Jill E. Lavigne

Hot flashes, fatigue, treatment exposures and work productivity in breast cancer survivors

IntroductionWhile fatigue has been associated with work limitations the combined influence of specific diagnosis and treatment exposures based on medical records on work limitations in breast cancer survivors is currently unknown. Since symptom burden and perceived health can interfere with work, the present study investigated the relationship among these variables and work outcomes.MethodsMedical chart abstraction, demographic measures, SF 36, the Work Limitations Questionnaire (WLQ) and measures of symptom burden, including hot flushes were obtained in 83 breast cancer survivors a mean of three years post treatment. OLS and poisson regression were used to determine the relationship of these factors to work productivity and work absences.ResultsBreast cancer survivors reported a mean reduction in productivity of 3.1% below the healthy worker norm. This amounts to a loss of 2.48 hours of work over two weeks of full time employment. Stages 1 and 2 were related to work limitations. After controlling for stage, fatigue and hot flashes were each associated with work performance losses of 1.6% (p = 0.05) and 2.2% (p < 0.001), respectively. Protective factors included marriage and greater personal earned income.ConclusionsFatigue and hot flashes are important factors related to work productivity in breast cancer survivors even at three years post treatment.Implications for survivorsTherapy for hot flashes should be given serious consideration in breast cancer survivors who are experiencing work limitations.

Educating Pharmacy Students to Improve Quality (EPIQ) in colleges and schools of pharmacy.

Objective. To assess course instructors’ and students’ perceptions of the Educating Pharmacy Students and Pharmacists to Improve Quality (EPIQ) curriculum. Methods. Seven colleges and schools of pharmacy that were using the EPIQ program in their curricula agreed to participate in the study. Five of the 7 collected student retrospective pre- and post-intervention questionnaires. Changes in students’ perceptions were evaluated to assess their relationships with demographics and course variables. Instructors who implemented the EPIQ program at each of the 7 colleges and schools were also asked to complete a questionnaire. Results. Scores on all questionnaire items indicated improvement in students’ perceived knowledge of quality improvement. The university the students attended, completion of a class project, and length of coverage of material were significantly related to improvement in the students’ scores. Instructors at all colleges and schools felt the EPIQ curriculum was a strong program that fulfilled the criteria for quality improvement and medication error reduction education. Conclusion The EPIQ program is a viable, turnkey option for colleges and schools of pharmacy to use in teaching students about quality improvement.

Smoking cessation agents and suicide

The risk is uncertain, so patients should make an informed decision

Student Self-Screening for Methicillin-Resistant Staphylococcus Aureus (MRSA) Nasal Colonization in Hand Hygiene Education

Objective. To determine the feasibility and effectiveness of adding a hand hygiene exercise in self-screening for Methicillin-Resistant Staphylococcus Aureus (MRSA) nasal colonization to a health care delivery course for first-year pharmacy (P1) students. Design. About one month after students were trained in hand hygiene technique and indications, faculty members demonstrated how to self-screen for MRSA nasal colonization. Students were then asked to screen themselves during the required class time. Aggregated class results were shared and compared to prevalence estimates for the general population and health care providers. Assessment. The 71 students present in class on the day of the self-screening exercise chose to participate. A survey comparing presecreening and postscreening responses indicated incremental improvements in student knowledge and awareness of health care associated infections and motivation to perform hand hygiene. On the written exam, student performance demonstrated improved knowledge compared to previous class years. Conclusion. Self-screening for MRSA nasal colonization in a health care delivery course for P1 students increased students’ motivation to perform hand hygiene techniques and follow indications promulgated by the World Health Organization.

A Continuous Professional Development Process for First-Year Pharmacy Students

Objectives. To develop, pilot test, and evaluate a continuous professional development (CPD) process for first-year pharmacy (P1) students. Design. Students and faculty members were introduced to the important elements of the CPD process via a live training program. Students completed the year-long 4-step CPD cycle by identifying a learning objective, creating a plan, completing the learning activity, evaluating their learning outcome, documenting each step, and meeting with their faculty advisor for feedback and advice. Assessment. Seventy-five first-year students (100%) successfully completed the CPD process during the 2009-2010 academic year. The students spent an average of 7 hours (range 2 to 20 hours) on the CPD process. The majority of faculty members (83%) completing the survey instrument found the process valuable for the students and would like to see the program continued. Conclusion. Integrating a CPD requirement for students in a college or school of pharmacy is feasible and valuable to students’ developing life-long learning skills. Effective and frequent training of faculty members and students is a key element in the CPD process.

Utilization of prescription drugs with warnings of suicidal thoughts and behaviours in the USA and the US Department of Veterans Affairs, 2009

Objectives  To develop a list of prescription medications labelled with warnings for adverse effects of suicidal ideation or behaviour and to describe utilization in the USA and in the Department of Veterans Affairs (VA) in 2009.

The pharmacology and epidemiology of post-market surveillance for suicide: the case of gabapentin

Objectives  To describe the challenges in measurement of suicidal thoughts and behaviours and any causal relationship to prescription drug exposures. Recent US Food and Drug Administration (FDA) investigations of potential provocation of suicidal ideation and behaviour have led to black‐box warnings of suicidal thoughts and behaviour on drugs ranging from smoking cessation to urinary incontinence agents. We describe the challenges faced in studying the effects of specific drug exposures on suicidal thoughts and behaviours using gabapentin (Neurontin) as an example because it has been implicated by the FDA as a drug that may induce suicidal thoughts or behaviours, offers more than 20 diverse indications including several known to be associated with an increase in suicide risk, and derives its clinical effect from 2 divergent mechanisms.

Exposure to Prescription Drugs Labeled for Risk of Adverse Effects of Suicidal Behavior or Ideation among 100 Air Force Personnel Who Died by Suicide, 2006-2009.

Prescription drugs for many indications are labeled with warnings for potential risk of suicidal ideation or behavior. Exposures to prescription drugs labeled for adverse effects of suicidal behavior or ideation among 100 Air Force personnel who died by suicide between 2006 and 2009 are described. Air Force registry data were linked to administrative prescription data. Descriptive statistics illustrate utilization: 89 personnel had a prescription history, 35 filled at least one prescription labeled with a warning, 26 had antidepressants on hand at death, and 2 died by drug overdose. Most airmen were not exposed to any prescriptions labeled for risk of suicidal ideation or behavior prior to death by suicide.

A Retrospective Study of Patient Factors That Indicate Provider Nonadherence to an Institutional Clostridium difficile Treatment Guideline

Background: Clostridium difficile infection (CDI) is treated most often with metronidazole or vancomycin. Both have been effective in treatment of mild to moderate infection. In more severe cases, vancomycin may be more effective. Objectives: The primary objectives were to quantify the severity of CDI and to describe overall adherence to the institutional CDI guideline. Secondary objectives were to assess factors associated with adherence to the guidelines. Methods: Retrospective analysis of the electronic medical record was used to evaluate adherence to institutional guidelines. Data collected included demographics and other factors potentially contributing to adherence: Charlson comorbidity index, severity of infection, recurrence, intensive care unit (ICU) admission, infectious diseases (ID) consult, total duration and number of antibiotics, alternative therapies, and acid suppression. Descriptive statistics and bivariate analyses were used to describe and compare factors associated with guideline adherence; multivariate logistic regression assessed independent predictors of adherence. Results: A total of 387 patients met the inclusion criteria. CDI severity was 55.8% mild/moderate cases, 42.4% severe, 0.5% fulminant, and 1.3% prophylaxis. Overall, institutional guideline adherence was 51.9%. In bivariate analyses, 5 factors were associated with nonadherence to guidelines: older age, ICU admission, duration of antibiotics, mild/moderate and severe infection (all P < .05). In the logistic regression model, severe infection (P < .001) and longer duration of antibiotics (P < .05) were independently associated with guideline nonadherence. Conclusion: In this study, 42.4% of the patients met criteria for severe infection. Providers for patients with severe infection and longer duration of antibiotic therapy were less likely to adhere to the institutional guideline.

Community pharmacies and population health

To bridge the transition of care from the hospital to the community, drugstore chains are collaborating with inpatient teams and bringing outpatient prescriptions directly to the hospital to counsel patients about which medications they will continue and discontinue and how the neighborhood store