Pharmacy and Pharmaceutical Sciences Commons^™

Pharmacy Interventions In Transitions Of Care From Hospital Discharge (Pitch) Pilot Program For Medicare Part D Patients At High-Risk For Readmission, Muirisha Nicole Lavender

Doctor of Pharmacy Honors Theses

Background: Pharmacist implemented transitions-of-care (TOC) programs focus on identifying adherence issues, developing care plans, investigating medication-related insurance problems, and instilling the value of medication treatment in patients frequently admitted to hospitals for manageable, chronic disease-states.

Study objective: The primary objective of this study is to determine the impact of pharmacist interventions during a TOC pilot on hospital readmission rates for patients with acute myocardial infarction (AMI), heart failure (HF), chronic obstructive pulmonary disease (COPD), or pneumonia.

Methods: This study is a retrospective review of patients receiving high intensity care to prevent readmission, including pharmacy intervention during a three-month pilot period …

Occurrence Of Potential Adverse Drug Events From Prescribing Errors In A Pediatric Intensive And High Dependency Unit In Hong Kong: An Observational Study, Chad A. Knoderer, Celeste L. Ewig, Hon Ming Cheung, Kwok Ho Kam, Hiu Lam Wong

Scholarship and Professional Work – COPHS

No abstract provided.

The Value Driven Pharmacist: Basics Of Access, Cost And Quality, Carriann Smith, Annette Mcfarland, Chad Knoderer, Joseph Jordan, Trish Devine, Jessica Wilhoite

Butler University Books

No abstract provided.

Evaluating Prescriber Adherence To Guideline-Based Treatment Pathways Of A Newly Initiated Antimicrobial Stewardship Program At A Rehabilitation Hospital, Christie Bertram

Undergraduate Honors Thesis Collection

Background: Inappropriate use of antimicrobials in the healthcare setting is associated with consequences including antimicrobial resistance, Clostridium difficile infection (CDI), adverse drug reactions, and increased healthcare costs. To combat this, hospitals are creating antimicrobial stewardship programs (ASPs) which seek to optimize antimicrobial utilization. To date, no studies have been done to assess adherence to an ASP in a rehabilitation hospital setting. The objective of this study is to evaluate prescriber compliance to treatment pathways for common infections before and after ASP implementation.

Methods: This was a retrospective cohort study of patients admitted to the Rehabilitation Hospital of Indiana (RHI) who …

The Impact Of Accountable Care: Interactions Between Patients And Payers – Where Do Pharmacists Lie?, Danielle Stone

Undergraduate Honors Thesis Collection

Introduction: Over the past several years, patient outcomes became the focus of health care. With increased accountability, pharmacy education must transform the next generation of health care providers according to the new 2016 Accreditation Council for Pharmacy Education standards, which includes preparing future pharmacists to provide patient-centered care and population health. Butler University College of Pharmacy and Health Sciences (COPHS) faculty have responded by creating a required, four semester, integrated course series: Pharmacy Practice and Healthcare Administration.

Purpose: To design a chapter within a pharmacy based textbook, which will replace the physician based Health Care Handbook currently used in the …

The Pharmacy (Organization) Divide: A Focus On The Impact In Pediatric Pharmacy, Chad A. Knoderer, Lisa Lubsch, Kristin C. Klein

Scholarship and Professional Work – COPHS

No abstract provided.

Improving Collaboration Between Pharmacists And Physicians, Paras Patel

BU Well

Physicians and pharmacists have differing but complementary roles that can optimize patient care when structured effectively. Unfortunately, these two professionals are not collaborating well enough, as patient outcomes, especially in relation to medication adherence, continue to decline. Coordinated care of patients can improve by expanding bidirectional communication and sharing additional patient information with each other. It will be necessary to continue to promote collaborative care in the educational and training stages of these professionals’ careers to build trust and understanding of professional scope. Ultimately, the healthcare infrastructure will have to continue to progress to make collaboration more available and valuable …

An N Of One: My Review Of Management Of Type 1 Diabetes, Myself As Patient, Jarred Daugherty

BU Well

As technology has advanced, so has the management of diabetes. Insulin, the essential medication for type 1 diabetes, is marketed in an array of formulations and devices. Continuous glucose monitors (CGM) can be inserted to measure blood glucose every 5 minutes. The rise of social media has given diabetics online support groups, where they can share their story and learn from others overcoming similar challenges. So, how well do the current diabetes management strategies work? My name Is Jarred and I’m a type 1 diabetic. I have tried many of these products and this article is a review of my …

Student-Generated E-Learning For Clinical Education, Sarah Nisly, Alex N. Isaacs, Alison M. Walton

Scholarship and Professional Work – COPHS

Background

Within clinical education, e-learning facilitates a standardised learning experience to augment the clinical experience while enabling learner and teacher flexibility. With the shift of students from consumers to creators, student-generated content is expanding within higher education; however, there is sparse literature evaluating the impact of student-developed e-learning within clinical education. The aim of this study was to implement and evaluate a student-developed e-learning clinical module series within ambulatory care clinical pharmacy experiences.

Methods

Three clinical e-learning modules were developed by students for use prior to clinical experiences. E-learning modules were created by fourth-year professional pharmacy students and reviewed by …

Comparison Of Tranexamic Acid And Aminocaproic Acid In Coronary Bypass Surgery, Lisa K. Lecleir

Butler Journal of Undergraduate Research

Abstract

OBJECTIVE: Tranexamic acid (TXA) and ɛ-aminocaproic acid (EACA) are used in coronary bypass surgery for antifibrinolytic therapy. Since the removal of aprotinin, data directly comparing their blood sparing effect and their side effects is still missing.

METHODS: Fifty patients undergoing coronary bypass cardiac surgery at St. Vincent’s Hospital and Health Services in Indianapolis, IN were evaluated in a retrospective cohort study. Perioperative data was collected by a thorough chart review. Patients received EACA from 01/01/2013 to 04/05/2013 or TXA from 05/07/2013 to 12/31/2013. Primary outcome was the amount of chest tube output throughout the hospital stay. Secondary …

Optimizing Guideline-Recommended Antibiotic Doses For Pediatric Infective Endocarditis, Chad A. Knoderer, Kristen R. Nichols, Emily N. Israel, Christopher A. Thomas

Scholarship and Professional Work – COPHS

The American Heart Association recently published an updated scientific statement on the management of infective endocarditis in childhood. The recommendations included for vancomycin, aminoglycoside, and β-lactam dosing and monitoring are based primarily on expert opinion and do not consider available evidence for dose optimization based on pharmacokinetic and pharmacodynamic principles in pediatric patients. This is concerning because even when clinically necessary, some practitioners may be hesitant to deviate from guideline-recommended doses. In this perspective, we highlight potential areas for improvement in the statement-recommended doses and summarize evidence supporting antibiotic dosing optimization. The addition of a pediatric clinical pharmacist with expertise …

Venous Thromboembolism Prophylaxis Compliance Before And After Electronic Health Record Implementation, Lindsay Saum, David Reeves

Scholarship and Professional Work – COPHS

Background: Adherence to American College of Chest Physicians (CHEST) and National Comprehensive Cancer Network (NCCN) guidelines for venous thromboembolism (VTE) prophylaxis helps avoid thromboembolic complications during hospitalization. Electronic health records (EHR) have the potential to make an impact on guideline adherence, but data are lacking.

Objectives: To determine compliance with VTE prophylaxis guidelines in internal medicine and oncology populations and to determine whether EHR implementation had any effect on the rate and appropriateness of prophylaxis practices.

Methods: A retrospective chart review was conducted on medical and oncology patients admitted to the hospital for a 2-month period pre-EHR and post-EHR implementation. …

Design Of Drug-Induced Diseases Elective Utilizing Active Learning, Alison M. Walton, Alex N. Isaacs, Annette T. Mcfarland, Lauren M. Czosnowski, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objectives

To describe active learning utilized in a drug-induced diseases (DID) elective and determine inter-rater reliability of the assessment rubric for oral case-based presentations.

Methods

The design of this DID elective focuses on problem-based learning to enhance students’ critical thinking and problem-solving skills pertaining to the treatment of inducible diseases and general medicine. Each class incorporates active learning, utilization of drug information resources, and group work. The primary course assessment is student developed oral case-based presentations evaluated with a standard rubric.

Results

The intra-class correlation coefficient (ICC) was calculated amongst evaluators to assess the inter-rater reliability of the DID rubric …

Strategies For The Management Of Postoperative Anemia In Elective Orthopedic Surgery, Taylor D. Steuber, Meredith L. Howard, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesisstimulating agents, and erythropoietin. Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery …

Glp-1 Agonists In Type 1 Diabetes Mellitus: A Review Of The Literature, Kristin M. Janzen, Taylor D. Steuber, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective: To review the use of GLP-1 agonists in patients with type 1 diabetes mellitus (T1DM). Data Sources: A search using the MEDLINE database, EMBASE, and Cochrane Database was performed through March 2016 using the search terms glucagon-like peptide 1 (GLP-1) agonists, incretin, liraglutide, exenatide, albiglutide, dulaglutide, type 1 diabetes mellitus. Study Selection and Data Extraction: All English-language trials that examined glycemic end points using GLP- 1 agonists in humans with T1DM were included. Data Synthesis: A total of 9 clinical trials examining the use of GLP-1 agonists in T1DM were identified. On average, hemoglobin A1C (A1C) was lower than …

Ascorbic Acid For The Treatment Of Rasburicase Induced Methemoglobinemia In The Setting Of Acute Renal Failure, David J. Reeves, Lindsay Saum, Ruemu Birhiray

Scholarship and Professional Work – COPHS

Purpose A case of apparent rasburicase-induced methemoglobinemia and acute kidney injury treated with i.v. ascorbic acid because of suspected glucose-6-phosphate dehydrogenase (G6PD) deficiency is reported.

Summary A 46-year-old African-American man with a recent diagnosis of multiple myeloma and renal insufficiency was admitted to the hospital with a cough, hemoptysis, and fatigue. His medical history included hypertrophic cardiomyopathy, ventricular tachycardia, attention deficit/hyperactivity disorder, and pleural effusion. No treatments for multiple myeloma were started before hospital admission. Levofloxacin 750 mg orally daily for possible pneumonia, lenalidomide 10 mg orally daily, and dexamethasone 20 mg orally weekly were administered. Plasmapheresis was also initiated. …

Development And Implementation Of A Pharmacist-Managed Outpatient Parenteral Antimicrobial Therapy Program, Eun Kyoung Chung, Cole B. Beeler, Eva W. Muloma, Danielle Osterholzer, Kendra M. Damer, Sharon M. Erdman

Scholarship and Professional Work – COPHS

Purpose The development and implementation of a pharmacist-managed outpatient parenteral antimicrobial therapy (OPAT) program in a county teaching hospital are described.

Summary A pharmacist-managed OPAT program was developed and implemented at a county teaching hospital to provide consistent evaluation, approval, and monitoring of patients requiring OPAT for the treatment of infection. The developmental and implementation stages of the OPAT program included (1) a needs assessment, (2) the identification of resources necessary for program operation, (3) delineation of general OPAT program operations and activities of individual OPAT clinicians, (4) the development of patient selection criteria, including a plan of care algorithm, …

Nucleosome Distortion As A Possible Mechanism Of Transcription Activation Domain Function, Tamara Y. Erkina, Alexandre M. Erkine

Scholarship and Professional Work – COPHS

After more than three decades since the discovery of transcription activation domains (ADs) in gene-specific activators, the mechanism of their function remains enigmatic. The widely accepted model of direct recruitment by ADs of co-activators and basal transcriptional machinery components, however, is not always compatible with the short size yet very high degree of sequence randomness and intrinsic structural disorder of natural and synthetic ADs. In this review, we formulate the basis for an alternative and complementary model, whereby sequence randomness and intrinsic structural disorder of ADs are necessary for transient distorting interactions with promoter nucleosomes, triggering promoter nucleosome translocation and …

Retrospective Analysis Of Methotrexate Elimination When Coadministered With Levetiracetam, David Reeves, Sarah Didominick, Suzanne Finn, Hyeon Jin Kim, Amanda Shake

Scholarship and Professional Work – COPHS

Background: Delayed elimination of methotrexate was previously reported in 2 patients receiving concomitant levetiracetam. Objective: To explore the potential interaction between methotrexate and levetiracetam in patients receiving high-dose methotrexate. Methods: This retrospective study reviewed the records of 81 adults receiving 280 cycles of methotrexate to determine the effects of levetiracetam on methotrexate elimination. Institutional review board approval was obtained. Results: Levetiracetam was administered in 33 (12%) cycles of methotrexate. Patients receiving levetiracetam had significantly lower 24-hour methotrexate concentrations compared with those not receiving levetiracetam (2.91 vs 7.37 µmol/L, P = 0.005). Despite this difference, concentrations at 48 and 72 hours …

Population Pharmacokinetics And Pharmacodynamics Of Extended-Infusion Piperacillin And Tazobactam In Critically Ill Children, Chad A. Knoderer, Kristen R. Nichols, Eun Kyoung Chung, Lauren E. Buenger, Daniel P. Healy, Jennifer Dees, Ashley S. Crumby, Michael B. Kays

Scholarship and Professional Work – COPHS

The study objective was to evaluate the population pharmacokinetics and pharmacodynamics of extended-infusion piperacillintazobactam in children hospitalized in an intensive care unit. Seventy-two serum samples were collected at steady state from 12 patients who received piperacillin-tazobactam at 100/12.5 mg/kg of body weight every 8 h infused over 4 h. Population pharmacokinetic analyses were performed using NONMEM, and Monte Carlo simulations were performed to estimate the piperacillin pharmacokinetic profiles for dosing regimens of 80 to 100 mg/kg of the piperacillin component given every 6 to 8 h and infused over 0.5, 3, or 4 h. The probability of target attainment (PTA) …

Food/Drug Interactions: Assessing Student Knowledge Before And After Viewing An Interactive Educational Website, Cole Smith

Undergraduate Honors Thesis Collection

Background: Knowledge of food and drug interactions is important and may greatly impact compliance and success of drug therapy. Patients are required to be educated about food and drug interactions at the point of care by the Joint Commission on Accreditation of Healthcare Organizations’ standards; and, in both the institutional and community settings, quality of patient care is improved if the patient understands the importance of food and drug interactions. Methods: This study was conducted online via a web-based survey using Survey Monkey. Students in their second year of pre-pharmacy classes were asked to complete a pre-survey, review a website …

The Efficacy Of Antidepressants In Alleviating Anhedonia In Depressed Patients, Paras Patel

Undergraduate Honors Thesis Collection

Background: Anhedonia, or the inability to feel pleasure, is an important symptom of depression because it may be involved in preventing complete recovery and facilitating depression relapse. The relationship between depression severity and anhedonia in patients being treated with antidepressants has not been widely studied. The objective of this study was to characterize the alleviation of anhedonia in patients taking antidepressants for depression.

Methods: This was a prospective survey distributed at three outpatient psychiatric settings. Subjects above the age of twenty who indicated a depression diagnosis were included. Subjects with schizophrenia, bipolar disorder, or substance abuse disorder were excluded. A …

Compatibility Of Vancomycin And Oxacillin During Simulated Y-Site Delivery, Chad A. Knoderer, Hilary M. Teibel, Kristen R. Nichols

Scholarship and Professional Work – COPHS

Background: Vancomycin and oxacillin may be used together as empiric coverage in patients with proven or suspected Staphylococcus aureus infections. Though vancomycin hydrochloride 20 mg/mL and oxacillin sodium 160 mg/mL are reported to be compatible via Y-site delivery, Y-site compatibility of commonly used concentrations, vancomycin 10 mg/mL and oxacillin 20 mg/mL, has not yet been reported. Objective: To determine the Y-site compatibility of vancomycin 10 mg/mL and oxacillin 20 mg/mL. Methods: One vancomycin hydrochloride 1 g vial was reconstituted with 10 mL sterile water for injection (SWFI) and diluted with 90 mL 5% dextrose in water (D5W) …

Vaccine Education And Compliance Statistics In The Greater Indianapolis Area, Matthew Brennan Budi

Undergraduate Honors Thesis Collection

Background: Recently, rates of certain vaccine-preventable diseases have increased and outbreaks have occurred. For example, in 2014, the incidence of measles in the United States reached a record high since 2000, with 644 total cases reported to the Centers for Disease Control and Prevention's (CDC's) National Center for Immunization and Respiratory Diseases. Increases such as this may likely be due to widespread public fears that vaccines can cause serious adverse events.Therefore, due to their accessibility, pharmacists can play a crucial role in lessenning these public fears through proper education.

Study objective: The primary objective of this study was to dispel …

The Impact Of Peptide Nucleic Acid Fluorescence In Situ Hybridization (Pna Fish®) Rapid Diagnostic Testing On The Initiation Of Appropriate Antifungal Therapy In Patients With Candida Species Bloodstream Infections, Jenna Lee Ksiazkiewicz

Undergraduate Honors Thesis Collection

Background: Traditional methods for detecting positive blood cultures include the use of broth bottles with sensitive indicators for growth. These techniques can take 24-48 hours to signal a positive test. Another 24 hours are often required to determine the species of the organism. The use of rapid diagnostic testing for Candida species bloodstream infections provides accurate species identification in less than two hours.

Objective: Evaluate the time to appropriate antifungal therapy in patients in which rapid diagnostic testing was utilized.

Methods: This study was a retrospective, observational cohort of patients who had positive blood cultures for Candida species and had …

Interactive Web-Based Learning Modules Prior To General Medicine Advanced Pharmacy Practice Experiences, Alex N. Isaacs, Alison M. Walton, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective. To implement and evaluate interactive web-based learning modules prior to advanced pharmacy practice experiences (APPEs) on inpatient general medicine.

Design. Three clinical web-based learning modules were developed for use prior to APPEs in 4 health care systems. The aim of the interactive modules was to strengthen baseline clinical knowledge before the APPE to enable the application of learned material through the delivery of patient care.

Assessment. For the primary endpoint, postassessment scores increased overall and for each individual module compared to preassessment scores. Postassessment scores were similar among the health care systems. The survey demonstrated positive student perceptions of …

Assessment Of Empathy Scores In A Pharmacy Professional Nutrition Support Elective Course, Megan M. Mayhew

Undergraduate Honors Thesis Collection

Background: Clinical empathy may be defined as "the ability to listen to, understand, sympathize with, and provide support to another individual." Empathy has been shown to influence patient satisfaction, adherence, and improve clinical outcomes. Teaching empathy skills in the classroom and clinical setting is imperative to allow students to develop and enhance their communication with patients.

Study Objective: To evaluate two empathy projects in the RX 618 Nutrition Support Professional Elective to identify if the projects are effective in improving pharmacy students' knowledge of empathy.

Methods: The study objective was met using a prospective cohort survey based study. An interactive …

Evaluating The Non-Evidence Based Practice Of Rounding Serum Creatinine In The Elderly And The Impact On Medication Dosing, Kelly Lynn Roden

Undergraduate Honors Thesis Collection

Background: The Cockcroft and Gault equation is widely accepted in practice as the most appropriate way to calculate an estimated creatinine clearance. Geriatric patients often present with reduced muscle mass, and therefore lower creatinine production, due to normal changes in body composition associated with aging. Because serum creatinine and creatinine clearance are inversely proportional using the Cockcroft and Gault equation, a lower serum creatinine may falsely overestimate renal function in the elderly population. Rounding to a normal serum creatinine is believed by some practitioners to prevent over estimation of creatinine clearance and renal function.

Objective: The objective of this study …

Context And Contribution: Going Beyond The Research Paper In The Health Sciences, Laura Menard

Scholarship and Professional Work

Conference poster presented at the Midwest Medical Library Association Chapter Meeting, October 2-6, 2015 in Louisville, KY.

Acid-Suppressing Agents And Risk For Clostridium Difficile Infection In Pediatric Patients, Katelyn E. Brown, Chad A. Knoderer, Kristen R. Nichols, Ashley S. Crumby

Scholarship and Professional Work – COPHS

Background. Acid-suppressing agents have been associated with increased Clostridium difficile infection (CDI) in adults. The objective of this study was to evaluate the association of acid-suppressing therapy with the development of CDI in the pediatric population.

Methods. This was a retrospective case-control study. Children aged 1 through 17 years with a positive C difficile polymerase chain reaction (PCR) result obtained between June 1, 2008, and June 1, 2012, were randomly matched to a control population selected from patients with negative PCR.

Results. A total of 458 children were included. No difference was observed in acid-suppressive therapy prior …