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Background: Opioid use is classified as an epidemic by many due to the impact of these medications on society. Federal and state laws for prescribing and dispensing opioids have changed rapidly in a short period of time to hopefully balance proper pain control with their use. Pharmacy directors must be informed of these rapid changes to effectively work as part of any opioid stewardship team. Objective: The objective of this study was to provide foundational leadership guidance to pharmacy directors on current opioid legislation, literature, and best practices to assist in improving opioid use. Methods: A review of the literature from 2003 to the present was conducted along with collating important up to date resources and other publications that provide foundational information to help support a comprehensive management of opioid use. A summary of these data has been collated into an easy to use table and summarized throughout this article. Conclusion: The information provided in this article helps to properly inform pharmacy leaders to the resources available to improve the prescribing, dispensing, and monitoring of opioids and alternatives. [ABSTRACT FROM AUTHOR]

As spending on medications in the United States increases with each passing year, the need for drug pricing transparency by manufacturers also increases. Drug spending, excluding rebates and discounts, was $309.5 billion in 2015, up 8.5% from 2014. Drug pricing transparency has been a topic of debate across the health care system. This column reviews the issue of drug pricing and emphasizes the need for transparency in this area. We will discuss factors that influence drug pricing, policies and ways to reduce the rising costs of drugs, and the role of pharmacy leaders in managing this problem. A multitude of factors are driving the country to spend more and more on medications; pharmacy leaders can employ various strategies to counteract this escalation of drug prices. After reviewing this article, the pharmacy director will have an increased ability to address drug pricing issues with stakeholders as they develop patient-centered pharmacy services. [ABSTRACT FROM AUTHOR]

The integrity of the pharmaceutical supply chain is threatened by medication counterfeiting, importation of unapproved and substandard drugs, and grey markets - all of which have the potential to distribute drug products with the potential for serious harm. On November 27, 2013, President Obama signed into law Title II of the Drug Quality and Security Act, now known as the Drug Supply Chain Security Act (DSCSA). Over the next 10 years, the DSCSA will require the pharmaceutical supply chain to implement medication tracking and tracing; serialization, verification, and detection of suspicious products; and strict guidelines for wholesaler licensing and reporting. This article reviews the important aspects of the DSCSA and outlines the role of health-system pharmacy leaders in ensuring compliance to the DSCSA. By verifying that medication supplies are free from adulteration and tampering, the DSCSA serves as a foundational law to ensure quality in providing patient-centered pharmacy services. [ABSTRACT FROM AUTHOR]

The article discusses various considerations available to pharmacy leaders as they move towards retirement planning in the U.S. Topics discussed include the employment status of leaders in the pharmacy sector, importance of an integrated life plan which enhances personal growth necessary to meet retirement goals, and a case showing a situation that most pharmacy directors face as retirement approaches.

On March 28,2014, The United States Pharmacopeia and The National Formulary (USP-NF) published USP General Chapter <800> Hazardous Drugs-Handling in Healthcare Settings, as open for public comment in the USP Pharmacopeial Forum (PF) 40(3). Pharmacy directors must be proactive in understanding the impact that USP <800> will have on their processes for preparing sterile products. USP General Chapter <797> pertains to the compounding of both hazardous and nonhazardous drugs. USP <800> serves as a new standard to guide the handling of hazardous drugs in order to protect patients, health care personnel, and the environment. USP <800> describes hazardous drug handling related to the receipt, storage, compounding, dispensing, administration, and disposal of both sterile and nonsterile products and preparations. Regardless of all of the requirements listed in USP <800>, there is no substitute for disciplined, consistent work practices regarding proper sterile technique. This point should be emphasized with all compounding personnel. Even if one is compounding in the most compliant USP <800> cleanroom, improper technique can negate all the benefits of the physical structures. Pharmacy leaders at every level will play a key role in assisting an organization to achieve timely compliance with USP <800> standards. Until the standard becomes official, it is important for pharmacists to become familiarized with the latest draft to identify potential barriers to compliance and to strategize a plan to overcome barriers. Although complying with USP <800> may seem to be a daunting task, it can be manageable if approached in a systematic organized way. [ABSTRACT FROM AUTHOR]

Historically, bank regulators have restricted bank dividends as part of a larger effort to preserve banks' capital and make them more able to withstand losses. In today's dynamic banking markets, the formulaic and rigid ways by which regulators have traditionally policed dividends have become anachronistic. Against this background, the Federal Reserve Board has attempted to update and reinvigorate dividend regulation through two regulatory reforms: (1) the Comprehensive Capital Analysis and Review (CCAR) program and (2) the Dodd-Frank Act Stress Test program. This Article will explore the important practical and theoretical implications that result from these regulatory reforms. As a practical matter, the ability of banks to make distributions--the most basic method by which equity investors obtain returns on their capital investment--has been made contingent and contestable to an unprecedented degree. For example, over the past two years the Federal Reserve Board has required Bank of America, Citigroup, and Goldman Sachs to adjust their dividend plans. In a privatized system of banking, restrictions on the ability of stock investors to obtain returns potentially complicate bank funding. As for regulatory theory, these reforms are noteworthy because they unite, for the first time, what had previously been two separate sub-systems of the bank regulatory framework: the formal-mandatory dimension of bank regulation, exemplified by the formulaic, automatic application of traditional dividend restrictions, and the informal-discretionary dimension of bank regulation, exemplified by the context-specific regulation of "unsafe and unsound practices" and stress testing. These reforms provide further evidence of a broader trend in financial regulation towards greater emphasis on hypothetical and conjectural future stress scenarios. Finally, this Article links the CCAR program to the existing "risk regulation" literature that has developed in the environmental, health, and safety regulatory arenas. Although the risk regulation model has not yet taken hold in financial regulatory scholarship, the CCAR program provides a clear example of its relevance to the regulatory tasks of bank supervisors. By viewing the program through the risk regulatory lens, the Article frames future research questions concerning the utility of applying the risk regulatory model to risk-taking financial institutions. [ABSTRACT FROM AUTHOR]

The article examines the laws related to post-crisis reforms of the financial supervisory system that have focused on improving the resilience of individual firms. Topics discussed include ways in which post-crisis supervisory reform agenda promoted resilience and containment in high reliability organizations (HROs); importance of capital adequacy regulation and creating an orderly liquidation authority; and supervisory framework applicable to the largest U.S. financial institutions.

The article focuses on deliberation-oriented stress testing regulation in the U.S. Topics include value-at-risk management systems, the use of stress tests as a regulatory tool, and systems reliability analysis. Information is provided on assurance-oriented stress testing and the regulation of the banking industry in the U.S. in 2014.

The article discusses the editorial policies of the periodical which focuses on providing patient-centered hospital health services through pharmacy leaders. Topics discussed regarding fulfilling of goals by hospital pharmacists includes well-trained hospital pharmacist inclusion, realistic payment promotion to hospital pharmacists to attract and retain career personnel services and hospital pharmacy resource utilization to improve whole profession.

The article offers information on the 50th anniversary of the periodical. It informs about the objectives of the journal for expansion of scientific role of hospital pharmacist. It further informs about the development of professional accountability, scientific growth and role of the pharmacist as a leader in health care.

The article discusses the role of a pharmacy academy in improving the pharmacy practice model of an organization. The American Society of Health-System Pharmacists' (ASHP) Pharmacy Practice Model Initiative (PPMI) was created to manage limited resources and provide safer services. It states that the system can be made patient-centric by students with specific responsibilities and emphasizes the need for a good relationship between the academy leadership and students to improve patient services.

The article discusses financial market complexity and viability of structural regulations in the financial services industry as of September 2012. An examination of several U.S. administrative law issues is presented, along with information on the topics of arbitrary regulation of industry and the complexity capture theory.

The article discusses how pharmacy directors can enhance their practice models by hiring specialty trained pharmacists. It provides several strategies for recruiting specialty trained pharmacists including job posting, professional meetings, and networking. It adds that the said strategies apply to the building models of small hospitals and large academic medical centers.

The article offers information on the Accountable Care Organization (ACO), an intiative under the Patient Protection and Affordable Care Act which aims to reduce the cost of health care in the U.S. It discusses the role of pharmacy directors, pharmacists, and pharmacies in the country in making such initiative successful. Moreover, it cites care coordination as the key to the success of ACO.

The article discusses the need for pharmacy directors to develop patient-centered pharmacy practices and services in the U.S. It explores the important role of pharmacy directors to ensure the success of their practice model particularly in providing the foundation for creating patient-centered approach for the safe and effective use of medications. Furthermore, it outlines the different kinds of pharmacy practice models for directors to consider and apply in their settings.

The article discusses the importance of the capital adequacy regulation of the financial institutions in the U.S. It explores the formation of the Basel Committee on Banking Supervision as the international bank regulatory policy coordinator. It highlights the committee's three central achievements which include Basel Accord of 1988, the market risk amendments of 1996, and Basel II of 2004. It provides an overview of new governance theory.

The Director's Forum series has been written and edited by Robert Weber and Michael Sanborn and is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. Effective this issue, Scott M. Mark, PharmD, MS, MEd, FASHP, FACHE, FABC, will assume the responsibilities of editing the column along with Robert Weber, PharmD, MS, BCPS, FASHP. Michael Sanborn, MS, FASHP, will step down as coeditor of this column with this issue. We would like to acknowledge the excellent work done by Mr. Sanborn in originating and editing this column for the last 4 years. His contributions significantly influenced the leadership direction of hospital and health-system pharmacists. Dr. Mark is currently the Director of Pharmacy at the University of Pittsburgh Medical Center and Associate Professor and Vice Chair of Pharmacy at the University of Pittsburgh School of Pharmacy. His practice and teaching are in the area of pharmacy leadership and practice management. We welcome Dr. Mark as a co-editor of the Director's Forum. This month's article focuses on assessing the ability of the pharmacy director in managing the pharmacy's financial operations--a key skill set necessary in developing patient-centered pharmacy services. [ABSTRACT FROM AUTHOR]

The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed for guiding pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is addressing many of the key challenges that pharmacy directors currently face, while also providing information that will foster growth in pharmacy leadership and patient safety. Previous articles in this series have discussed the many different aspects of pharmacy management and leadership challenges. This feature addresses the impact of the American Recovery and Reinvestment Act (the Stimulus Program) on hospital pharmacy practices. [ABSTRACT FROM AUTHOR]

The article describes pharmacy-based immunization in the U.S. and highlights the role of pharmacists in administering such immunization. It mentions that hospital-based retail pharmacies provide an opportunity to develop patient-centered pharmaceutical programs. Also cited are the steps to develop pharmacy-based immunization service including obtaining proper certification and licensing as well as safe administration of vaccines.

The article discusses the Standards for Professional Development Schools incorporated by the National Council for Accreditation of Teacher Education (NCATE) in evaluating teacher education programs and assessing school improvements in the U.S. According to the article, the specification acknowledges the concept that certain kinds of learning can be experienced in the real world and that the progression in the development of knowledge can be achieved through using various methodologies and putting them into action. In addition, it states that it is important for educators to have knowledge on what is service learning and how it can benefit students.

The article focuses on the need for U.S. hospitals and health systems to develop a medication patient safety program in order to prevent medical errors, including medication errors that occur at an average of 19% to 36% in hospitals. The report "Preventing Medication Errors," released by the Institute of Medicine suggested a national agenda for preventing such errors which included improving drug packaging and labelling and funding medication safety research.

This article introduces professionals in the areas of adapted physical activity to Fishing Has No Boundaries Inc. (FHNB) and provides information so schools, organizations, or clubs might be encouraged to include fishing as part of their programming or become a part of FHNB. FHNB is a non-profit, national volunteer organization founded in 1986 by a local professional fishing guide, Bobby Cammack. It is dedicated to assisting individuals with disabilities in the U.S. through the world of fishing to enjoy the great outdoors. To start an FHNB fishing event, one will need a curriculum from the national office, fishing rods and reels, dip nets, tackle and tackle boxes, first aid kit and personal flotation devices. When pricing these items it might appear as if the cost of conducting a unit on fishing may be cost prohibitive; but fear not, for there are many sources of help.

Summarizes the short sales rules contained in Regulation of Short Sales (SHO) and the amendments to Regulation M, regulations governing short sales in the U.S. Definitional and order-making requirements contained in Regulation SHO; Main reason behind the promulgation of Regulation SHO by the U.S. Securities and Exchange Commission; Enforcement actions for violations of short sale regulations.

Focuses on the approach of the University of Pittsburgh Medical Center--Presbyterian (UPMCP), Pittsburgh, Pennsylvania in managing issues regarding patient care. Background information on UPMCP; Creation of the position of pharmacy manager by the institution; Revision of the organizational structure of UPMCP to increase its focus on patient safety.

Focuses on the University of Pittsburgh Medical Center Presbyterian's compliance with the U.S. Joint Commission on Accreditation of Healthcare Organization's (JCAHO) TX.3.5 standard. Accountability of pharmacy department for the proper storage, control and security of medications; Monitoring compliance with JCAHO; Medication-control review tool.

Describes the interactions that occurred between a leeside arctic front and topographically modulated flows through the integrated analysis of remote sensing and in situ data taken along the Front Range of Colorado. Instrument characteristics and locations for sites in northeastern Colorado; Information on nonclassical frontal propagation in northeastern Colorado; Analytic solutions for front-relative flow.

This paper is a short introduction to computer-aided content analysis in which words or phrases are the basic units. The advantages of computer-aided content analysis are noted and some general issues in its use discussed-Several ways of manipulating text by computer are then illustrated, including ordered word frequency lists, key-word-in-context lists, concordances, classifications of text in terms of content categories, category counts, and category-based retrievals from text. Although examples are based on Democratic and Republican platforms in presidential campaigns. these techniques can he applied to texts from a variety of sources, including in-depth and open-ended interviews, fieldnotes, letters, speeches, newspapers, books, and diaries, to cite a few examples. [ABSTRACT FROM AUTHOR]

Mohler (1987) claims that German culture does not display thematic cycles like those found by Namenwirth and Weber (1987) in America and Great Britain. We argue that Mohier's claim is not supported by the emperical evidence he presents. We also find his claim to be flawed conceptually and theoretically. [ABSTRACT FROM AUTHOR]

When multiple items are sold through the use of simultaneous ascending-bid auctions, bidders can find it in their mutual interests to reduce their aggregate demand for the items while prices are still low relative to the bidders' valuations. The FCC's first broadband PCS auction provides examples of how such mutual reductions might be arranged even when the bidders are not allowed to communicate with one another outside of the auction arena. [ABSTRACT FROM AUTHOR]

The globalization of the international trading market creates a possibility that product liability laws can operate as real and substantial barriers to trade, innovation, and economic growth. In adopting a strict liability system, Japan should draw from the collective experience of the United States and the European Economic Community as a first step toward ensuring that the movement to reform international product liability practice creates no more barriers than necessary. [ABSTRACT FROM AUTHOR]

Describes the cover art of the Summer 2003 issue of the journal 'Libraries & Culture,' which features a bookplate of the National Sporting Library of Middleburg, Virginia. History of the library; Size of the library's collection; Sources of funding; Rare books.

Disseminated sporotrichosis may present with inflammatory arthritis and cutaneous ulcerations that mimic noninfectious skin conditions such as pyoderma gangreonsum (PG). Sporotrichosis must therefore be ruled out before administering immunosuppressive agents for PG. Furthermore, dimorphic fungi such as sporotrichosis may grow as yeast in bacterial cultures, even before fungal cultures become positive. We present a case of disseminated cutaneous and osteoarticular sporotrichosis mimicking PG and describe the differential diagnosis and the diagnostic and treatment approach to this condition. [ABSTRACT FROM AUTHOR]

The author discusses the leadership role of the American Society of Health-System Pharmacists (ASHP) in implementing the programs and medication-use technology that are learned from the 2014 ASHP national survey. Topics covered include the adoption of technology in compliance of the Health Information Technology for Economic and Clinical Health Act, use of barcode-assisted medication dispensing device, and the increase in the application of smart infusion pumps.

Color infrared photography and airborne ATLAS images were utilized to develop a vegetation map and a supervised land-cover classificationfor the Blue Canyon reach of Moenkopi Wash on the Hopi Reservation, Arizona. An orthophoto mosaic was produced, enabling photointerpretation of riparian vegetation within the study area. Polygons representing homogeneous vegetation patches were delineated using stereo pairs and ground verification techniques. Vegetation transects measured percent cover and species composition. The Spence-Romme-Floyd-Rowlands vegetation classification scheme served as a framework to map the vegetation. Image processing techniques such as Tasseled Cap transformations and image masking were used in an attempt to minimize soil noise from the ATLAS images prior to classification. Land-cover classification accuracy for the pilot study area was 40 percent. TNDVI and MSAVI2 vegetation indices were evaluated for their ability to indicate vegetation extent and relative plant vigor. [ABSTRACT FROM AUTHOR]

Purpose. Consensus recommendations to help ensure safe insulin use in hospitalized patients are presented. Summary. Insulin products are frequently involved in medication errors in hospitals, and insulin is classified as a high-alert medication when used in inpatient settings. In an initiative to promote safer insulin use, the American Society of Health-System Pharmacists (ASHP) Research and Education Foundation convened a 21-member panel representing the fields of pharmacy, medicine, and nursing and consumer advocacy groups for a three-stage consensus-building initiative. The panel's consensus recommendations include the following: development of protocol-driven insulin order sets, elimination of the routine use of correction/ sliding-scale insulin doses for management of hyperglycemia, restrictions on the types of insulin products stored in patient care areas, and policies to restrict the preparation of insulin bolus doses and i.v. infusions to the pharmacy department. In addition, the panelists recommended that hospitals better coordinate insulin use with meal intake and glucose testing, prospectively monitor the coordination of insulin delivery and rates of hypoglycemia and hyperglycemia, and provide standardized education and competency assessment for all hospital-based health care professionals responsible for insulin use. Conclusion. A 21-member expert panel convened by the ASHP Foundation identified 10 recommendations for enhancing insulin-use safety across the medication-use process in hospitals. Professional organizations, accrediting bodies, and consumer groups can play a critical role in the translation of these recommendations into practice. Rigorous research studies and program evaluations are needed to study the impact of implementation of these recommendations. [ABSTRACT FROM AUTHOR]

Focuses on the practical approach to grading the formulary recommendations of drugs in the U.S. Provision of impetus for ensuring patient safety and maintaining pharmaceutical costs and expenditures in the formulary decision-making process; Evaluation of evidence on formulary decisions; Means of monitoring and assessing drug therapy.

The Pittsburgh Regional Healthcare Initiative (PRHI) is an innovative model for health system change based on regionwide shared learning. By linking patient outcomes data with processes of care and sharing that information widely, PRHI supports measurable improvements in regionwide clinical practice and patient safety. In addition, through the redesign of problem solving at the front lines of care, PRHI helps health care organizations to evolve toward becoming sustainable systems of perfect patient care. This paper describes PRHI's design for change, reviews the progress and limitations of the shared learning model, and offers a set of broader policy considerations. [ABSTRACT FROM AUTHOR]

Assesses the interest of arthritis patients in an arthritis management Web site in the U.S. Survey conducted on patients of a community-based, university rheumatology practice; Percentage of respondents using the Internet to search for medical or drug information; Correlation of Internet access and previous Internet searching for health information with interest.