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Sally Rafie,1 Rebecca H Stone,2 Tracey A Wilkinson,3 Laura M Borgelt,4,5 Shareen Y El-Ibiary,6 Denise Ragland7 1Department of Pharmacy, UC San Diego Health, San Diego, CA, 2Department of Clinical and Administrative Pharmacy, University of Georgia, College of Pharmacy, Athens, GA, 3Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 4Department of Clinical Pharmacy, 5Department of Family Medicine, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, 6Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, AZ, 7Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA Abstract: Women and couples continue to experience unintended pregnancies at high rates. In the US, 45% of all pregnancies are either mistimed or unwanted. Mishaps with contraceptives, such as condom breakage, missed pills, incorrect timing of patch or vaginal ring application, contraceptive nonuse, forced intercourse, and other circumstances, place women at risk of unintended pregnancy. There is a critical role for emergency contraception (EC) in preventing those pregnancies. There are currently three methods of EC available in the US. Levonorgestrel EC pills have been available with a prescription for over 15 years and over-the-counter since 2013. In 2010, ulipristal acetate EC pills became available with a prescription. Finally, the copper intrauterine device remains the most effective form of EC. Use of EC is increasing over time, due to wider availability and accessibility of EC methods. One strategy to expand access for both prescription and nonprescription EC products is to include pharmacies as a point of access and allow pharmacist prescribing. In eight states, pharmacists are able to prescribe and provide EC directly to women: levonorgestrel EC in eight states and ulipristal acetate in seven states. In addition to access with a prescription written by a pharmacist or other health care provider, levonorgestrel EC is available over-the-counter in pharmacies and grocery stores. Pharmacists play a critical role in access to EC in community pharmacies by ensuring product availability in the inventory, up-to-date knowledge, and comprehensive patient counseling. Looking to the future, there are opportunities to expand access to EC in pharmacies further by implementing legislation expanding the pharmacist scope of practice, ensuring third-party reimbursement for clinical services delivered by pharmacists, and including EC in pharmacy education and training. Keywords: pharmacist, community pharmacy, emergency contraception, levonorgestrel, ulipristal acetate, intrauterine device

Full-length or intact parathyroid hormone [rDNA origin] for injection (PTH [1-84], Preos, NPS Pharmaceuticals) is currently under FDA review for the treatment of postmenopausal osteoporosis. If approved, parathyroid hormone (1-84) will join teriparatide (PTH [1-34], Forteo, Lilly), the truncated N-terminal (1-34) form of the hormone, as the only anabolic therapies available for osteoporosis treatment. There are currently no published head-to-head trials comparing teriparatide and intact parathyroid hormone, though the effects of each on bone mineral density and fracture rate reduction appear comparable. The adverse effects of the 2 formulations are similar, including injection site reactions, headache, dizziness, nausea, and hypercalcemia. More studies are needed to determine when and if parathyroid hormone monotherapy should be used, whether and how it should be used in conjunction with antiresorptive therapies, and which patient populations would benefit most from parathyroid hormone treatment. [ABSTRACT FROM AUTHOR]

Objectives: To highlight areas of pharmacogenetics in which pharmacists may play a role and to describe those roles in the context of specific examples from a major academic medical center.Data Sources: Literature search (PubMed) and personal interviews for the University of California at San Francisco case examples.Data Synthesis: The field of pharmacogenetics presents a wide range of opportunities for pharmacists. Specific roles for pharmacists are likely to fall within three major domains: developing research methodologies and setting research directions, establishing the value of pharmacogenetic testing in clinical practice, and participating in education and infrastructure development that moves pharmacogenetic technologies toward implementation.Conclusion: As drug therapy experts, pharmacists are in a unique position to push the frontiers of pharmacogenetics in both the research and clinical practice environments. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic significantly impacted pharmacy students' education and well-being. The primary aim of this study was to evaluate the effects of the pandemic on students' perceived stress by comparing third- and fourth-year students from the pre-pandemic Class of 2019 with mid-pandemic Class of 2021 at two public institutions. Secondary aims were to evaluate the pandemic effects on students' academic and professional development skills and practice readiness. The Perceived Stress Scale (PSS) and the Brief Coping Orientation to Problems Experienced (COPE) scale were used to measure student well-being. Students' self-rated problem-solving, time management, and study skills were used to measure their academic and professional development; practice readiness was measured using students' self-rated confidence levels. PSS scores were significantly higher in mid-pandemic than pre-pandemic students, and the Brief COPE avoidant coping subscale differed between pre-pandemic and mid-pandemic students. No differences were found in any academic and professional development skills between the pre- and mid-pandemic students, and there were significant improvements in student confidence levels for practice readiness among the mid-pandemic students. In conclusion, the pandemic appeared to affect students' stress and avoidant coping mechanism but had variable effects on academic and professional development and practice readiness.

Objective: The objective of this study is to evaluate the Well-being Promotion (WelPro) program and its effect on burnout in Advanced Pharmacy Practice Experience (APPE) students at the University of California, San Francisco., Methods: A longitudinal cohort study evaluating the WelPro program was conducted in the class of 2021 (Transformation, a 3-year all-year-round curriculum, and Pathway (P), a 4-year traditional curriculum) APPE students. The primary and secondary aims were to evaluate changes in emotional exhaustion (EE) scores from the beginning of year (BOY) to end of year (EOY) for the class of 2021 students and compare EOY EE scores between the classes of 2021 (P) and 2020 (P) students using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS [MP]) survey. Independent and paired t tests were used to evaluate EE scores; Wilcoxon signed-rank test and Wilcoxon Mann-Whitney rank sum test were used to evaluate ordinal data., Results: Evaluable survey response rates were 69.6% BOY and 57.7% EOY for the class of 2021 students and 78.7% EOY for the class of 2020 (P) students. No differences in EE scores were observed for the matched class of 2021 from BOY to EOY and between classes of 2021 (P) and 2020 (P) students., Conclusion: WelPro did not change EE scores for class of 2021 APPE students. Given multiple confounding factors in the study, additional studies are warranted to determine the effectiveness of such a program on APPE student burnout., (Published by Elsevier Inc.)

Objective. The objective of this pilot study was to evaluate the attitudes and self-efficacy of advanced pharmacy practice experience (APPE) conference leaders after completing the Well-being Promotion (WelPro) training program developed at the University of California, San Francisco (UCSF) School of Pharmacy. Methods. The WelPro training program was developed to equip participants with the knowledge and tools to assist APPE students in distress and promote student wellness. After completing the WelPro training program, a 20-item survey was administered to 10 conference leaders via a web-based survey tool to assess their attitudes about burnout and self-efficacy in assisting students in distress. Descriptive statistics were used to characterize attitudes and self-efficacy. Results. Ten conference leaders participated in the training program. Of these, nine reported experiencing burnout in their careers, and all believed burnout within the pharmacy profession could be avoided. After the WelPro training program, confidence levels of the conference leaders significantly improved in the following areas: identification of students in distress, identification of resources for students, and recognition of when and how to refer students in distress. Conclusion. Increased self-efficacy of conference leaders to identify and assist students in distress could be translated into their improved ability to support students' overall well-being. The WelPro training program can serve as a model for similar wellness training programs that directors and preceptors in experiential education can implement at their institutions., (© 2022 American Association of Colleges of Pharmacy.)

Objective. To assess in pharmacy academicians the six domains of worklife (community, control, fairness, reward, workload, values) that have been associated with burnout and poor job satisfaction. Methods. We aimed to assess the Areas of Worklife Survey (AWS) among a sample of pharmacy academicians attending a national meeting to evaluate personal, environmental, or workplace factors that may influence the worklife environment. Data were analyzed using SPSS, descriptive statistics were identified, and Kruskal-Wallis and Pearson correlations were performed. Results. The participant response rate was 40% (n=49/121 attendees). Eighty-eight percent of participants reported working more than 40 hours per week. Mean AWS scores ranged from 2.7 to 3.9 (whereby 1 indicated a strong mismatch between person and work environment and 5 indicated a strong match). The workload and fairness domains had the lowest reported scores, whereas control had the highest. Higher mean scores were reported for control and reward in those with a mentor and for fairness in those having a hobby. Conclusion. Participants gave the lowest ratings to two worklife areas, workload and fairness. Developing targeted interventions, such as in mentorship, hobbies, and transparency in the work setting, may be important for preventing burnout in pharmacy academicians. Further studies in a larger population may help to determine factors associated with the areas of worklife that received low ratings., (© 2022 American Association of Colleges of Pharmacy.)

Objective: To describe the programmatic stress-related interventions that colleges of pharmacy are providing for their students., Methods: A paper-based questionnaire was distributed to 80 college teams who attended two consecutive offerings of the American Association of Colleges of Pharmacy institute focused on promoting student well-being. The five-part questionnaire consisted of: 1) tracking and assessment of perceived student stress levels, 2) the types and formats of stress-coping interventions that are offered, 3) the measured impacts of any stress-coping interventions, 4) the level of faculty/staff training and involvement in student stress remediation, and 5) institutional demographics., Results: Of the 40 college teams responding to the survey there were similar numbers of private (44%) and public (56%) institutions. More than half (57.5%) reported measuring student stress levels. The most common interventions offered were counseling (95%), academic advising (82%), physical exercise support (77%), and relationship building activities (70%). Topics offered in the curriculum were most often related to handling substance abuse (50%), time-management (45%), and finances (40%). A majority (79.5%) of schools reported they do not offer formal training on student stress and mental health to faculty and staff and do not formally assess the impact of stress and coping interventions., Conclusion: Colleges of pharmacy are addressing student stress and well-being, yet variability exists in terms of assessment, interventions, and didactic offerings. Multiple barriers to improvement remain and mediating barriers and determining assessments for coping and interventions may be next steps for Colleges of Pharmacy., Competing Interests: Conflicts of Interest: None, (© Individual authors.)

Introduction: The primary objective of this study was to identify the single question on the Maslach Burnout Inventory - Educator Survey (MBI-ES) that correlated with high emotional exhaustion (EE) among pharmacy practice faculty., Methods: We analyzed data collected from the electronic administration of the MBI-ES to faculty at United States (US) colleges and schools of pharmacy in 2014. For our primary outcome, we used Spearman's rho correlation (r s ) to identify a single question on the MBI-ES that was highly correlated with high EE (one of three subscales of MBI-ES). We calculated likelihood ratio statistics for each level of the item with the largest r s with total EE, then converted those to adjusted predicted probabilities of high EE. De-identified data were collected via Qualtrics version 60949 (Provo, Utah) and analyzed using IBM SPSS Statistics, Version 22.0 (Armonk, NY)., Results: The single item, "I feel emotionally drained from my work" (r s  = 0.833, p = 0.01), was most correlated with high EE score on the MBI-ES. Faculty who reported "I feel emotionally drained from my work" once per week and few times per week had 62.8% and 93% chance of having high EE, respectively., Conclusion: The single item that was most highly correlated with EE may be used for further evaluation of faculty who may be at risk for burnout. Interventions for reducing burnout among pharmacy practice faculty are critically needed for sustaining our pool of faculty., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Pharmacists prescribe contraception in some states following expansions in scope of practice. Adequate education on contraception in pharmacy curricula is crucial to effectively deliver these services., Methods: A 26-item survey assessing contraception curricula regarding was administered by email to instructors and administrators at 139 pharmacy schools in the United States. The survey assessed teaching methods, hours taught, topic content, and opinion of adequacy of contraceptive education provided by the program., Results: The survey achieved a response rate of 40% (n = 56). All programs that responded offer emergency contraception and hormonal contraception content, 96% offer non-hormonal over-the-counter contraception content, and 91% offer long-acting reversible hormonal contraception content. Average number of hours taught were as follows: non-hormonal over-the-counter contraception 2.0 hours, emergency contraception 0.9 hours, hormonal contraception 3.0 hours, long-acting reversible hormonal contraception 0.8 hours, and non-reversible hormonal contraception 0.5 hours. Patient cases were most used to supplement didactic content in all topics. Standardized patient interviews were used less frequently for both hormonal contraception (25%) and emergency contraception (7%). About 68% of programs agreed or strongly agreed that the contraceptive education provided by the program was adequate. A majority (70%) indicated interest in a standardized contraceptive curriculum., Conclusions: Contraceptive education is broadly covered in didactic curricula within pharmacy education. Further assessment and development of curricula standards may be warranted to assess quality and adequacy of contraceptive education in pharmacy., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Members from Cohort 13 of the Academic Leadership Fellows Program (ALFP) 2016-2017 were challenged to present a debate on the topic: "In Turbulent Times, Pharmacy Education Leaders Must Take Aggressive Action to Prevent Further Declines in Enrollment" at the American Association of Colleges of Pharmacy INfluence 2017 meeting in Rio Grande, Puerto Rico. This paper is the result of thoughtful insights emerging from this debate. We present a discussion of the question of whether pharmacy education leaders must take aggressive action or strategic approaches to prevent further declines in enrollment. There are many thoughts regarding current declines in enrollment. Some educators contend that a more aggressive approach is needed while others argue that, while aggressive actions might lead to short-term gains, a more viable approach involves strategic actions targeting the underlying causes for decreasing enrollment. This paper explores themes of enrollment challenges, current and future workforce needs, and financial issues for both pharmacy programs and students. In summation, both aggressive actions and a strategic, sustainable approach are urgently needed to address declining enrollment.

Background and Purpose: To create, implement and evaluate an elective course for pharmacy students focusing on women's reproductive health topics., Educational Activity and Setting: A course was developed that included lectures discussing contraception, infertility, preconception care, pregnancy, and postpartum health. Active learning provided in the forms of journal article review and review of drug information resources for medication use in pregnancy were utilized. Workshops provided hands-on experiences with prescription contraceptives and over-the-counter fertility products. Knowledge and skills were assessed with in-class quizzes, journal article presentations, class participation, patient cases, and a final exam. A 46-item survey was administered to students pre- and post-course to assess self-perceived knowledge and confidence in women's reproductive health., Findings: A total of 33 students were enrolled in the course. The response rate for the pre-course survey was 100% (n = 33) and for the post-course survey was 91% (n = 30). Students' confidence in counseling on women's reproductive health topics significantly increased after the course (mean scores 2.62 pre-course and 3.75 post-course, p < 0.0001). Similar results were seen in students' self-perceptions of their overall knowledge in women's health (mean scores 2.63 pre-course and 3.92 post-course, p < 0.0001). Preferred methods of learning included product workshops, and journal club presentations were the least preferred learning method., Discussion and Summary: A women's reproductive health course was well received by students and increased their self-perceived knowledge and confidence in the areas of prescription contraceptives and over-the-counter fertility products., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To provide guidance for clinicians on risk assessment of medication use during pregnancy and lactation., Data Sources: Authors completed PubMed searches to identify articles focused on the use of medications in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease., Study Selection and Data Extraction: Articles were reviewed to provide overall guidance to medication selection during pregnancy. The following information was reviewed: medication use in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease., Data Synthesis: This article will provide an overview of medication safety considerations during pregnancy and lactation. Information was interpreted to help clinicians predict the potential risk and benefit in each patient to make an evidence-based decision. The article concludes with guidance on risk assessment and how pharmacists may support fellow health care providers and their patients when considering medication use., Conclusions: Information about the effects of medication use during reproductive periods is limited. With the removal of the Food and Drug Administration pregnancy categories, clinicians will be relying on pharmacists to aid in the appropriate selection of therapies for patients. It is critical that pharmacists keep abreast of resources available and be able to assess data to help prescribers and their patients.

There are currently three forms of emergency contraception: oral levonorgestrel, oral ulipristal acetate, and the copper intrauterine device. The copper intrauterine device is the most effective, followed by ulipristal acetate and levonorgestrel, respectively. Although levonorgestrel is the least effective method, studies show that more prescribers are familiar with it and that is the most frequently used method. Clinicians should consider several factors when helping women make informed medical decisions regarding emergency contraception, including access to the products, a woman's individual preference, timing since unprotected intercourse, body mass index or weight, and initiation or resumption of routine contraception. This article explains and summarizes these considerations and provides an algorithm to guide clinicians., (© 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.)

Objectives. To measure the level of burnout among pharmacy practice faculty members at US colleges and schools of pharmacy and to identify factors associated with burnout. Methods. Using a cross-sectional, electronic, anonymous survey-design, we measured faculty burnout (n=2318) at US colleges and schools of pharmacy using the Maslach Burnout Inventory-Educators Survey (MBI-ES), which measures burnout dimensions: emotional exhaustion, depersonalization, and personal accomplishment. We assessed MBI-ES scores, demographics and possible predictors of burnout. Results. The response rate was 32.7% (n=758). Emotional exhaustion was identified in 41.3% and was higher in women, assistant professors, and those without a hobby. Participants without a mentor had higher scores of depersonalization. Those with children ages 1-12 years had higher emotional exhaustion and depersonalization compared to those with older children. Conclusion. Pharmacy practice faculty members at US colleges and schools of pharmacy are suffering from burnout, exhibited mainly through emotional exhaustion.

Objective: To review the pharmacist's role in preconception health., Data Sources: PubMed search using the terms preconception, immunizations, epilepsy, diabetes, depression, tobacco, asthma, hypertension, anticoagulation, pharmacist, pregnancy, and current national guidelines., Data Synthesis: Preconception health has become recognized as an important public health focus to improve pregnancy outcomes. Pharmacists have a unique role as accessible health care providers to optimize preconception health by screening women for tobacco use, appropriate immunizations, and current medication use. Counseling patients on preconception risk factors and adequate folic acid supplementation as well as providing recommendations for safe and effective management of chronic conditions are also critical and within the scope of practice for pharmacists., Conclusion: Pharmacists play an important role in medication screening, chronic disease state management, and preconception planning to aid women in preparing for healthy pregnancies.

Objective: To assess the outcomes from an 11-year nontraditional professional development activity implemented by female faculty members at several colleges and schools of pharmacy., Design: Within the context of an online fantasy football league, faculty members practiced community-based faculty development strategies, including peer mentoring, skills development, constructive feedback and other supportive behaviors., Assessment: Data were extracted from curriculum vitae to characterize the academic progress of participants and to quantify scholarly work collaborations among league members. Analyses were limited to members who had participated in the league for 10 or more consecutive years. Seventy-one collaborative scholarly works occurred among team managers, including presentation of 20 posters and 2 oral presentations at national or international meetings, publication of 29 peer-reviewed articles and 15 book chapters, and funding of 5 research projects., Conclusion: Social media platforms can foster nontraditional faculty development and mentoring by enhancing connectivity between pharmacy educators who share similar interests.

Objective: Assess pharmacy postgraduate year 1 (PGY1) residency application statistics and identify the qualities most desired in the ideal pharmacy residency candidate., Methods: A list of PGY1 residency program directors across the United States (n = 750) was acquired, and a validated electronic survey was created. The survey contained 25 questions pertaining to program demographics, application statistics, and candidate characteristics., Results: A total of 252 programs completed the survey. The average number of positions per program was 3.4 ± 2.6. The average ratio of applicants to available positions was 15:1. The highest scored quality was familiarity with an applicant's college of pharmacy (7.7 ± 2.5). Holding a leadership position within the college/university scored 6.5 ± 2, while poster presentations and publications were rated lower (4.1 ± 2.5 and 3.1 ± 2.3, respectively). When asked to rank modifiable characteristics, strong letters of recommendation, letters of intent, and prior experience with the applicant were ranked the highest., Conclusions: Strong letters of recommendation and intent along with prior experience with an applicant are highly valued. Although leadership positions and scholarship are not ranked as highly, they may distinguish applicants if the preceding criteria are met. Applicants should strive to build relationships with preceptors and obtain work experience or experiential rotations at potential residency locations.

Objective: To examine the relationship between proton pump inhibitor (PPI) usage and nosocomial Clostridium difficile infection (CDI) and determine the duration of therapy at which CDI risk increases., Patients and Methods: This retrospective case-control study included consecutive adult patients in whom nosocomial CDI developed after hospitalization for 3 or more days at one of 2 affiliated hospitals between June 1, 2010, and October 31, 2011. These patients were matched to patients hospitalized within 6 months who did not have CDI development in a 1:2 ratio using age, sex, and antibiotic usage. Potential risk factors for CDI, including PPI use and duration, were evaluated. Multivariate analysis was performed to control for confounding variables and identify risk factors., Results: A total of 201 patients were evaluated, 67 with CDI and 134 matched controls. Patients in whom CDI developed were more likely to have received a PPI (76% vs 39%; P<.001) and had a longer duration of PPI therapy (median [range], 5 [0-20] days vs 0 [0-11] days; P<.001) than those who did not have CDI development. After controlling for prior hospital admission, intensive care unit admission, admission from a skilled nursing facility, immunosuppression, number of antibiotics received, PPI duration, and time to event via multivariate analysis, PPI duration was found to be a risk factor for CDI (odds ratio, 1.14; 95% CI, 1.02-1.27; P=.018). The probability for CDI was higher when PPI use exceeded 2 days in patients without a prior hospital admission and 1 day in patients with a prior admission., Conclusion: The duration of PPI therapy is significantly associated with CDI. Clinicians should strongly consider restricting PPI use given the short exposure time associated with this increased risk., (Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the influence of genetic and environmental risk factors upon postpartum depression., Design: Case-control, prospective study., Setting: The University of California at San Francisco Obstetric and Gynecology Clinic., Participants: Mothers screened for postpartum depression six weeks after delivery with the Edinburgh Postnatal Depression Scale and recruited as cases and controls., Measurements: Eligible subjects completed a series of assessments and a structured clinical interview to confirm diagnosis of depression. Deoxyribonucleic acid was obtained for genotyping of 81 single nucleotide polymorphisms in 12 genes hypothesized to be postpartum depression-related., Results: Twenty-four cases and 24 controls were eligible for analysis. Three single necleotide polymorphisms in the serotonin 2A receptor (HTR2A) gene were associated with postpartum depression. The strongest association at a functional promoter polymorphism (rs6311), a functional promoter single nucleotide polymorphisms (p=0.002, odds ratio 0.25, 95% confidence interval:0.10-0.63), was a finding robust to population stratification. Gene-wide association was significant for HTR2A (permuted p=0.008), but not when corrected for all 12 genes. Analysis of demographic and psychosocial risk factors identified distressed relationship, unplanned pregnancy, and a previous history of depression as significant predictive variables (p≤0.05)., Conclusions: This pilot data suggests deoxyribonucleic acid variations in HTR2A may be associated with postpartum depression. Psychosocial variables were also identified as risk factors. The relative influence of these variables on the manifestation of postpartum depression is yet to be determined.

Addressing the issue of unintended pregnancy is a national priority. One proposed strategy to reduce unintended pregnancy is to improve access to oral contraceptives by changing them to over-the-counter (OTC) status. Existing data indicate that oral contraceptives meet safety criteria required of OTC products. Available literature demonstrates that women can self-screen for contraindications to oral contraceptives and can do this as well as clinicians, and experience with OTC emergency contraception suggests that OTC oral contraceptives would not increase sexual risk-taking behavior. Women support OTC access to oral contraceptives, but express an interest in accessing pharmacist counseling. On the basis of these data, the Women's Health Practice and Research Network of the American College of Clinical Pharmacy supports changing oral contraceptives to OTC status under two conditions: that they are sold where a pharmacist is on duty and that there are mechanisms in place to cover OTC contraceptives through Medicaid. Future research should address the issues of out-of-pocket costs to individuals, label-comprehension studies, and models for pharmacist reimbursement for time spent counseling on contraception.

Objectives: To review available information on pharmacokinetic effects of HIV antiretrovirals on hormonal contraceptives., Methods: A PubMed search was conducted from 1964 to 2006 using each antiretroviral generic name and the keywords contraceptive, contraception, ethinyl oestradiol, oestrogen, and progestin. Abstracts from the annual Conference on Retroviruses and Opportunistic Infections and International AIDS Society Conferences from 1998-2006 as well as package product inserts were reviewed for completeness., Results: Antiretroviral regimens containing protease inhibitors and non-nucleoside reverse transcriptase inhibitors may decrease the area under the curve (AUC) levels of steroids released by hormonal contraceptives. Some antiretroviral-hormonal contraceptive pairs do not decrease steroid hormone levels., Conclusion: Pharmacokinetic interactions of antiretrovirals on hormonal contraceptives are specific to the type of antiretroviral and hormonal contraceptive being utilized. HIV-positive women may be counselled to use dual methods of hormonal and barrier contraception to prevent pregnancy with maximal efficacy as well as to reduce possibility of HIV transmission. Oral contraceptives might be administered with non-ritonavir boosted atazanavir or non-ritonavir boosted indinavir without a loss of contraceptive efficacy. Depot medroxyprogesterone acetate may be safe to administer with efavirenz, nevirapine, and nelfinavir. However, further studies are needed to determine the clinical relevance of the interactions between hormonal contraceptives and antiretrovirals and to explore potential dose adjustments to improve contraceptive efficacy.

Objective: To assess pharmacists' perception of their role in dispensing emergency contraception (EC) in San Francisco., Design: Cross-sectional study., Setting: Community chain pharmacies in San Francisco during summer 2002., Participants: 76 Walgreens community pharmacists., Interventions: Self-administered survey mailed to all pharmacists (n = 122) working in all Walgreens units (n = 49) in San Francisco., Main Outcome Measures: Pharmacists' attitudes regarding EC provision. Variations in sociodemographic, training, and practice characteristics were tested using chi-square statistics for categorical variables and Student t test for continuous variables., Results: 76 pharmacists (62%) responded to the survey (approximately 50% women and 74% Asian). Knowledge among the pharmacists was very high; most knew the timing of the first dose (95%), the adverse effect of nausea (99%), the effectiveness compared with oral hormonal contraception (92%), that EC offers no protection from sexually transmitted infections (99%), differences from medical abortion (100%), and that EC does not increase the risk of birth defects (100%). Most pharmacists (91%) reported that participation in a direct pharmacy-access program would make them feel more important in their pregnancy prevention role, and nearly all (99%) supported pharmacy-access legislation for EC. Knowledge and attitudes did not differ by highest degree earned, position, age, or sex., Conclusion: An assessment of pharmacist experiences in the San Francisco area showed high capability and support for an enhanced professional role regarding EC.

Objective: To assess readability of over-the-counter (OTC) contraceptive product instructions currently available, compare the results with previous studies from a decade ago, and review the implications for health care providers, in particular pharmacists counseling on OTC contraceptives., Methods: A sample of contraceptive instructions was submitted to a readability analysis using four standard readability formulas. Products included condoms, spermicides, and emergency contraception instruction pamphlets., Results: Reading grade levels for condoms ranged from 6th to 12th grade. The average reading levels for the spermicides were 9th-10th grade and for the emergency contraceptives 10th-12th grade. These results were consistent with those of similar studies performed a decade ago., Conclusions: Consumers need to have at least a high school reading level in order to comprehend current product instructions. Very little has changed in the past decade regarding readability of OTC contraceptive patient instructions, despite calls to simplify written instructions. Healthcare providers, in particular pharmacists, must be aware of these disparities to enhance patient education and advocate for simpler reading materials.