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The purpose of this study was to explore existing practice models and opportunities surrounding community pharmacist-delivered opioid counseling and naloxone (OCN) services in the U.S., with the goal of enhancing organizational readiness and improving patient access. A scoping literature review was conducted. English-language articles published in peer-reviewed journals from January 2012-July 2022 were sought via PubMed, CINAHL, IPA, and Google Scholar using permutations of terms such as "pharmacist/pharmacy", "opioid/opiate", "naloxone", "counseling", and "implement/implementation". Original articles reporting the resources/inputs (personnel; pharmacist full-time equivalents; facilities and expenses; in-house versus outsourced personnel), implementation processes (legal source of pharmacist authority; patient identification strategies; intervention procedures; workflow strategies; business operations), and programmatic outcomes (uptake and delivery; interventions made; economic impact; patient or provider satisfaction) of pharmacist-delivered OCN services in community (retail) settings were retained. Twelve articles describing ten unique studies were included. The studies primarily used quasi-experimental designs and were published from 2017 to 2021. The articles described seven broad program elements/themes: interprofessional collaboration (n = 2); patient education format including one-on-one patient education (n = 12) and group education sessions (n = 1); non-pharmacist provider education (n = 2); pharmacy staff education (n = 8); opioid misuse screening tools (n = 7); naloxone recommendation/dispensing (n = 12); and opioid therapy and pain management (n = 1). Pharmacists screened/counseled 11-2716 patients and provided 11-430 doses of naloxone. Limited implementation costs, patient/provider satisfaction, or economic impact measures were reported. This review may serve as a guide for community pharmacists in implementing OCN services in their own practices. Future studies should clarify OCN program implementation costs, patient/provider satisfaction, and the economic impact.

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BACKGROUND: Deep South states, particularly Alabama, experience disproportionately higher opioid prescribing rates versus national rates. Considering limited opioid use disorder (OUD) providers in this region, collaborative efforts between non-healthcare professionals is critical in mitigating overdose mortality. The Alabama Opioid Training Institute (OTI) was created in 2019 to empower community members to take action in combatting OUD in local regions. The OTI included: 1) eight full-day in-person conferences; and 2) an interactive mobile-enabled website ( https://alabamaoti.org ). This study assessed the impact of the OTI on influential community members' knowledge, abilities, concerns, readiness, and intended actions regarding OUD and opioid overdose mitigation. METHODS: A one-group prospective cohort design was utilized. Alabama community leaders were purposively recruited via email, billboards, television, and social media advertisements. Outcome measures were assessed via online survey at baseline and post-conference, including: OUD knowledge (percent correct); abilities, concerns, and readiness regarding overdose management (7-point Likert-type scale, 1 = strongly disagree to 7 = strongly agree); and actions/intended actions over the past/next 6 months (8-item index from 0 to 100% of the time). Conference satisfaction was also assessed. Changes were analyzed using McNemar or Marginal Homogeneity tests for categorical variables and two-sided paired t-tests for continuous variables (alpha = 0.05). RESULTS: Overall, 413 influential community members participated, most of whom were social workers (25.7%), female (86.4%), and White (65.7%). Community members' OUD knowledge increased from mean [SD] 71.00% [13.32] pre-conference to 83.75% [9.91] post-conference (p < 0.001). Compared to pre-conference, mean [SD] ability scale scores increased (3.72 [1.55] to 5.15 [1.11], p < 0.001) and concerns decreased (3.19 [1.30] to 2.64 [1.17], p < 0.001) post-conference. Readiness was unchanged post-conference. Attendees' intended OUD-mitigating actions in the next 6 months exceeded their self-reported actions in the past 6 months, and 92% recommended the OTI to others. CONCLUSIONS: The Alabama OTI improved community leaders' knowledge, abilities, and concerns regarding OUD management. Similar programs combining live education and interactive web-based platforms can be replicated in other states.

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BACKGROUND AND PURPOSE: Self-evaluation is a critical step in professional development. Peer evaluation may enhance student learning and help peer evaluators recognize their own limitations. However, these evaluations may not accurately assess performance. This study's purpose is to evaluate differences between faculty, self-, and peer evaluations of student journal club (JC) presentations during advanced pharmacy practice experiences (APPEs). EDUCATIONAL ACTIVITY AND SETTING: Student JC presentations for three APPE sites were identified between May 2015 and April 2018 and included if at least one faculty, self-, and peer evaluation were complete. Overall grades and individual rubric ratings were compared. FINDINGS: Seventy-four students had complete data sets. The mean overall scores for JC presentations were 82.72%, 86.05%, and 91.01% for faculty, self-, and peer evaluations, respectively. Self-evaluation ratings were significantly higher than faculty on each domain, except for "presentation and communication skills" (mean difference: -0.2, p = .034) and "ability to answer questions" (mean difference: -0.1, p = .247). Linear regression showed a statistically significant relationship between self-evaluation and faculty evaluation ratings for ability to answer questions (beta = 0.5, p < .001). Peer evaluation ratings were significantly higher than faculty and self-evaluations (p < .05). SUMMARY: Faculty scores on JC presentations completed during APPEs were lower compared to student evaluations of themselves and their peers. Further incorporation of self- and peer evaluation throughout pharmacy school curricula may improve student competence in performing these evaluations. Formal training is needed to improve students' ability to complete self and peer evaluations.

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Pain continues to be a serious health care concern in the United States. Patients with chronic pain experience the impact of the disease throughout their lives including their social interactions, family relationships, and in many cases economic productivity. Multiple surveys have found that many pharmacists hold misconceptions regarding opioids, pain disease states, and their understandings of current regulations. Multiple barriers affect the ability of pharmacists to deliver care to patients' prescribed opioid therapy. Inadequate communication between health care professionals and patients is one of the hurdles, which prevents quality care. Increased communication between health care providers including access to health information is one step, which is crucial to improving provision of pharmacotherapy. Finally, the quality of educational opportunities relative to opioids and pain management specifically for pharmacists needs to be increased, and consideration needs to be given for making appropriate pain management education mandatory.

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Pharmacy education has experienced substantial growth in the number of new schools and existing schools establishing satellite campuses. Several models have previously been used to connect primary and satellite campuses. We describe the Auburn University Harrison School of Pharmacy's (AUHSOP's) experiences using synchronous video conferencing between the Auburn University campus in Auburn and a satellite campus in Mobile, Alabama. We focus on the technology considerations related to planning, construction, implementation, and continued use of the various resources that support our program. Students' perceptions of their experiences related to technology also are described.

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This paper reviews the literature, analyzes current and future practice, develops a list of competencies necessary for future pharmacists, and provides recommendations to pharmacy's academic enterprise regarding curricula of the future. Curricula of the future will center around 3 functional roles for pharmacists: patient-centered care, population-based care, and systems management; and must also foster the development of 5 cross-cutting abilities in student pharmacists: professionalism, self-directed learning, leadership and advocacy, interprofessional collaboration, and cultural competency. Future curricula must be developed in an evidence-based manner, focus less on information storage and retrieval, engage student pharmacists in a variety of highly interactive learning experiences, and expand experiential learning opportunities throughout all years.

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A 45-year-old man with paranoid schizophrenia with delusions was transferred from a group home for treatment of diabetic ketoacidosis (DKA). Six months before this episode, he had been hospitalized in an inpatient psychiatric institution and treated with valproic acid and quetiapine 400 mg with normal blood sugars recorded. The patient was treated for diabetic ketoacidosis, and all outpatient medications were discontinued. Insulin resistance is commonly cited as the mechanism for hyperglycemia, a theory supported by the efficacy of insulin- sensitizing medications in reported cases. Although antipsychotic- associated DKA is uncommon, hyperglycemia associated with these medications is commonplace. Analysis of case series have not identified risk factors for hyperglycemia or diabetic ketoacidosis within this population. Considering the incidence and unpredictability of hyperglycemia associated with quetiapine and atypical antipsychotics, clinicians should initiate intensive monitoring in patients, including weight, hyperglycemia, and dyslipidemia.

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OBJECTIVE: To evaluate the relative safety and efficacy of finasteride for treatment of hirsutism related to hyperandrogenism in women. DATA SOURCES: Literature retrieval was accessed through MEDLINE (1966-March 2003) using the terms finasteride and hirsutism. Additional information was obtained from the drug manufacturer. DATA SYNTHESIS: Finasteride has been evaluated for treatment of hirsutism in multiple observational and randomized trials. Finasteride lowered hirsutism scores by 30-60% in most trials, as well as decreasing average hair diameter. In comparative trials, finasteride demonstrated efficacy similar to that of other antiandrogens, with fewer adverse effects. CONCLUSIONS: Finasteride does reduce the overall hair diameter and number in androgen-sensitive areas. Reported adverse effects have been minimal. Concern over potential teratogenicity and lack of long-term safety information leave finasteride a secondary treatment option for hirsutism.

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OBJECTIVES: To establish the steady-state pharmacokinetic profile of vancomycin in pediatric cardiology patients; determine an empiric vancomycin dose; and evaluate the correlation between fluid balance and volume of distribution (Vd), serum creatinine and clearance (CL), and daily dose of furosemide and Vd. METHODS: Retrospective pharmacokinetic evaluation in 36 pediatric cardiology, cardiac surgery, or cardiac transplant patients treated with vancomycin. The pharmacokinetic profile for vancomycin including elimination half-life (t1/2), elimination rate constant (ke), volume of distribution (Vd), and clearance (CL) was calculated for each patient. The relationship between fluid balance and Vd, serum creatinine and CL, and the total daily dose of furosemide and Vd was evaluated. RESULTS: The patient population had an average half-life of 5.9±1.2 hr and a Vd of 0.4±0.12 L/kg. A statistically significant correlation was noted between serum creatinine and CL (r(2)=0.19, P<0.01). Additionally, a statistically significant correlation exists between the total daily furosemide dose and the Vd (r(2)=0.31, P<0.01). A dose of 10 mg/kg/dose every 12 hrs was predicted to result in the greatest number of serum vancomycin concentrations within the reference range. CONCLUSIONS: Routine monitoring of serum vancomycin concentrations is prudent for this population, and special consideration should be given to those with elevated serum creatinine and to those receiving large doses of furosemide.

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OBJECTIVE: To determine if propylene glycol accumulates in children receiving continuous lorazepam infusion and, if accumulation occurs, to determine if it is associated with significant laboratory abnormalities. DESIGN: Prospective study. SETTING: A tertiary care pediatric intensive care unit. PATIENTS: Eleven intubated pediatric intensive care patients receiving continuous lorazepam infusion for sedation. INTERVENTIONS: Propylene glycol accumulation was determined by comparing concentrations at baseline, after 48 hrs, and at end of therapy. Laboratory abnormalities were determined by comparing serum lactate and osmolar gap at baseline, after 48 hrs, and at end of therapy. Correlation between the cumulative dose of lorazepam received and the propylene glycol concentration measured at the end of therapy was determined. MEASUREMENTS AND MAIN RESULTS: Patients aged 1-15 months were studied. Lorazepam infusion rates ranged from 0.1 to 0.33 mg.kg.hr and lasted 3-14 days. Propylene glycol accumulated significantly in patients receiving continuous infusion of lorazepam. The propylene glycol concentration increased during the study from 86 +/- 93 microg/mL at baseline to 763 +/- 660 microg/mL at the end of the study ( p=.038). A statistically significant correlation between the cumulative dose of lorazepam received and propylene glycol concentration at the end of therapy was demonstrated ( r(2)=.65, p<.005). However, the propylene glycol accumulation was not associated with significant laboratory abnormalities. Neither serum lactate concentrations nor osmolar gap were significantly elevated over baseline. CONCLUSION: Propylene glycol accumulated significantly in pediatric intensive care patients receiving continuous lorazepam infusion, and propylene glycol concentration correlated with the cumulative lorazepam dose the patient received. However, significant laboratory abnormalities due to propylene glycol accumulation were not observed.

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Sickle cell disease affects 70,000 Americans who experience an average of 0.8 painful episodes each year. The pathophysiology of sickle cell pain is not completely understood. The disease is characterized by both acute and chronic pain syndromes. Patients with sickle cell pain often encounter barriers to receiving appropriate care, including lack of continuity of care and perceived opiate addiction. Studies describing pharmacotherapy for sickle cell pain have been primarily retrospective and uncontrolled. In analyzing the available literature regarding pathophysiology, assessment, and treatment of sickle cell pain, we found a need for increased practitioner education and intervention to improve the level of care provided to patients with this disease.

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