologic (breast milk and infant whole blood real time PCR) and immunologic (IgG, IgM, and IgG avidity) correlates were evaluated. A chart review examined whether infants had symptoms compatible with CMV disease. DNAlactia was identified in 65/150 (43%) of lactating mothers. Nine CMV infections were identified in 9/75 CMV-exposed infants (12% of exposed infants). A higher median breast milk viral load (DNAlactia) correlated with an increased likelihood of DNAemia (
= 0.05). Despite potential symptoms compatible with CMV infection, clinicians had not considered the diagnosis of CMV in 6/9 cases (66%). All of these infants had chronic lung disease at discharge. There was no correlation between IgG antibody titer or IgG avidity index and the likelihood of transmission or CMV disease. In conclusion, in VLBW infants receiving milk from seropositive mothers, CMV infections are commonly acquired, and are frequently unrecognized. Future studies are needed to determine whether routine surveillance for CMV of either breast milk or infant plasma is beneficial in preventing or recognizing infection.
PURPOSE.A case of probable gabapentin-induced visual hallucinations in a patient with no psychiatric history is reported.
SUMMARY.A 65-year-old white woman with no history of psychiatric conditions ...arrived at the pharmacy clinic with specific complaints of daytime sleepiness, fatigue, and visual hallucinations that started after coronary artery bypass graft surgery three years prior. After the surgery she began experiencing neuropathic pain in her chest, which was treated with gabapentin. Approximately one month later, she developed visual hallucinations that continued to occur at least two or three times per month. When first seen in the pharmacy clinic, the patient was taking gabapentin 300 mg orally four times daily plus 600 mg at bedtime, for a total daily dose of 1800 mg. Although gabapentin appears to have been prescribed as 600 mg three times daily, she had been taking it in five divided doses. One month later, she reported that she had self-reduced the gabapentin dosage to 300 mg once daily, after which she noticed improvement in her daytime sleepiness and fatigue and experienced one hallucination approximately one week after the dosage reduction. One month later, she completely discontinued gabapentin use, after which she experienced no further hallucinations. Assessment with the Naranjo et al. adverse drug reaction scale indicated a probable relationship between the patientʼs visual hallucinations and gabapentin use.
CONCLUSION.A 65-year-old woman with no psychiatric history developed visual hallucinations while taking gabapentin five times daily. Her hallucinations resolved after discontinuation of gabapentin and have remained absent after 1 year of follow-up.
The purpose of this national survey was to determine what constitutes a curricular track or concentration within colleges and schools of pharmacy. Additionally, for programs not currently offering ...curricular tracks or concentrations, this survey sought to identify barriers to implementation.
A survey instrument was developed and piloted. It was distributed electronically via SurveyMonkey to members of the American Association of Colleges of Pharmacy (AACP) Curriculum Special Interest Group (SIG) contact list, along with academic affairs contacts for the balance of programs not included on the SIG contact list, as obtained via a targeted website search.
Sixty-five of 134 programs responded to the survey (48.5%). Sixteen programs currently offer 38 curricular tracks or concentrations. On average, tracks or concentrations contained 10.6 didactic credits, with 4.6 elective and six required didactic credits; 0.7 introductory pharmacy practice experience (IPPE) credits; and 5.3 advanced pharmacy practice experience (APPE) credits, with 2.8 elective and 2.5 required APPE credits. Most tracks did not require a summative project (n = 13), while some required completion of a project individualized by interest/needs (n = 7). Forty-nine programs do not currently offer curricular tracks, most frequently due to logistics of faculty, oversight, or the curriculum structure. Of these programs not currently offering curricular tracks or concentrations, 38.8% are currently considering implementation.
Existing tracks or concentrations are highly variable in their composition. Many colleges and schools of pharmacy are considering implementation of curricular tracks or concentrations; this report provides guidance for appropriate rigor and development considerations.
Using a conceptual framework based on the uncertainty-identity theory, loyalty effect, identity fusion and sociometer model, I conducted a collective case study of five state Farm Bureau associations ...who were recognized for their membership programs by American Farm Bureau Federation with a Pinnacle Award for their efforts in 2019. The scope of this collective case study included Farm Bureaus in Arizona, Louisiana, Massachusetts, Texas, Utah, and Virginia. As I work for Massachusetts Farm Bureau Federation, that organization was excluded. None of the respondents were interviewed twice. This qualitative study utilized collective case study interviews with state Farm Bureau staff to answer the following research questions: (1) What are key components of successful membership recruitment programs? (2) What are key components of successful membership retention programs? (3) How involved are Farm Bureau volunteer leaders in successful membership recruitment and retention programs? Respondents’ answers were reviewed and grouped into themes. From these themes I was able to determine member benefits, specifically insurance, was a key component of a successful membership recruitment and retention programs for the state Farm Bureaus interviewed. I concluded these findings refuted Hogg et al.’s (2008) uncertainty-identity theory as a key motivator to join Farm Bureau but supported Reichheld’s (1996) loyalty effect as a key motivator to remain a Farm Bureau member. Additional key components of a successful Farm bureau membership program included a Young Farmers and Ranchers committee; individual phone calls to farmer members to discuss concerns and offer assistance; and a welcome packet. I concluded these findings support Hogg et al.’s (2008) uncertainty-identity theory as a motivator for joining. Those individuals reduced uncertainty about themselves and their place in the world by being a Farm Bureau member. I also determined that volunteer leader involvement with successful membership programs was limited. While a few of the Farm Bureaus indicated county leaders would call agricultural producers to renew their membership or potentially recruit a new member, they also indicated this pool of leaders was small. As such, I concluded these findings did not support or refute Swann et al.’s (2009) identity fusion model as a motivator for members to recruit other members.
Abstract
Background
CMV can be transmitted to babies after birth through breast milk and such infections may lead to a “sepsis-like syndrome” with neutropenia, hepatitis, and viremia. CMV infections ...can be epidemiologically characterized by envelope glycoprotein (gB) genotypes - gB1, gB2, gB3 and gB4. The role of specific genotypes in pathogenesis and immune control of infection is incompletely characterized. These studies aimed to characterize viral and host correlates of breast-milk transmission of CMV in a neonatal intensive care unit (NICU) setting.
Methods
200 infants were enrolled in a prospective study of infants <1500 grams at birth in the NICU at the University of MN Masonic Children’s Hospital. Breast milk samples were available from 164 mothers, representing 184 infants (including twin pairs). We compared CMV IgM titer (Gold Standard Diagnostics Corp, CA) and CMV IgG titer (Diamedix, FL) in non-viremic infants of seropositive mothers for whom we had available serum (n=48 infants), and in eight infants with DNAemia. Positive CMV Breast milk samples from 65 mothers were further characterized by a multiplex real-time PCR assay, to characterize and compare gB genotypes.
Results
The prevalence of DNAlactia in the breast milk was 65/150 (43%). There were 49 mothers for whom CMV was present in breast milk, for which we also had infant whole blood samples (58 infants; 40 singletons and 9 twin pairs). Eight infants, exposed to CMV in the breast milk, developed CMV viremia (8/58=13%). Clinicians had not tested for CMV in 5/8 cases. Anti-CMV IgM antibodies were detected in 6/8 (75%) viremic infants. One non-viremic infant with CMV infection was identified solely by the IgM assay. There was no difference in ELISA IgG titers between infants with CMV viremia, and nonviremic infants. The subset of 65 CMV positive breast milk samples, 25 were positive for gB1 (39%), 13 were positive for gB2 (20%), 23 were positive for gB3 (35%) and 11 were positive for gB4 (17%); 11 samples were positive for multiple gB genotypes. For six samples, the gB genotype was unable to be determined. The gB genotype was determined for 5 of eight breast milk samples from mothers of the viremic babies with gB1 being the most common. In 3 of the 8 viremic samples, genotype was unable to be determined.
Conclusion
Breast milk from CMV-seropositive lactating mothers in a NICU setting can lead to transmission of infection and development of symptomatic CMV disease, which may not be recognized by clinicians. The distribution of gB genotypes in breast milk is similar to that observed in other CMV epidemiological analyses, and multiple genotypes may be identified in lactating seropositive women. Since gB is a critical target in CMV vaccine design, understanding strain-specific transmission may have implications for understanding the impact of pre-pregnancy vaccination on breast milk transmission. Purified recombinant gB vaccines studied in clinical trials are based on based on the Towne strain of CMV, gB1 genotype (DOI: 10.1128/JVI.01695-18). Future studies should examine the impact of strain-specificity of vaccination on circulation of CMV strains in infants with CMV disease.
PDF
