Background The opioid epidemic remains a significant public health crisis in the United States. Naloxone has been identified as a critical component in combating this crisis. However, co-prescription rates among patients receiving opioids remain suboptimal, especially among certain high-risk populations. The purpose of the current study is to update and analyze recent trends in naloxone co-prescription rates in Iowa. Methods A retrospective analysis of de-identified prescription data from the Iowa Prescription Monitoring Program (PMP) was performed. Naloxone co-prescription rates per 1000 patients receiving opioids in the state of Iowa were calculated in 2019, 2020, 2021, and 2022 for nine categories, stratified by opioid dose, concurrent benzodiazepine use, and patient demographics. Exclusion criteria consisted of patients in a hospice or a non-ambulatory setting. Results The study found a year-over-year increase in naloxone co-prescriptions from 2019 to 2022 across all examined categories. High-risk groups, including patients on higher opioid doses and those prescribed opioids and benzodiazepines concurrently, showed substantial increases in naloxone co-prescriptions. Geographical and age-related disparities in naloxone co-prescribing rates were also observed, with rural areas and older patient groups less likely to receive naloxone. Conclusions The observed increases in naloxone co-prescribing rates indicate progress in opioid overdose prevention efforts. Nonetheless, co-prescription rates remain suboptimal among high-risk groups, underscoring the need for continued education and policy efforts to enhance naloxone accessibility and encourage its co-prescription with opioids, particularly among older patients and geographical areas with lower co-prescription rates.

Introduction Outcomes for specific racial and ethnic groups during the COVID-19 pandemic and the widespread protests demanding racial justice in 2020 renewed a focus on health equity practices and bias in medical education. Routine inclusion of sociodemographic identifiers such as sex/gender, age, race, and/or ethnicity in test items risks perpetuation of implicit bias and race-based practices in medical education. Methods A retrospective review was conducted of test items in a pathophysiology course series at an academic medical center in the Western United States. Sociodemographic identifiers in multiple choice test items were reviewed to determine clinical relevance. Results Of 795 test items, 475 referred to sociodemographic information (gender, race/ethnicity, age, sexual orientation) and in only 27.5% of questions, this inclusion was clinically relevant (131/475). Discussion Current evidence suggests that routine inclusion of sociodemographic information in test items infrequently supports the clinical diagnosis and perpetuates implicit bias and race-based practices in medical education. Thoughtful inclusion of sociodemographic information in assessment offers an opportunity to address sociostructural determinants of health.

Background: The novel coronavirus 2019 (COVID-19) pandemic impacted everyday life for most individuals, including students. Unique COVID-19 stressors among students may include virtual learning, mental stress, and being socially distanced from classmates. Studies examining the impact of COVID-19 on stress and lifestyle changes among pharmacy students are limited.Objective: The primary purpose of this study was to compare stress and food or housing insecurity changes associated with COVID-19 in U.S. Doctor of Pharmacy (PharmD) students pre-COVID vs. during-COVID. Methods: A 23-item survey was administered via Qualtrics (R) to multiple PharmD programs across the U.S. in pre-COVID-19 (spring 2019) and during-COVID-19 (spring 2021). Participants were recruited via e-mail. The survey included questions related to demographics, lifestyle (sleep, exercise, work hours, extracurricular activities), and food and housing insecurities. The survey also included a validated instrument to measure stress (Cohen-Perceived Stress Scale). Results from 2021 were compared to a similar national survey serendipitously administered prior to COVID-19 in Spring 2019. Results: Pre-and COVID-19 analytical cohorts included 278 and 138 participants, respectively. While pre-COVID-19 students were slightly older (29.9 +/- 4.7 vs. 27.7 +/- 4.2, p <= 0.001), relative to COVID-19 students, other demographic factors were similar. No significant difference was observed in reported stress levels (PSS = 20.0 +/- 6.3 vs. 19.7 +/- 6.2, p = 0.610) between time periods. Significant differences in food (53.2% vs. 51.4%, p = 0.731) and housing (45.0% vs. 47.1%, p = 0.680) insecurity were also not seen.Conclusions: These findings highlight that PharmD students' perceived stress and food and housing insecurities due to COVID-19 may have been minimal. Additional studies on pharmacy students should be conducted to validate these results. These results may help inform policymakers and stakeholders during the early stages of any future pandemics.

Objective: Poor adherence leads to worse glycemic control and increased complications in patients with type 1 diabetes mellitus (T1DM). Diabulimia characterizes patients with T1DM who skip or use less insulin for weight loss purposes. The study objectives were to determine: (1) the prevalence of diabulimia among adult patients with T1DM, (2) compare patients with and without diabulimia, and (3) identify factors that may place individuals at higher risk of diabulimia.Methods: A 40-item, web-based survey was administered to 21 T1DM discussion boards, Listservs, and social media outlets. The survey assessed demographics, diabetes management, psychiatric diagnoses, and screened for diabulimia. Individuals who reported intentionally skipping or using less insulin than directed for the purpose of weight loss or to prevent weight gain in the past 12 months were classified as having diabulimia.Results: Of the 225 participants who completed the survey, 8.9% had diabulimia. Patients with diabulimia had elevated hemoglobin A1C (A1C) levels (8.4% vs 6.9%; P = .014), higher rates of a diabetes-related emergency department visits or hospitalization (30.0% vs 13.2%; P = .042), and higher rates of a major depressive disorder diagnosis (40.0% vs 11.5%; P < .001) than patients without diabulimia. Factors associated with diabulimia included high A1C levels (odds ratio, 1.43; 95% CI [1.08-1.91]; P = .014) and a major depressive disorder diagnosis (odds ratio, 4.87; 95% CI [1.31-18.22]; P = .018).Conclusion: Approximately 1 in 11 adult patients with T1DM screened positive for diabulimia. Higher A1C levels and a diagnosis of major depressive disorder were associated with diabulimia.(c) 2023 AACE. Published by Elsevier Inc. All rights reserved.

Background:Changes in demographics and composition of pharmacy faculty, along with faculty perceived stress, work-life balance and career satisfaction have yet to be fully documented.Objective:To compare recent results from a national survey of work-life balance and career satisfaction of United States (U.S.) pharmacy faculty with results obtained from a similar survey from 2012.Methods:A 46-item anonymous survey administered via Qualtrics (Provo, UT) was sent to members of the American Association of Colleges of Pharmacy (AACP) in 2018. Information regarding demographics, stress, work-life balance, career satisfaction and intent to leave academia was collected. Although not part of the previous survey, participant information related to bullying and abuse in the pharmacy academic work was also gathered. While actual p-values are reported for all comparisons, a more conservative p-value of 0.01 was chosen a priori to indicate significance as multiple comparisons were made.Results:A total of 1090 pharmacy faculty completed the survey, comparable to the number obtained in 2012 (n = 811). Overall response rates were similar for both years. The majority of pharmacy faculty in 2018 were female, white, married or with partner, worked in a pharmacy practice department and for a public institution. Notable differences between surveys included an increase in females, more associate professors and an increase in non-white faculty in 2018, relative to 2012. Stress, as measured by mean Perceived Stress Scale (PSS) scores was also significantly higher in 2018 (16.0 ± 6.6 vs. 13.5 ± 6.7, p < 0.01) relative to 2012. Faculty from 2018 were significantly less likely to report an intention to remain in academia (61.8% vs 86.3%, p < 0.01), relative to 2012. A sizable number of pharmacy faculty surveyed in 2018 also reported observing or experiencing hostility in the workplace, which included either bullying or verbal or physical abuse.Conclusions:The makeup of pharmacy educators has evolved quickly over the last several years to comprise more female and associate professors who work within a pharmacy practice department. Also noteworthy is the significant increase in self-reported stress over the six-year timeframe. The direct implications of these findings are unknown but suggest that pharmacy academia is maturing in rank and changing to reflect the current pharmacy workforce (i.e., more females and additional clinical practice roles). Increases in responsibility likely accompany these maturing roles and may, along with other factors, contribute to the observed changes in the reported stress levels among faculty. Further research is called for regarding the reported hostility in pharmacy academic workplace and dovetails with concurrent work being done on citizenship and organizational citizenship behavior among pharmacy faculty. Findings of the study may aid pharmacy school administrators and stakeholders with plans to recruit, develop and retain faculty.

Researchers attempt to minimize Type-I errors (concluding there is a relationship between variables, when there in fact, isn't one) in their experiments by exerting control over the p-value thresholds or alpha level. If a statistical test is conducted only once in a study, it is indeed possible for the researcher to maintain control, so that the likelihood of a Type-I error is equal to or less than the significance (p-value) level. When making multiple comparisons in a study, however, the likelihood of making a Type-I error can dramatically increase. When conducting multiple comparisons, researchers frequently attempt to control for the increased risk of Type-I errors by making adjustments to their alpha level or significance threshold level. The Bonferroni adjustment is the most common of these types of adjustment. However, these, often rigid adjustments, are not without risk and are often applied arbitrarily. The objective of this review is to provide a balanced commentary on the advantages and disadvantages of making adjustments when undertaking multiple comparisons. A summary discussion of familiar- and experiment-wise error is also presented. Lastly, advice on when researchers should consider making adjustments in p-value thresholds and when they should be avoided, is provided.

Background: The use of claims data for identifying comorbid conditions in patients for research purposes has been widely explored. Traditional measures of comorbid adjustment included diagnostic data (e.g., ICD-9-CM or ICD10-CM codes), with the Charlson and Elixhauser methodology being the two most common approaches. Prescription data has also been explored for use in comorbidity adjustment, however early methodologies were disappointing when compared to diagnostic measures. Objective: The objective of this methodological review is to compare results from newer studies using prescription-based data with more traditional diagnostic measures. Methods: A review of studies found on PubMed, Medline, Embase or CINAHL published between January 1990 and December 2020 using prescription data for comorbidity adjustment. A total of 50 studies using prescription drug measures for comorbidity adjustment were found. Conclusions: Newer prescription-based measures show promise fitting models, as measured by predictive ability, for research, especially when the primary outcomes are utilization or drug expenditure rather than diagnostic measures. More traditional diagnostic-based measures still appear most appropriate if the primary outcome is mortality or inpatient readmissions.

INTRODUCTION:We sought to compare student performance on acute care advanced pharmacy practice experiences (APPEs) pre- and post-incorporation of mock acute care patient simulations into the curriculum.METHODS:A series of mock acute care APPE simulations (MACAS) were developed and incorporated into Touro University California College of Pharmacy curriculum for first- and second-year pharmacy students. Results for student performance on Acute Care I and Acute Care II APPEs were collected for students who received none, one year, or two years of the MACAS. Student admission characteristics and didactic academic performance (grade point average [GPA]) were also gathered. Student characteristics and APPE performance were compared across cohorts of students who received none, one year, and two years of MACAS. Multivariate models were created to measure the impact of the MACAS while controlling for student characteristics.RESULTS:The final cohort included 394 students. In unadjusted analyses, students with one or two years of MACAS received significantly higher preceptor acute care APPE evaluations for communication, professionalism, and patient scores vs. students who received no MACAS. In multivariate models controlling for age, gender, and undergraduate GPA, one year of MACAS increased student acute care APPE communication, professionalism, and patient care scores, relative to no MACAS. Similar increases in acute care APPE scores were seen for students who received two years of MACAS.CONCLUSIONS:MACAs significantly improved acute care APPE scores relative to students with no MACAS. This improvement in acute care APPEs occurred after students received a single year of MACAS.

INTRODUCTION:The purpose of this study was to investigate the significant contributions of coping, resilience, personal characteristics, and health behaviors on the emotional well-being of pharmacy students during the COVID-19 pandemic. COVID-19 was identified in December 2019 and declared a pandemic by the World Health Organization in March 2020. Pharmacy students may experience greater stress during this outbreak because of interruptions in classes or rotations, concerns regarding personal or family health, and social isolation from peers. These changes may result in behavior shifts, difficulty concentrating, and increased use of negative coping strategies. The extent to which these factors affect overall student well-being during a pandemic is largely unknown.METHODS:A cross-sectional study of 3 colleges of pharmacy was completed during May to July 2020 via an online, anonymous 64-item questionnaire using REDCap software. Linear regression and descriptive statistical analyses were conducted using SPSS version 26.RESULTS:Using the enter method, levels of coping strategies, personal resilience, and Hispanic ethnic identity explain 29% of the variance in emotional well-being scores in pharmacy students during the first months of the COVID-19 pandemic (F (2,76) = 11.785, P < .000, R2 = 0.317, R2 adjusted = 0.291). For this sample (N = 104), higher levels of resilience, greater use of coping strategies, and identifying as Hispanic were significant predictors of emotional well-being.DISCUSSION:Student mental health continues to be important, especially during crises and pandemics. Therefore, pharmacy programs should cultivate an environment that supports the emotional well-being of their students. Campus-based initiatives may be needed to encourage healthy coping behaviors and bolster students' personal resilience to better prepare them for providing front-line patient care in the future.

BACKGROUND/OBJECTIVES Glyburide was added to the 2012 American Geriatrics Society (AGS) Beers Criteria® due to the risk of hypoglycemic events in older adults. The objective of this study was to evaluate trends of glyburide use in persons aged 65 and older with diabetes mellitus, type II, before, during, and after the 2012 AGS Beers Criteria® Update. DESIGN Multicenter retrospective cohort study comparing pharmacy claims data from four Sharp Rees‐Stealy clinic regions over 5 years (2010–2015). SETTING Pharmacy claims database. PARTICIPANTS A total of 3,005 patients with diabetes mellitus, type II, aged 65 and older. MEASUREMENTS Prescription fill history of the sulfonylureas glyburide, glipizide, and glimepiride were collected along with comorbidity (Elixhauser) and demographic information. Odds of glyburide prescribing were stratified by year, clinic region, and by prescriber type. RESULTS Glyburide use decreased across each study year (35.8%, 27.7%, and 4.2% in 2011, 2013, and 2015, respectively; P < .01). Adjusted odds of glyburide use indicated that regions A and D were 24% ( P = .045) and 11% ( P < .01) less likely to prescribe glyburide in 2011, regions A and D were 37% ( P < .01) and 8% ( P = .03) less likely to prescribe glyburide in 2013, respective to the overall average, whereas region B was 41% ( P = .04) more likely. No significant regional site variations remained in 2015. Internists were 47% more likely to prescribe glyburide than family medicine providers in 2013; P < .01), but not in any other study years. CONCLUSION Rates of glyburide use decreased after release of the 2012 AGS Beers Criteria® demonstrating successful adoption of evidence‐based medicine at a large multiregional site. However, regional differences may affect timing of implementation. Education, system‐level initiatives, and strong professional support may help enhance more uniform adoption. J Am Geriatr Soc 68:2354–2358, 2020.

Introduction: In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic impacting the mental wellbeing of the general public Pharmacy students may experience greater stress during this pandemic due to interruptions in classes or rotations, concerns regarding personal/family health, and social isolation from peers These changes may result in behavior shifts, difficulty concentrating, and increased use of negative coping strategies The extent to which these factors affect overall student wellbeing during a pandemic is largely unknown Research Question or Hypothesis: The purpose of this study was to assess coping, resilience, personal characteristics, and emotional wellbeing among pharmacy students during the COVID-19 pandemic Study Design: This was a cross-sectional study of three pharmacy programs in California, Florida, and North Carolina, after the onset of the COVID-19 pandemic via an online, anonymous 71-item questionnaire using REDCap software during May-July 2020 Methods: The Emotional Wellbeing in Healthcare Professions Students Questionnaire (EWB-Q) assessed coping, personal resilience, personal characteristics in pharmacy students and determined emotional wellbeing vis-a-vis these factors Linear regression and descriptive statistics analyses were conducted using SPSS v 26 Results: Multiple linear regression indicated levels of coping strategies, personal resilience, and ethnicity (Hispanic vs non-Hispanic) explained a significant amount of the variance (approximately 30%) in emotional wellbeing scores of pharmacy students (N = 104) A significant regression equation was found, F(2,76) = 11 785, P < 000, R2 = 317, R2 adjusted = 291) No differences were noted between students in didactic coursework vs rotations Greater use of coping strategies, higher levels of resilience, and identifying as Hispanic were significant predictors of increased emotional wellbeing Conclusion: Student mental health continues to be of importance, especially during crises and pandemics Therefore, pharmacy programs should cultivate emotional wellbeing of their students Campus-based initiatives may be needed to encourage healthy coping behaviors and bolster students' personal resilience to better prepare them for providing front-line patient care in the future

BACKGROUND:Non-prescription cannabidiol (CBD) products have recently been available in community pharmacies. However, there is only limited data to support its use, placing community pharmacists in a challenging position to provide evidence-based information to patients.OBJECTIVE:The objective of this study was to assess knowledge, experience, and confidence of non-prescription CBD products among community pharmacists.METHODS:A 38-question pen-and-paper survey pertaining to knowledge, experience, and confidence of non-prescription CBD products was administered to community pharmacists in the California Bay Area. Inclusion criteria consisted of registered pharmacists at community pharmacies during regular business hours. Participants were excluded if they were under 18 years old or unwilling to participate.RESULTS:Of 128 pharmacists, 103 took part and completed the survey (response rate 80.4%). The majority (78.5%) were unable to answer at least 80% of the non-prescription CBD knowledge-based questions. Over 50% have received patient questions and 20.4% recommended non-prescription CBD products in the last 12 months. More than half were "not confident" answering questions about non-prescription CBD products, and 14.5% received formal training on the topic.CONCLUSION:Despite patients commonly asking about non-prescription CBD products, the majority of pharmacists lack clinical knowledge and confidence on the topic. There is a need to provide formal training and educational resources on non-prescription CBD products.

Introduction The percentage of women pharmacy students and pharmacy faculty has greatly increased over the last 40 years. However, it is not known whether gender differences exist in terms of career satisfaction, work-life balance, and stress in the pharmacy academia workplace. Methods Results from a national web-based survey administered to American Association of Colleges of Pharmacy (AACP) members were utilized. Bivariate analyses were conducted to compare differences among faculty according to gender (men vs women). A series of multivariate models controlling for demographic and other faculty and school-level factors were created to explore the impact of gender on satisfaction with current position, satisfaction with work-life balance, and perceived stress. Results Among the 802 survey respondents, 457 (57.0%) women were more likely to be younger, hold a lower academic rank, and be in a pharmacy practice department, relative to 345 (43.0%) men. In adjusted results, men pharmacy faculty were more likely to report being extremely satisfied with their current job, more likely to report being extremely satisfied with their work-life balance, and score lower on a standardized stress measure relative to women. Conclusion While primarily descriptive, the results suggest women pharmacy faculty in the United States are less satisfied with their current academic position, less satisfied with their current work-life balance, and have higher stress levels compared to men even after controlling for age, academic rank, and department (along with other factors). Further research is needed to explore and address causes of the observed gender-related differences among pharmacy faculty.

Magazines have traditionally been an effective medium for delivering health media messages to large populations or specific groups. In this retrospective cross-sectional study, we evaluated nine issues from 2016 publications of American men’s health-related magazines ( Men’s Health and Men’s Fitness ) to evaluate their recommendations and determine their validity by examining corresponding evidence found in the peer-reviewed scientific literature. We extracted health recommendations ( n = 161) from both magazines and independently searched and evaluated evidence addressing the recommendations. We could find at least a case study or higher quality evidence addressing only 42% of the 161 recommendations (80 recommendations from Men’s Health and 81 recommendations from Men’s Fitness ). For recommendations from Men’s Health , evidence supported approximately 23% of the 80 recommendations, while evidence was unclear, nonexistent, or contradictory for approximately 77% of the recommendations. For recommendations from Men’s Fitness , evidence supported approximately 25% of the 81 recommendations, while evidence was unclear, nonexistent, or contradictory for approximately 75% of the recommendations. The majority of recommendations made in men’s health-related magazines appear to lack credible peer-reviewed evidence; therefore, patients should discuss such recommendations with health-care providers before implementing.

CONTEXT:Medication nonadherence is an important barrier to achieving optimal clinical outcomes. Currently, there are limited data on methods used to train medical students about medication adherence.OBJECTIVE:To evaluate the knowledge, confidence, and attitudes of first-year osteopathic medical students before and after a 30-minute peer-to-peer medication adherence education program led by a third-year pharmacy student.METHODS:All first-year medical students from Touro University California College of Osteopathic Medicine were invited to participate in 1 of 3 medication adherence educational sessions held in May 2019. A third-year pharmacy student who received training from Touro University California College of Pharmacy faculty served as the peer educator. Each session took approximately 1 hour to complete. The session included a preprogram survey, a 30-minute program, and a postprogram survey. Survey items included demographics; medication adherence knowledge, confidence, and attitudes; and attitudes toward the peer-to-peer educational format. Statistical comparisons of preprogram and postprogram knowledge, confidence, and attitudes were made using a paired t test, the McNemar test, and the Wilcoxon signed-rank test. P<.05 was considered statistically significant. A sample size calculation was performed using mean knowledge scores to determine whether the study achieved 80% power.RESULTS:Twenty-three students participated in the study. Medication adherence knowledge scores improved after the program (17.4 [77.4%] vs 9.98 [92.2%]; P<.001). Confidence scores also improved for all 7 survey items (P<.001). Medical students had more positive attitudes toward medication adherence after the program, with 8 of 10 survey items in this domain showing improvement. Most students had a positive attitude toward the peer-to-peer educational format. All participants reported that they would implement the medication adherence skills learned at the program with future patients.CONCLUSION:A 30-minute peer-to-peer program led by a pharmacy student improved first-year medical students' knowledge, confidence, and attitudes with regard to medication adherence and provided an effective format to enhance interprofessional learning and collaboration.

Objective. To implement a mock acute care advanced pharmacy practice experience series into the didactic training of second-year pharmacy students and validate an accompanying assessment rubric. Methods. Three 90-minute acute care patient simulation laboratory sessions were developed with input from clinical specialists, preceptors, students, and faculty members. An accompanying student evaluation rubric was also developed. The assessment rubric was validated using pairs of preceptor raters to determine inter-rater reliability, along with predictive validity on advanced pharmacy practice experience (APPE) acute care scores. A student survey was also conducted. Results. The mock acute care APPEs were successfully implemented into the didactic curriculum. The assessment rubric had good inter-rater reliability and good predictive validity with acute care APPEs. Survey results indicated that students found the mock acute care APPE simulation laboratories useful. Conclusion. Other schools seeking to enhance their students' preparedness for and performance in acute care APPEs should consider implementing acute care APPE simulations in the didactic curriculum.

BACKGROUND AND OBJECTIVES:The majority of anabolic androgenic steroid (AAS) studies have focused on the general male population. Approximately 15% of gay or bisexual men are seropositive for HIV and many AASs are administered via injection. Thus, AAS use among gay and bisexual men likely poses a greater risk of spreading infectious disease. Gay and bisexual men who use AAS were compared with non-users regarding self-reported seropositivity for HIV and hepatitis B and C, sexual behaviors and injection practices, illicit drug and alcohol use, and psychiatric disorders.METHODS:The CASTRO (Castro Anabolic Steroid Research Observation) study was a 108-item cross-sectional survey of 153 gay and bisexual men who exercise. Data collection occurred outside four gyms in the San Francisco Castro District.RESULTS:The lifetime prevalence of AAS use among gay and bisexual men in the study was 21.6%. AAS users and non-users did not differ in self-reported seropositivity for HIV or hepatitis B and C, but AAS users reported higher rates of male-male condomless anal sex in the past year (84.8 vs 60.8%, p < .01) than non-users. More AAS users used ecstasy and methamphetamines (39.4 vs 16.7%, p < .01 and 18.2 vs 5.0%, p = .01, respectively) than non-users.DISCUSSION AND CONCLUSIONS:Gay and bisexual men who used AAS were more likely to engage in unsafe sexual behaviors and use illicit drugs relative to non-users. Multiple factors place AAS users at higher risks for spreading infectious diseases.SCIENTIFIC SIGNIFICANT:Our study suggests increased infectious disease risk among gay and bisexual men who use AAS. (Am J Addict 2019;XX:1-10).