Jennifer Padden Elliott

The Impact of Elective Active-Learning Courses in Pregnancy/Lactation and Pediatric Pharmacotherapy

Objective. To implement and evaluate the impact of 2 elective courses, Pregnancy & Lactation and Pediatrics on student acquisition of knowledge and development of lifelong learning skills related to these special populations. Design. Two 3-credit elective courses were implemented using various student-driven learning techniques, such as case-based exercises, group presentations, pro-con debates, and pharmacist “grab bag” questions. Strong emphasis was placed on medication literature retrieval and analysis, and a wiki was used to create an electronic resource for longitudinal use. Assessment. Pre- and post-course tests showed significant improvement in knowledge related to pregnancy, lactation, and pediatrics. Pre- and post-course confidence and ratings on satisfaction survey tools also revealed significant improvement in several domains relating to lifelong-learning skills, knowledge related to medication use within these special populations, use of technology to enhance learning, and overall course design. Conclusion. The combination of student-directed learning techniques used in 2 pediatric-concentration courses is an effective teaching model.

Lifestyle Management for Enhancing Outcomes after Bariatric Surgery

Bariatric surgery has been safe and effective for treatment of severe obesity and comorbidities like type 2 diabetes mellitus (T2D). Nonetheless, weight loss and health outcomes vary considerably across individuals. Although the factors associated with outcomes are not fully understood, postoperative weight loss following any type of bariatric surgery is largely dependent on the extent to which patients can make and sustain changes in eating and activity. Therefore, lifestyle management including diet, exercise, and behavior modification is critical to helping patients achieve long-term weight loss. Pharmacotherapy and reoperation may also play a role after bariatric surgery. In this article, we highlight recent research findings in all of these areas to provide suggestions for how to enhance outcomes following bariatric surgery. Research on the mechanisms for weight loss and improvements in T2D following the different surgical procedures is needed to support the development of more personalized approaches to the multidisciplinary management of severe obesity.

Use of electronic medical records for clinical research in the management of type 2 diabetes

BACKGROUND Essential to optimal diabetes care is the organization and management of complex clinical data. An EMR system can facilitate better management of clinical and clinical-related information by standardizing care and increasing the efficiency of delivering quality care to patients. However, studies have not described clinical characteristics of patients with type 2 diabetes in a primary practice setting that utilizes an EMR system. OBJECTIVE To describe the demographic characteristics, clinical measures, and resource utilization of patients with type 2 diabetes in a primary care setting that employs an EMR system. METHODS Patients ≥18 years of age, having two or more visits with their physicians (January 1, 2012 to December 31, 2012), and with a recorded diagnosis of diabetes (ICD-9-CM: 250.xx) were retrospectively identified from the GE Centricity® EMR database of a primary care physician group. Demographic characteristics, clinical measures, and resource utilization were evaluated. Descriptive statistics were conducted using frequencies and proportions for categorical data and means and standard deviations for continuous variables. RESULTS 5170 patients with type 2 diabetes were identified for year 2012. Majority of patients with type 2 diabetes were males (53.38%), whites (86.63%), and obese (62.19%); had HbA1c levels <7% (51.72%), LDL-C levels <100 mg/dL (59.09%), HDL-C levels ≥40 (56.25%); and had never smoked (54.89%). Compared to patients with HbA1c <7% and 7%-9%, those with HbA1c >9% were the youngest, had higher average office visits/patient, and had a higher prevalence of depression, obesity, elevated LDL-C and lower HDL-C levels. CONCLUSIONS This study provides insight into the potential risk factors for diabetes such as the presence of obesity, dyslipidemia, and depression, specifically in patients with HbA1c levels above 9%. Physicians should use evidence-based benchmarks in the development of EMR disease management programs to improve patient outcomes and quality of care.

Impact of Student Pharmacist-Delivered Asthma Education on Child and Caregiver Knowledge

Objective. To evaluate the effectiveness of asthma education delivered by student pharmacists and to assess the impact of child and caregiver baseline asthma knowledge on asthma control in children. Design. Student pharmacists developed and implemented asthma self-management education interventions for children and their caregivers and performed asthma screenings for children at a series of asthma camps. Assessment. Eighty-seven children, ages 5-17 years, and their caregivers were enrolled in this study. A previously validated asthma questionnaire was modified to assess asthma knowledge among children and adults. Asthma knowledge increased significantly in children following participation in the education intervention (p<0.001). The education intervention, however, did not increase caregiver knowledge of asthma. A significant association was observed between caregiver baseline asthma knowledge and better asthma control in their children (p=0.019). Conclusion. The results of this study demonstrate that student pharmacist-delivered asthma education can positively impact asthma knowledge in children, and that caregivers’ knowledge of asthma is strongly correlated with better asthma control in their children.

Influence of Viscosity and Consumer Use on Accuracy of Oral Medication Dosing Devices

Background: In response to numerous reports of overdoses with over-the-counter (OTC) liquid medications, the Food and Drug Administration has recommended that all OTC liquid drug products contain a measuring device but provided no recommendation on the type of device to be included. Objective: To evaluate the accuracy of liquid medication dosing devices (cup, dropper, syringe) in dispensing medications of varying viscosity in the laboratory and clinical settings. Methods: This experimental study evaluated dosing device accuracy. A pharmaceutics laboratory was used to evaluate accuracy under ideal conditions and subjects ≥18 years of age were recruited from community pharmacies to evaluate accuracy when used by consumers. Results: In the laboratory setting, the syringe was the most accurate for the more viscous formulations (cherry and grape suspension; 1% error, 1.2% error, respectively), and the dropper was the most accurate for the less viscous formulation (solution; 0.8% error). A volunteer sample of 320 participants was enrolled from the clinical setting. In the clinical setting, the syringe was most accurate, followed by the cup and then the dropper for all formulations (mean error, 2%, 14%, 33%, respectively). The cup was the most likely to overdose (mean, 5.7 mL), while the dropper was most likely to underdose (mean, 3.3 mL). Conclusions: The results of this study suggest that medication viscosity, consumer use, and dosing device contribute to dosing accuracy. The syringe appears to be the most accurate dosing device, accounting for differences in medication viscosity and the impact of consumer use.

An asthma sports camp series to identify children with possible asthma and cardiovascular risk factors.

Abstract Background: The prevalence of asthma and obesity in children has increased over the past several years, with obesity being associated with higher rates of asthma. In response to known disparities in asthma prevalence and morbidity, along with barriers to diagnosis, assessment and education, a comprehensive asthma sports camp series was developed and implemented.Objective: The primary objective was to evaluate the effectiveness of utilizing a sports camp model to identify children with undiagnosed and uncontrolled asthma, and to provide recommendations for follow-up care. The secondary objectives were to identify the presence of and associations between related co-morbidities and risk factors for asthma morbidity such as obesity, hypertension and exposure to tobacco smoke; and to assess asthma medication use.Methods: Six daylong camps at an inner-city university were offered to children 5–17 years of age over a period of two years. Asthma, body mass index, blood pressure (BP) and carbon monoxide screenings were conducted at each camp.Results: In this sample, 43.7% of children had previously diagnosed asthma, and 12.6% were classified as having potential, undiagnosed asthma. Of the children with previously diagnosed asthma, 76% were considered uncontrolled. Thirty-eight percent were determined to be overweight or obese and 17% had elevated BP.Conclusions: An interdisciplinary sports camp model can be used to identify children with undiagnosed and uncontrolled asthma and cardiovascular risk factors; and to provide recommendations for follow-up care.

Treatment of Obesity Among Youth With Intellectual and Developmental Disabilities: An Emerging Role for Telenursing

Childhood obesity is a serious health issue, associated with medical comorbidity and psychosocial impairment that can persist into adulthood. In the United States, youth with intellectual and developmental disabilities are more likely to be obese than youth without disabilities. A large body of evidence supports the efficacy of family-based treatment of childhood obesity, including diet, physical activity, and behavior modification, but few interventions have been developed and evaluated specifically for this population. We highlight studies on treatment of obesity among youth with intellectual and developmental disabilities, including both residential/educational settings as well as outpatient/hospital settings. All interventions were delivered in-person, and further development of promising approaches and delivery via telenursing may increase access by youth and families. Nursing scientists can assume an important role in overcoming barriers to care for this vulnerable and underserved population.

Relationship between antipsychotics and weight in patients with Prader-Willi syndrome.

Individuals with Prader–Willi Syndrome (PWS) are at increased risk for developing behavioral and psychiatric disorders, often requiring antipsychotics (APs). Contrary to significant AP‐associated weight gain observed in the general population, existing literature suggests weight loss in patients with PWS.

Pharmacist-led screening program for an inner-city pediatric population.

OBJECTIVES To identify the prevalence of asthma, obesity, hypertension, and environmental tobacco smoke (ETS) exposure among youth and provide recommendations for follow-up care. METHODS This cross-sectional study consisted of 12 health screenings for children between 5 and 17 years of age in various inner city, lower socioeconomic, and predominantly black communities throughout the city of Pittsburgh, PA. The screenings were conducted by pharmacists and student pharmacists from April 2010 to April 2012. Asthma, obesity, hypertension, and ETS screenings were offered at each event. RESULTS A total of 144 children (50% girls, 89% black, non-Hispanic) were enrolled. Sixteen percent of the study population had a previous diagnosis of asthma; 4% were poorly controlled, and 18% were identified as having potential, undiagnosed asthma. Fifty-three percent were at an unhealthy weight (0.7% underweight, 24.3% overweight, 28.5% obese), 24% had abnormal blood pressure (12.8% prehypertension, 8.5% stage 1 hypertension, 2.8% stage 2 hypertension), and 26% had ETS exposure equivalent to that of smokers (0.7% light smokers, 17.5% smokers, and 7.7% heavy smokers). Overall, 177 specific referrals were made. The incidence of hypertension (P <0.001) and the proportion of ETS equivalent to heavy smokers increased (P = 0.019) with increased weight classification. CONCLUSION Within this self-selected inner city, predominantly black pediatric population, there were high rates of positive screens for potential asthma, obesity, hypertension, and smoking. Additionally, the risk for high ETS exposure and hypertension increased with increasing weight. This study highlights the importance of pharmacists in disease screening and the need for alternative prevention and management strategies in disparate pediatric populations.