Ann M. Taylor

Educating preschoolers about sun safety.

OBJECTIVES This feasibility study examined whether a sun safety curriculum designed for and administered to preschoolers affects their cognition (knowledge, comprehension, application) regarding sun safety. METHODS Twelve classes of 4- to 5-year-olds were recruited from local preschools and randomly assigned to an intervention group or a control group. The intervention group received an investigator-developed sun safety curriculum; the control group did not. Children in both groups were tested at the beginning of the study about their cognition related to sun safety. They then received posttests 2 and 7 weeks following the pretest. RESULTS The curriculum had a significant effect on the knowledge (P = .01) and comprehension (P = .006) components of cognition. The application component of cognition was not significantly changed by the curriculum. CONCLUSIONS A structured curriculum was found to be an efficacious means of enhancing knowledge and comprehension of sun safety in preschool children. At the preoperational developmental stage, however, children may not be able to apply such knowledge and comprehension.

Public education projects in skin cancer. The evolution of skin cancer prevention education for children at a comprehensive cancer center

Background. Skin cancer affects more Americans than any other type of cancer. Children are prime targets for prevention education, because sun overexposure in early childhood may affect the development of skin cancer later in life. Preventive behaviors adopted early in life may be less resistant to change than those acquired in adulthood. Thus, there is a need to educate children at an early age about sun overexposure.

Long-term effects of language intensity in preventive messages on planned family solar protection.

A series of sun safety messages containing highly intense language and deductive logical style achieved the most immediate compliance by parents, particularly when they intended to improve protection. Inductive messages were more successful when no intentions existed (D. B. Buller, Borland, & Burgoon, 1998; D. B. Buller et al., 2000). Interviewers recontacted 568 parents during the winter following message dissemination and assessed solar protection. A 2 (language intensity) ×2 (logical style) ×3 (behavioral intention) ×2 (person) mixed-model analysis of variance showed that parents receiving high-intensity, deductive messages reported the most improved solar protection and improvement was greatest when parents intended to improve protection. Over the long term, high language intensity may reinforce decisions to take preventive action and does not appear to provoke psychological reactance or resistance to these highly directive messages.

Evaluation of the Sunny Days, Healthy Ways Sun Safety Curriculum for Children in Kindergarten through Fifth Grade

Abstract:  Childhood sun protection is important to reduce the risk of developing skin cancer later in life. An evaluation of an expanded version of the Sunny Days, Healthy Ways sun safety instructional program was conducted with 744 students in 77 kindergarten to fifth grade classes in 10 elementary schools. Students in six schools received instruction twice over two school years. Students in four schools received it only once in a single school year or were enrolled in a no‐treatment control group. A single presentation of the sun safety materials improved sun safety knowledge in students in grades 2–5 (p < 0.05). Repeated presentation over 2 years improved all outcomes, including increasing self‐reported sun protection (p < 0.05) and decreasing skin darkening indicative of exposure to ultraviolet radiation (p < 0.05). The program did not improve childrens knowledge or skin darkening in kindergarten and grade 1. These results highlight the need to provide sun protection education over several school years, not just one time, to produce changes in sun safety behavior.

Healthcare Professional Students’ Knowledge of Drug-Drug Interactions

Objectives. To evaluate changes in medical, pharmacy, and nurse practitioner students’ drug-drug interaction (DDI) knowledge after attending an educational program. Design. A DDI knowledge assessment containing 15 different drug pairs was administered to participants before and after a 45-minute educational session. Evaluation. Pharmacy, medical, and nursing students scored significantly higher on the posttest assessment for DDI recognition (median change 3, 9, and 8, respectively) and management strategy (median change 5, 9, 8, respectively), indicating a significant improvement in DDI knowledge as a result of the educational session. Pharmacy students scored significantly higher on the pretest; however, no difference was observed between the students’ posttest scores. Posttest scores for all student groups were significantly greater than their respective pretest scores (p < 0.001). Conclusions. Significant improvement in healthcare professional students’ DDI knowledge was observed following participation in the educational session.

Smoking quit rates among patients receiving pharmacist-provided pharmacotherapy and telephonic smoking cessation counseling.

OBJECTIVES Tobacco use is the nations leading cause of preventable illness and death, causing a significant burden on the health care system. Many cessation pharmacotherapy treatment options are available to help smokers quit, including nicotine replacement therapies (NRTs) and prescription medications. Research indicates that pharmacists are able to provide a positive benefit to smokers who want to quit through pharmacologic and nonpharmacologic interventions. The aim of the present work was to examine the quit rates among participants who received smoking cessation pharmacotherapy and pharmacist-provided telephone-based quit counseling services. DESIGN Retrospective database review of enrolled participants. SETTING Telephone-based pharmacotherapy and medication counseling services offered from a medication management center. PARTICIPANTS State employees who voluntarily contacted a medication management center for smoking cessation services after receiving promotional flyers. MAIN OUTCOME MEASURES Long-term quit rates at 7 and 13 months were determined by means of patient self-report in response to questioning. Smoking cessation was considered to be a success if the patient reported not smoking for the past 30 days. RESULTS A total of 238 participants were included in the review. Thirty-nine participants completed the program after the first treatment, 12 participants after the second treatment, and 4 participants after the third treatment. Two patients completed the program more than once. Eighty-five participants (36%) reported results at 7-month follow-up; of these, 43 (51%) were smoking free. A total of 44 participants (18%) reported results at 13-month follow-up; of these, 24 participants (55%) reported being smoking free. There were no significant differences in the percentages of smoking-free participants at 7 or 13 months, regardless of their first treatment (P = 0.06 and 0.345, respectively). CONCLUSION Successful quit rates were higher than previously demonstrated with other telephone-based smoking cessation programs. Therefore, pharmacist-provided telephone-based counseling may be beneficial in helping patients to quit smoking. Future research is warranted to examine the benefits of these types of programs.

Centruroides sculpturatus envenomation in three adult patients requiring treatment with antivenom

Abstract Context: Envenomation by Centruroides sculpturatus can manifest with cranial nerve dysfunction and neuromuscular hyperactivity. While these symptoms are most commonly seen in young children, they may also be seen in adults. Case details: Three cases of adult patients are presented with grades III & IV scorpion envenomation. They reported symptoms including disconjugate, roving eye movements, and motor involvement. Also reported were hyposmia, difficulty with fine motor movements, and dysgeusia. All were first treated with benzodiazepines with little to no effect. They then received a three vial antivenom bolus with resolution of severe symptoms within 30–60 min. Discussion: Severe Centruroides envenomation can occur in adults as well as children. These three cases demonstrate the usefulness, safety, and effectiveness of antivenom therapy to quickly relieve symptoms in adult patients with grades III & IV envenomations.

The Discharge Companion Pilot Program

IN BRIEF “Quality Improvement Success Stories” are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a pilot project aimed at improving overall quality of care and reducing readmissions for patients discharged from a community hospital in Arizona.

Positive Medication Changes Resulting from Comprehensive and Noncomprehensive Medication Reviews in a Medicare Part D Population

BACKGROUND Health care organizations face the challenge of reducing costs while improving health outcomes. Currently, more than 39 million seniors are enrolled in a Medicare Part D prescription benefit plan, many of whom also qualify for medication therapy management (MTM) services. MTM programs provide valuable services designed to prevent or resolve medication-related problems (MRPs). Two core components of all MTM programs include comprehensive medication reviews (CMRs) with followup interventions and focused non-CMR interventions. Currently, there is limited research comparing the rate of MRPs resolved by CMR and non-CMR interventions. OBJECTIVE To determine whether CMRs versus non-CMR interventions resulted in more pharmacist-initiated intervention recommendations and positive medication changes. METHODS This retrospective, cross-sectional quality improvement project evaluated outcomes for individuals who received interventions following a CMR compared with those who received non-CMR interventions as part of a comprehensive MTM program. For this project, eligible individuals qualified for an MTM program. A positive medication change was defined as the addition of an appropriate medication or the removal of an inappropriate medication within 120 days of a pharmacist recommendation. Differences between the groups were calculated using the Wilcoxon rank sum test. RESULTS During the 2-year period (2012 and 2013), 788,756 beneficiaries were enrolled in the MTM program and evaluated for potential MRPs. In both years, pharmacists recommended more medication changes per member for those receiving a CMR (0.81 in 2012 and 0.82 in 2013) compared with the non-CMR group (0.68 in 2012 and 0.61 in 2013; P value < 0.001 for both years). However, recommendations made via non-CMR interventions (representing the vast majority of all medication reviews) were more likely to result in a positive medication change (OR = 1.24, 95% CI = 1.21-1.28 for 2012; OR = 1.26, 95% CI = 1.22-1.30 for 2013). CONCLUSIONS These quality improvement project results suggest that Medicare Part D beneficiaries participating in a university-based MTM program who received non-CMR interventions had a higher likelihood of having positive medication changes than those receiving CMRs. These results are enlightening and may provide initial evidence to support inclusion of a non-CMR performance metric for the Centers for Medicare & Medicaid Services star ratings for MTM programs. DISCLOSURES No outside funding supported this study. The University of Arizona Medication Management Center (UAMMC)/SinfoniaRx provides grant funding to the University of Arizona for research. Augustine reports support from the UAMMC and ownership of Pfizer stock and was a graduate student at the University of Arizona College of Pharmacy at the time of this study. The authors report no other potential conflicts of interest. Buhl and Augustine contributed study concept and design, collected the data, and wrote the manuscript. Data interpretation was performed by all the authors. Taylor, Warholak, Augustine, and Martin revised the manuscript.