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The rise in “vaping”-associated deaths in the United States raises serious concerns. A justification for some level of risk is that e-cigarettes might provide a “reverse-gateway” from smoking traditional cigarettes to a less-harmful alternative. But are users actually smokers? We developed an electronic on-line survey to gather data regarding e-cigarette usage in a target study population of pharmacy students. The survey was created using Google Forms to collect the responses anonymously. We surveyed medical-savvy healthcare students about their e-cigarette use, and whether or not their healthcare providers were aware of their e-cigarette use. Although nearly one-fourth of a convenience sampling of 134 pharmacy-student respondents (23.9%) reported using e-cigarettes, only 2.0% reported prior regular cigarette use, 28% used cartridges containing nicotine and only 11.2% had tried and wanted to quit. The majority (64.1%) reported that their healthcare providers did not ask about such use, and respondents did not volunteer this information. The results of this pilot survey reveal a significant e-cigarette use among health-aware pharmacy students, and they do not support the notion that the respondents do so to quit smoking. The observation that most of the students’ healthcare providers did not inquire about their e-cigarette use, coupled with the finding that users did not volunteer their vaping behavior, suggests that the information should be included when getting a medical history. Further research is needed to determine what behavioral factors may play a role in this type of decision-making among student healthcare professionals.

Background: Electronic cigarettes have increased in popularity amongst college-aged adults. Although often advertised as smoking cessation tools, students have taken to them as their primary exposure to nicotine. For many reasons, e-cigarettes are extremely convenient and have become the most common tobacco products among this generation. Objective: To assess perceptions and reasons for e-cigarette use in college students Methods: A 20 question online Qualtrics® survey was distributed to college students aged 18 and above across the United States. All responses were anonymous and data were analyzed using quantitative and qualitative inferential and descriptive statistics. Results: Of those who used e-cigarettes, 67.7% are not likely to smoke when they are upset or sad, 56.8% disagree that stress is a factor, and 83.5% cited that alcohol was involved when smoking. Most respondents, 74% (n = 467), associated smoking with emotions of happiness, joy or peace. 43.7% who associated e-cigarettes with happiness or peace were more likely to agree that stress was an influence versus 26.5% for those who did not (p = 0.004). Conclusion: Results show a high prevalence of e-cigarette usage among college-aged students. Emotional pleasurable connections with e-cigarettes, similar to traditional cigarettes, play a role in their use. This information will allow healthcare professionals to tailor educational messages surrounding cessation.

Purpose A collaborative advanced pharmacy practice experience (APPE) education model established within a healthcare institution during the coronavirus disease 2019 (COVID-19) pandemic is described. Summary The COVID-19 pandemic caused a nationwide disruption of APPE pharmacy education. Healthcare institutions faced the challenge of educating APPE students while attempting to simultaneously de-densify work areas and reduce transmission risk for employees and patients. A pharmacist coordinator and pharmacist academic partners at a large teaching hospital created a collaborative common core curriculum model for resourceful implementation of APPE education. Healthcare network pharmacists, clinical pharmacist academic partners, and pharmacy residents delivered the curriculum to 35 pharmacy students over a 9-week time period. Main components of the curriculum included patient case discussions, topic discussions, journal club presentations, live continuing education (CE) webinars, and development of pharmacy technician CE programs. A majority of students reported positive experiences working with a variety of preceptors from different specialties (81%) and collaborating with students from other universities (62%). Conclusion A health system can leverage institutional, network-wide, and academic partner resources to implement a collaborative APPE curriculum during challenging times such as those experienced during the COVID-19 pandemic.

Objectives To assess physician perspectives on perceived barriers and facilitators to type 2 diabetes self-management (DSM) in a primary care setting. Methods The study utilized survey methodology to measure perspectives of primary care physicians on DSM and the challenges they face in managing patients with poor glycaemic stability. Demographic and practice site-related information of the physicians were also collected. Key findings Of the 21 physicians who responded (53.8% response rate), 71.2% were aged 50 years or older, 54.2% had ≥25 years of clinical experience, and 50% practiced in an urban setting. The physicians examined 5–60 patients with type 2 diabetes per week (mean = 20), and over 75% of them spent Conclusions The study results underscore the importance of DSM in the overall management of type 2 diabetes. Addressing the challenges faced by physicians may result in better self-management and improved clinical outcomes in type 2 diabetes population.

What is known and objective Electronic nicotine delivery systems (ENDS) are battery-powered devices that allow nicotine and/or other substances to be inhaled in aerosolized form. e-Cigarettes (electronic cigarettes), the most commonly used ENDS, have been proposed to be smoking cessation aids. However, despite the rapid surge in their popularity, little is known about long-term health consequences of e-cigarette usage. We assess published data to see if they deliver what they promise. Comment e-Cigarettes may contain uncertain quantities of various ingredients, and evidence of adulteration has been identified. Flavouring agents can alter the pharmacokinetics of nicotine and have uncertain impact on the nature of e-cigarette use (eg ab initio use vs smoking cessation). What is new and conclusion Although e-cigarettes have been proposed to be a safe approach to encouraging smoking cessation, there are inconsistencies in available data. And further data are needed regarding long-term implications of primary and secondary exposure to e-cigarette products.

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting, two-thirds had been providing tobacco treatment for 1 year or less, and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.

Aims: This study aimed to evaluate pharmacists’ and physicians’ perception and knowledge of e-cigarettes, including comfort level in counselling patients on these products. The study also assessed if, and to what extent, patient e-cigarette usage is collected as a marker of tobacco use status.Methods: Surveys were distributed to community pharmacists and family practice physicians for 3 months, and responses were analysed utilising descriptive and inferential statistics.Results: The majority of respondents reported not feeling fully confident on counselling patients about e-cigarettes, and responses revealed gaps in knowledge in both groups. Mixed results were obtained on the inclusion of e-cigarettes in assessment of patient smoking status.Conclusions: Pharmacists and physicians would benefit from further information on e-cigarettes. Due to the increasing popularity, healthcare professionals will be called upon to serve as, care providers and informational resources to patients who use these products. This survey provided a consensus that further steps should be taken to increase product training and information dissemination.

Objective: To evaluate the effect transition of care follow-up and counseling performed by a pharmacist, within a physician’s practice, can have on 30-day hospital readmissions among Medicare patients when compared to the current standard of care Methods: A pharmacist telephonically contacted patients ≥65 years with Medicare insurance following hospital discharge to perform medication reconciliation, review discharge instructions, and schedule a follow-up appointment (n = 34). At this follow-up appointment, the pharmacist reviewed the patient’s electronic medical record (EMR) and communicated recommendations to the physician. The current standard of care, which does not involve a pharmacist, at a similar local physician practice was used as a comparative group (n = 45) Results: The difference in 30-day readmission rates did not reach statistical significance ( P = .27); however, there was a trending decrease in the percentage of patients readmitted between the control and the intervention groups (26.7% vs 14.7%). Additionally, there was nearly a statistically significant decrease in readmission rates for those patients who interacted with the pharmacist face to face versus only telephonically ( P = .05) Conclusions: These results impact the decision to continue and expand the pilot program and demonstrate that pharmacists in the ambulatory setting based within a patient-centered medical home have a potential role in decreasing 30-day hospital readmissions.

Background Community pharmacists are in an ideal position to ameliorate migraineur under-consulting, under-diagnosis, and under-treatment. Contemporary education/training on developing therapeutic alliances with patients and in advanced pharmacotherapy may further motivate pharmacists to impact the care of migraineurs. Objectives The objectives of this study were to assess pharmacists' perceptions of a migraine training program and their self-assessment of subsequent impact on patient care and to develop and assess a tool evaluating the impact of the training program from the patients' perspectives: (1) for patients diagnosed with migraines – identify perceptions of care by pharmacists who have undergone specialty training in migraine vs. pharmacists who have not; and (2) for patients with recurrent headaches and not diagnosed with migraines – identify perceptions of pharmacist effectiveness and thoroughness, after specialty training, to identify a potential migraine diagnosis and referral for advanced care vs. pharmacists that have not undergone specialty training. Methods This study employed a mixed method survey design using community pharmacies from the Tulsa, Oklahoma and Pittsburgh, Pennsylvania greater metropolitan areas. Pharmacists from intervention pharmacies received specialty training on migraine and were surveyed on their current practices and about the education program. Approximately 1 month after the training, control and intervention pharmacists were surveyed on current practices. Additionally, patients from both pharmacies were surveyed to assess Migraine Disability Assessment (MIDAS) and pharmacists' delivery of care derived from the Pharmacists' Care of Migraineurs Scale (PCMS). Surveys were handed out for a period of 3-months. Results There were 16 pharmacists and 61 patients recruited. There was no difference in patient perceptions of pharmacists' care or in patient self-perceptions between migraineurs and recurrent headache sufferers. Ninety-two percent of pharmacists agreed that the program could be transferred to an internet-based educational program. The 14-item patient survey, however, demonstrated good internal consistency reliability, with each question having a Cronbach's alpha 0.80 or higher. Conclusions There are few studies evaluating the role and potential impact community pharmacists can have on patients suffering from migraines or recurrent headaches. While no difference was found between the groups, the internal reliability of the survey questions and the need to address needs of migraineurs warrants tool dissemination and a larger-scale study.

Background Standards from the Accreditation Council for Pharmacy Education require student pharmacists on advanced pharmacy practice experience (APPE) rotations to be involved with direct patient care activities. The American Association of Colleges of Pharmacy Center for the Advancement of Pharmaceutical Education mandates public health as a curriculum target. Involving APPE student pharmacists in disease-prevention programs fulfills both requirements. Objectives Study objectives were to provide student pharmacists with experiences for direct patient interaction, engagement in a public cardiovascular disease health screening, and to evaluate the impact of student pharmacist screening and consultation on patient behaviors to reduce cardiovascular risk. Methods Three free health screenings providing blood pressure, cholesterol, blood glucose, and body mass index (BMI) screenings were held at underserved community pharmacy locations. APPE students provided the screenings, conducted cardiovascular risk assessments, and counseled patients on their results. Students administered a follow-up questionnaire to determine the impact these interventions had on patient behaviors. Results A total of 51 patients participated. Only 24% of the participants knew their cholesterol levels prior to the event, and 12% knew their BMI. Education delivered by the students influenced patient-reported lifestyle behavior change, specifically initiation of an exercise program, healthier eating habits, and tobacco cessation. Conclusions Student pharmacists were successful in developing and implementing a cardiovascular risk-screening program. This program provided the students with a significant educational experience that included direct patient contact and a positive impact on patient behaviors.

Objective: To evaluate the financial and clinical outcomes of an over-the-counter (OTC) medication consultation performed by doctorate of pharmacy student pharmacists in a community pharmacy. Design: Cross-sectional survey. Setting: Independent and chain community pharmacy locations in Pittsburgh, Pennsylvania. Participants: Fourth professional year (PY4) advanced experiential student pharmacists on community rotations at the designated settings who performed OTC consultations and the participants of these encounters. Main Outcome Measured: Financial and clinical impact of an OTC consultation performed by student pharmacists on rotation. Results: A total of 559 OTC consultations were offered in 5 participating community pharmacy settings over a period of 1 year. Student pharmacists initiated 62.4% of all documented interactions and 60.5% of all participants accepted the consultation offer. The student pharmacists’ OTC recommendations resulted in significant cost savings to the participant. Those participants accepting consultation reported being more likely to consult with a pharmacist in the future. PY4 students were also able to demonstrate capability in impacting clinical outcomes on several occasions by implementing OTC medication changes due to patient safety concerns. Conclusion: Student pharmacist OTC consultations have the potential to positively impact both financial and clinical outcomes associated with the use of OTC medications.

Background: In response to numerous reports of overdoses with over-the-counter (OTC) liquid medications, the Food and Drug Administration has recommended that all OTC liquid drug products contain a measuring device but provided no recommendation on the type of device to be included. Objective: To evaluate the accuracy of liquid medication dosing devices (cup, dropper, syringe) in dispensing medications of varying viscosity in the laboratory and clinical settings. Methods: This experimental study evaluated dosing device accuracy. A pharmaceutics laboratory was used to evaluate accuracy under ideal conditions and subjects ≥18 years of age were recruited from community pharmacies to evaluate accuracy when used by consumers. Results: In the laboratory setting, the syringe was the most accurate for the more viscous formulations (cherry and grape suspension; 1% error, 1.2% error, respectively), and the dropper was the most accurate for the less viscous formulation (solution; 0.8% error). A volunteer sample of 320 participants was enrolled from the clinical setting. In the clinical setting, the syringe was most accurate, followed by the cup and then the dropper for all formulations (mean error, 2%, 14%, 33%, respectively). The cup was the most likely to overdose (mean, 5.7 mL), while the dropper was most likely to underdose (mean, 3.3 mL). Conclusions: The results of this study suggest that medication viscosity, consumer use, and dosing device contribute to dosing accuracy. The syringe appears to be the most accurate dosing device, accounting for differences in medication viscosity and the impact of consumer use.

Objective: To evaluate the impact of a pharmacist-directed osteoporosis screening program utilizing the fracture risk assessment (FRAX) tool on patient and physician behavior. Methods: Postmenopausal women 45 to 65 years with Achilles T score Results: A total of 749 patients were screened, with 87 meeting the enrollment criteria (43 control and 44 intervention). Physician behavior was not different between the groups with respect to ordering vitamin D levels, prescription medication, or dual-energy x-ray absorptiometry scan. A significant difference in vitamin D supplementation occurred between the 2 groups ( P = .024). At follow-up, 72.2% of responding participants increased daily calcium intake and 76.4% started or increased physical activity. Conclusion: Physician behavior was not influenced by FRAX results in the intervention group; however, positive patient behavior changes occurred in both groups. Primary prevention efforts conducted through heel ultrasound screening and pharmacist consultation led women to follow-up; however, awareness still needs to be raised of the value of FRAX in osteoporosis prevention.

The purpose of this randomized control trial was to determine whether choline in combination with several doses of caffeine, could facilitate short-term visual and verbal memory and attention in adult and middle aged human subjects with normal cognitive function. The effects of several doses of caffeine in combination with choline on short-term visual and verbal memory, blood pressure and heart rate were assessed in 125 healthy adult and middle-aged men and women using six standardized tests from the Wide Range Assessment of Memory and Learning, Second Edition (WRAML 2). Tests included: Verbal Learning, Design Memory, Picture Memory, Story Memory, Finger Windows and Number/Letter. Group comparisons utilized one-way analysis of variance with Dunnett’s test post-hoc. Subjects administered caffeine 25 mg/choline 2 g scored significantly higher on tests for short-term visual memory than the placebo group. Conversely, the caffeine 50 mg/choline 2 g treatment group scored significantly lower on tests for short-term verbal memory and attention than the placebo group. There were no significant differences in memory test scores between men and women and no significant changes in blood pressure or heart rate following administration of any of the treatment combinations. These results suggest that oral caffeine 25 mg in combination with choline 2 g may enhance short-term memory in healthy adults without affecting cardiovascular function.

Objective: To determine the impact of a proactive first day prescription counseling program on medication adherence to new cardiovascular maintenance medications Design: Cross-sectional study Setting: Regional chain community pharmacy in Pittsburgh, Pennsylvania; August 2009 through November 2010 Patients: Data was collected from all patients aged 18-89 presenting with a new or transferred prescription or change in dosage within the study dates at four study locations Interventions: Patients presenting with a new or transferred prescription or change in dosage were identified to receive pharmacist or student pharmacist counseling. Data from the counseling session was tracked weekly to determine if the program increased adherence to statins, ACEIs and/or ARBs. Main Outcome Measured: Adherence to statins, ACEIs and/or ARBs was determined by differences in proportion of days covered (PDC) at six months and medication persistence to therapy. Results: Analysis was conducted using IDNA sm software. Results of the 6,916 prescriptions included in the study revealed that persistence rates for statins was 32.5% (intervention) and 34.2% (control) (p

Objective. To implement and assess a pharmacy dermatology and cosmeceutical compounding elective course and its impact on graduates’ careers. Design. A 3-credit elective course that incorporated classroom lectures on ambulatory dermatologic diseases and cosmeceutical products with case studies, weekly quizzes, and a comprehensive business plan project was implemented in a doctor of pharmacy (PharmD) program in 2010. Assessment. Assessment instruments including weekly quizzes, a business plan project, and pre- and post-course tests were used to evaluate course content. Across 3 offerings of the course (2010, 2011, 2012), pre- and post-course test scores improved. Results of a postgraduate survey showed that 54% of respondents worked at a pharmacy offering compounding services, and 57% felt that the course played a significant or very significant role in their counseling on dermatologic conditions. Conclusions. Assessment methods revealed student learning of course content and the course appeared moderately beneficial to graduates’ early careers. A more longitudinal analysis is needed to assess the course’s impact on long-term career choices, particularly those dealing with compounding of cosmeceutical products.