Pharmacy and Pharmaceutical Sciences Commons^™

Reducing Unnecessary Acid Suppression Use In Hospitalized Patients: A Description Of Targeted Strategies Implemented Across A Large Health System, Elizabeth H. Wiggins, L. Hayley Burgess, Joan Kramer

HCA Healthcare Journal of Medicine

Background

Ensuring the appropriate use of proton pump inhibitors (PPIs) and histamine type 2-receptor antagonists (H2RAs) is an important hospital patient safety and quality initiative because therapy may be inappropriately continued during transitions of care. In this article, we aim to describe the impact of targeted quality improvement strategies to reduce unnecessary acid suppression use in hospitalized patients across a large health system.

Methods

Beginning January 1, 2018, focused quality improvement strategies to prevent unnecessary initiation and continuation of proton pump inhibitors (PPIs) and histamine type 2-receptor antagonists (H2RAs) were implemented throughout a large health system. Targeted strategies were initially …

Clinical Impact Of Oral Step-Down Therapy For Gram-Negative Bacteremia: A Retrospective Study, Nhi Nguyen, Ashitha Jayachandran, Minhhang Mui, Kelsey Olson

HCA Healthcare Journal of Medicine

Background

In recent years, there has been a growing body of evidence that supports oral step-down therapy for the treatment of gram-negative bacteremia. The purpose of this study was to compare outcomes for hospitalized patients who received intravenous-only (IV-only) therapy versus oral step-down therapy with low, moderate, and highly bioavailable antimicrobials for the treatment of gram-negative bacteremia.

Methods

In this retrospective, single-center, observational study, we examined data from adult patients hospitalized with gram-negative bacteremia in a 1-year period. Data analysis was performed using information collected from electronic medical records and a clinical surveillance system.

Results

A total of 199 patients …

Implementation Of Clinical Pharmacy Surveillance Technology And A Pharmacy Practice Model Re-Design Across A Multi-State Health System, Elizabeth H. Wiggins, Joan Kramer, L. Hayley Burgess, Carley Warren

HCA Healthcare Journal of Medicine

Background

Outcomes-directed pharmacy models are necessary to further comprehensive, patient-centric clinical care. This report describes the implementation of clinical surveillance technology and the development of clinical pharmacy metrics to measure outcomes that support return on investment. The overall goal of clinical surveillance technology implementation in this quality improvement project was to extend the pharmacists’ reach and to improve patient safety and clinical outcomes with greater operational efficiencies.

Methods

In 2013, a clinical pharmacy surveillance tool was piloted and expanded over the next 2 years to 154 hospitals across the health system. Over the next 6 years, the number of hospitals …

Anti-Factor Xa Level Monitoring For Enoxaparin Prophylaxis And Treatment In High-Risk Patient Groups, Lucie Sikes, Kipson Charles, Abigail Antigua, Rima Patel, Selina Imboywa, Pheba Cherian

HCA Healthcare Journal of Medicine

Monitoring anti-factor Xa levels is a controversial topic in the inpatient setting due to resource utilization and unclear conditional guideline recommendations regarding this practice. Enoxaparin dosing in certain high-risk patient populations such as those with low body weight, obesity, renal insufficiency, and pregnancy has not been determined. The objective of this review was to assess the safety and efficacy of enoxaparin monitoring via anti-factor Xa levels in high-risk patient populations.

The PubMed database was searched for articles related to low-molecular-weight heparin monitoring. Randomized controlled trials and meta-analyses that evaluated the safety and efficacy of enoxaparin prophylaxis and treatment in patients …

Best Practice Proposal To Enhance Application Of The Standardized Antimicrobial Administration Ratio (Saar), Jill Butterfield-Cowper

HCA Healthcare Journal of Medicine

A core element of hospital antibiotic stewardship programs is the tracking of outcomes. It is recommended that hospitals do this by reporting to the National Healthcare Safety Network (NHSN) Antimicrobial Use (AU) Option. With this, hospitals can access the Standardized Antimicrobial Administration Ratio (SAAR) for various antibiotic groupings and locations. While there are benefits to the SAAR, several limitations reduce the interpretation and utility of SAAR values. In particular, the SAAR cannot inform users of antimicrobial appropriateness. This article describes an antimicrobial days of therapy (DOT) report that was developed by a tele-stewardship infectious diseases pharmacist. This article proposes that …

Leveraging Technology In Risk Evaluation And Mitigation Strategy Programs, Sondra Davis, Katie Reynolds, Charles Ulrich

HCA Healthcare Journal of Medicine

Medication safety is improved through REMS programs. Multidisciplinary teams and frontline staff are vital in setting up a REMS program and should be included in any discussions surrounding REMS programs. Certain components of the REMS requirements may be replaced with CDS screens. Utilizing technology can help advance patient safety and aid in regulatory compliance.

The Rubik's Cube Of Manufacturers' Coupons: Making The Case For Sneetches, Bruce Wolf

HCA Healthcare Journal of Medicine

Asthma maintenance inhalers are inordinately expensive, inhibiting patients from affording their medication and compromising compliance and adherence and optimal health outcomes. The objective of this article was to examine and highlight the competitive world and challenged opportunity of manufacturers' coupons discounting the inordinate cost of respiratory inhalers and asthma treatment. The cost of asthma treatment, in particular the cost of respiratory medicines, even with health insurance, can be prohibitive (upwards of $700 per month for one inhaler). Medication costs restrict medication access. Compliance and adherence suffer attested by monthly maintenance inhalers being filled less than 50% of the time. Pharmaceutical …

Diversity, Equity, And Inclusion In The Profession Of Pharmacy: The Perspective Of Three Pharmacy Leaders, Aigner George, Keith Teelucksingh, Kara Fortune

HCA Healthcare Journal of Medicine

Diversity, equity, and inclusion (DEI) is a growing force within all industries, with healthcare being no exception. The 2020 sociopolitical landscape made DEI a priority for the majority of organizations. The structural element of DEI education in pharmacy is comprised of academia, professional organizations, and healthcare systems and companies. To address inequities that stand before students, professional pharmacy organizations must have a voice that sets an inclusive tone. This article provides background into DEI in the pharmacy profession and provides the unique perspectives of 3 pharmacy leaders.

Interprofessional Education: Models That Promote Shared Clinical Decision-Making, James D. Nash

HCA Healthcare Journal of Medicine

Interprofessional education continues to be emphasized as an area that needs to continue to grow by agencies that accredit higher education professional degree programs. Teams of healthcare professionals need to learn more about each other, collaborate, and understand what matters most to the patient when care is needed in an acute or ambulatory care setting. Settings that promote clinical shared decision-making and collaboration with pharmacists among the team and increase communication between members and the patient will decrease medical errors, increase patient safety, and improve the quality of life for the patient.

Elevating Exposure Of Pharmacy Services And Medication Management, L. Hayley Burgess, Joan Kramer, Jocasta G. Olp

HCA Healthcare Journal of Medicine

Medications are the mainstay of treatment for many disorders and diseases. Our guest editorial board is proud to highlight the complexity of medication management and the talented pharmacists dedicated to safety and effectiveness. This special issue of the HCA Healthcare Journal of Medicine is dedicated specifically to pharmacy services across the healthcare spectrum, featuring pharmacist medication management research and education aimed at enhancing the safety of patients and colleagues.

Eruptive Lentigines Confined To Resolving Psoriatic Plaques Following Treatment With Guselkumab, Jacob R. Kilgore Md, James C. Curry, Shane E. Cook Md

Marshall Journal of Medicine

Eruptive lentigines in the area of resolving psoriatic plaques has been well documented in the literature following successful treatment with multiple therapies. This is historically associated with light treatment but has been expanded to include other therapies such as anti-tumor necrosis factor therapies and, more recently, some biologics⁵. Guselkumab (Tremfya) is an IgG1λ monoclonal antibody used in the treatment of plaque psoriasis with only one case of eruptive lentigines confined to resolving psoriatic plaques (ELRP) noted as a side effect. We present the second such case of ELRP associated with successful treatment of plaque psoriasis with Guselkumab, as …

Treatment Of Oral Vascular Malformations With Ethamolin: A Report Of Two Cases, Maria Clara De Moura Santos Coelho Ferreira, Marco Vinícius De Sales Lima, Anna Laura Almeida Barreto, Dárcio Kitakawa, Alexandre Do Prado Scherma, Felipe Peralta, Luis Felipe Das Chagas E Silva De Carvalho

Journal of Dentistry Indonesia

A hemangioma is a benign vascular neoplasm, relatively common in the head and neck. In the oral region, it affects the tongue, gums, mucosa, palate, and lip. Its size can vary from millimeters to centimeters, characterized as a purplish or reddish lesion. The present study aims to present two clinical cases of hemangiomas, the first of a male patient treated by sclerotherapy and the second of a female patient in which she was treated with ethamolin and later surgical treatment. It was concluded that sclerotherapy, in addition to being a safe treatment, managed to drastically reduce the initial size of …

Timing Of Dual Antiplatelet Therapy (Dapt) Initiation Post Mechanical Thrombectomy With Stent Placement In Acute Ischemic Sroke, Mallory R. Stringer, Eric Shaw, Osman Perez, Emily G. Bowers

South Atlantic Division GME Research Day 2023

No abstract provided.

1.8% Balanced Sodium Bicarbonate/Sodium Chloride Compared To 3% Sodium Chloride For The Management Of Cerebral Edema, Rebecca K. Ortega, Eric Shaw, Emily Bowers, Alisha B. Terry

South Atlantic Division GME Research Day 2023

No abstract provided.

Pharmacists’ Perceptions And Knowledge Of The Legalization Of Medical Marijuana In Mississippi, Faith Houston

Honors Theses

The legalization of medical cannabis in Mississippi was a debated topic among all citizens. This thesis specifically explored pharmacists’ perceptions and knowledge as medical professionals who will be involved with patients certified to use medical cannabis. Information was gathered using a voluntary online survey on the Qualtrics platform to produce a cross-sectional, descriptive study.

From the information gathered, it was apparent that pharmacists in Mississippi have varying opinions regarding medical marijuana. Some are in favor of using these products, and some are not. However, as cannabis has been officially accepted and put into patient's medical plans both current and future …

Testing Of Indazole Inhibitors Of Kasa, A Vital Enzyme Of M. Tuberculosis, Karissa Highlander

Departmental Honors & Graduate Capstone Projects

Tuberculosis is a disease that affects the lungs caused by Mycobacterium tuberculosis (M. tuberculosis). Although drug treatment options exist, increased rates of antibiotic resistant strains have become more prevalent in recent years, driving a need for new treatment approaches. KasA, a β-ketoacyl synthase, has been found to synthesize parts of the cell wall and been identified as an attractive drug target. Previous medicinal chemistry research has been completed to synthesize six effective competitive inhibitors of KasA that would potentially block the enzyme from binding the substrate, preventing elongation of the backbone and creation of the mycolic fatty acids that …

Low-Dose Psilocybin Enhances Novel Object Recognition But Not Inhibitory Avoidance In Adult Rats, Claire E. Miller, Colin R. Del Valle, Margaret M. Naylor, Heather R. Sparkman, Connor M. Cruea, Rachel E. Rice, Brooke E. Bramlage, Lillianna P. Puppel, Madison L. Brown, Aleece K. Al-Olimat, Elizabeth S. Dietz, Phillip R. Zoladz

ONU Student Research Colloquium

Given the recently renewed interest in using psychedelics to aid in the treatment of psychological disorders, we aimed to examine the impact of psilocybin, a 5-HT_2A agonist, on learning and memory in rodents. Previous work has demonstrated that psilocybin and other 5-HT_2A agonists can enhance fear conditioning, fear extinction, and novel object recognition (NOR). Thus, we predicted that low doses of psilocybin would enhance inhibitory avoidance (IA) and NOR memory. In the first experiment, adult male and female Sprague-Dawley rats underwent step-through IA training (involving 0.45, 0.65, or 1 mA scrambled footshock) and were injected intraperitoneally (i.p.) with …

Psilocybin Prevents Symptoms Of Hyperarousal And Enhances Novel Object Recognition In Rats Exposed To The Single Prolonged Stress Paradigm, Colin R. Del Valle, Heather R. Sparkman, Margaret M. Naylor, Connor M. Cruea, Rachel E. Rice, Claire E. Miller, Brooke E. Bramlage, Lillianna P. Puppel, Madison L. Brown, Aleece K. Al-Olimat, Elizabeth S. Dietz, Phillip R. Zoladz

ONU Student Research Colloquium

Pharmacotherapy for stress-related psychological disorders remains inadequate. Patients who are treated with conventional pharmacological agents frequently report negligeable symptom reduction, and, in most cases, less than 50% experience full remission. Clearly, there is a need for additional pharmaceutical research into both established and novel approaches to alleviate these conditions. Over the past several years, there has been a renewed interest in the use of psychedelics to aid in the treatment of psychological disorders. Several studies have reported promising results in patients with major depression, anxiety disorders, and post-traumatic stress disorder (PTSD) following treatment with psychedelic agents such as lysergic acid …

Racial And Ethnic Disparities In Alcohol-Attributed Deaths In The United States, 1999–2020, Ibraheem M. Karaye, Nasim Maleki, Ismaeel Yunusa Ph.D.

Faculty Publications

The disparities in alcohol-attributed death rates among different racial and ethnic groups in the United States (US) have received limited research attention. Our study aimed to examine the burden and trends in alcohol-attributed mortality rates in the US by race and ethnicity from 1999 to 2020. We used national mortality data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database and employed the ICD-10 coding system to identify alcohol-related deaths. Disparity rate ratios were calculated using the Taylor series, and Joinpoint regression was used to analyze temporal trends and calculate annual and …

Effects Of Cannabichromene On Pain And Neuroinflammation In Hiv-1 Tat Transgenic Mice, Sydney Wheeler

Honors Theses

HIV-1 TransActivator of Transcription (Tat) is a vital regulatory protein involved in HIV replication and implicated in development of HIV-associated pain and neurocognitive deficits. Tat is thought to contribute to these pathologies through proinflammatory pathways. Developing mechanisms to curb Tat-mediated inflammation is a key step in improving the quality of life of those living with HIV. Both recreational and medicinal cannabis use is prevalent among many people living with HIV; given this prevalence and the perceived anti-inflammatory benefits of cannabis use, it is important to investigate how chemical constituents of cannabis may impact HIV. In the present study, the effects …

Combating Long-Term Care Isolation Through Healing Touch, Veronica J. Butts

ONU Student Research Colloquium

Loneliness is defined as feelings of disconnectedness, lack of belonging, and perceived isolation that can manifest as a physical or psychological state. In long-term care facilities, this sentiment can develop into social isolation in which residents are disconnected from family, removed from familiar environments, and suffer from various cognitive conditions that cause them to socially withdraw. Various clinical studies seek to identify the connection between isolation, loneliness, and lack of human touch with worsening health conditions and outcomes, determining that there is a correlation between this feeling of discontent. To combat this, healing touch has been a rising topic of …

Utilizing Evidence-Based Resources For Collaborative Falls Prevention, Kristyn Elise Catrine

ONU Student Research Colloquium

More than 25% of seniors will fall each year due to modifiable and nonmodifiable risk factors. The result is three million emergency department visits and 50 billion dollars in annual healthcare costs.1 Effective falls prevention is complex and needs collaboration from all members of the healthcare team. The best national, state and local strategies individualize patient safety from all sources of harm.2 Multifactorial interventions use health and mobility reviews to reduce the rate of falls and educate older adults.3 The CDC’s Stopping Elderly Accidents, Deaths and Injuries (STEADI) and ASCP/NCOA’s Falls Risk Reduction Toolkit are examples of national programs that …

The Global Fatty Liver Disease-Sustainable Development Goal Country Score For 195 Countries And Territories, Jeffrey V. Lazarus, Hannah Han, Henry E. Mark, Saleh A. Schattenberg, Jörn M. J., Ismaeel Yunusa Ph. D., Et Al.

Faculty Publications

Background & Aims:

Fatty liver disease is highly prevalent, resulting in overarching wellbeing and economic costs. Addressing it requires comprehensive and coordinated multisectoral action. We developed a fatty liver disease-Sustainable Development Goal (SDG) country score to provide insights into country-level preparedness to address fatty liver disease through a whole-of-society lens.

Approach & Results:

We developed two fatty liver disease-SDG score sets. The first included six indicators (child wasting, child overweight, non-communicable disease [NCD] mortality, universal health coverage service coverage index, health worker density, and education attainment), covering 195 countries between 1990-2017. The second included the aforementioned indicators plus an urban …

Antibiotic Over Prescription For Upper Respiratory Tract Infections, Amina Boudaia

Evidence-Based Practice Project Reports

Antibiotic overuse is a major contributor to antibiotic resistance that is estimated to be responsible for 23,000 deaths annually in the United States (Durante et al., 2017; Garcia et al., 2016). Upper respiratory tract infections (URTIs) are speculated to be a leading contributor to the overprescribing of antibiotics (Aplin-Snider et al., 2020). The purpose of this project was to address the PICOT question: Does the implementation of patient education posters and protocol plus online training modules for providers (I) over an 8-week period or 30 patient charts (T) help to decrease antibiotic overprescription (O) in upper respiratory tract infections (P) …

Syndeep: A Deep Learning Approach For The Prediction Of Cancer Drugs Synergy., Anna Torkamannia, Yadollah Omidi, Reza Ferdousi

HPD Articles

Drug combinations can be the prime strategy for increasing the initial treatment options in cancer therapy. However, identifying the combinations through experimental approaches is very laborious and costly. Notably, in vitro and/or in vivo examination of all the possible combinations might not be plausible. This study presented a novel computational approach to predicting synergistic drug combinations. Specifically, the deep neural network-based binary classification was utilized to develop the model. Various physicochemical, genomic, protein-protein interaction and protein-metabolite interaction information were used to predict the synergy effects of the combinations of different drugs. The performance of the constructed model was compared with …

Antibody-Drug Conjugates For Multiple Myeloma: Just The Beginning, Or The Beginning Of The End?, Upasana Ray, Robert Z Orlowski

Faculty, Staff and Student Publications

Multiple myeloma is a malignancy of immunoglobulin-secreting plasma cells that is now often treated in the newly diagnosed and relapsed and/or refractory settings with monoclonal antibodies targeting lineage-specific markers used either alone or in rationally designed combination regimens. Among these are the anti-CD38 antibodies daratumumab and isatuximab, and the anti-Signaling lymphocytic activation molecule family member 7 antibody elotuzumab, all of which are used in their unconjugated formats. Single-chain variable fragments from antibodies also form a key element of the chimeric antigen receptors (CARs) in the B-cell maturation antigen (BCMA)-targeted CAR T-cell products idecabtagene vicleucel and ciltacabtagene autoleucel, which are approved …

The Application Of Continuous Stationary Phase Gradients To High-Performance Liquid Chromatography And Its Potential To Improve Pharmacological Research, Hannah Klose

Senior Honors Theses

The separation of mixtures into different components is integral to experimentation and analysis in a multitude of fields. Chromatography is one of the most popular, well-developed, and well-studied methods used to examine the makeup of a mixture. Thus, the improvement of chromatographic procedures directly benefits research across many scientific disciplines. The application of a continuous stationary phase gradient to High-Performance Liquid Chromatography (HPLC) methods has been proposed to improve the separation of complex mixtures that are difficult to achieve with existing separation techniques. By incorporating a gradient stationary phase, analysts will create a more selective mode of separation to improve …

Utilizing Pharmacist-Led Telehealth Services In Ambulatory Patients With Heart Failure, Ivanna L. Lugo Zamora, Crystal Lloyd, Shirley Lorenzo-Castro, Carolina Mussenden, Genevieve Hale

HPD Articles

Background: Heart failure is one of the leading causes of hospital admissions. Non-adherence to medications and poor dietary management for patients who suffer from this condition can lead to worsening of symptoms and hospitalization. Pharmacist interventions via telehealth have demonstrated a beneficial impact on disease management and adherence outcomes in patients with chronic conditions. Methods: This retrospective, descriptive cohort study reviewed subjects from a single-centered primary care office. Data was collected via electronic chart review between January and December 2021. Subjects eligible for inclusion were adults who were diagnosed with heart failure by their primary care provider and referred to …

B-Cell Monoclonal Antibodies For Management Of Relapse Remitting Multiple Sclerosis: A Cost Effectiveness Analysis, Sarah Glover

Pharmaceutical Sciences ETDs

Multiple sclerosis (MS) is a neurodegenerative disease in which the central nervous system’s myelin sheath is degraded by auto-immune cells. Relapse remitting multiple sclerosis (RRMS) is the most common MS phenotype, accounting for ~85% of new diagnoses. Disease modifying therapies (DMTs) are used in RRMS to reduce the frequency of relapses and prevent disability progression. The present study performed a cost effectiveness analysis of three B-cell depleting monoclonal antibody DMTs: ocrelizumab, ofatumumab and rituximab, in comparison to commonly utilized interferon beta-1a (IFN-B1a). A Markov model was created to determine the impact of selected DMTs on the number of …

Lessons From Canada’S Notice Of Compliance With Conditions Policy For The Life-Cycle Regulation Of Drugs, Melanie Mcphail, Howard Zhang, Zohra Bhimani, Tania M. Bubela

Office of the Provost

Innovative health technologies are not well regulated under current pathways, leading regulators to adopt contextual, life-cycle regulatory models, which authorize drugs based on earlier clinical evidence subject to the conduct of post-market trials that confirm clinical benefit and safety. In this paper, we evaluate all drugs authorized in Canada under the Notice of Compliance with conditions (NOC/c) policy from 1998 to 2021 to analyze its function, identify challenges and areas for improvement, and make recommendations to inform Health Canada's regulatory reforms. We analyzed a sample of 148 drugs authorized between 1998 and 2021, including characteristics about the pre- and post-market …