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Interpersonal violence is a public health crisis in need of multipronged interventions. Victims of violence experience both acute injuries and chronic illness and may seek acute self-care and/or have the need for chronic medication therapy. Thus, the community-based, ambulatory pharmacy setting can serve as a portal for identification of, and intervention for, victims of violence. This article provides background on four types of interpersonal violence, including intimate partner, child and elder abuse, in addition to sexual assault. This article briefly reviews the statutory reporting requirements for pharmacists in the United States, identifies educational needs for pharmacists with existing resources and suggests a method for the ambulatory pharmacist’s intervention.

To determine the impact of advanced pharmacy practice experiences (APPE) on student self-confidence related to medication therapy management (MTM), fourth-year pharmacy students were surveyed pre/post APPE to: identify exposure to MTM learning opportunities, assess knowledge of the MTM core components, and assess self-confidence performing MTM services. An anonymous electronic questionnaire administered pre/post APPE captured demographics, factors predicted to impact student self-confidence (Grade point average (GPA), work experience, exposure to MTM learning opportunities), MTM knowledge and self-confidence conducting MTM using a 5-point Likert scale (1 = Not at all Confident; 5 = Extremely Confident). Sixty-two students (26% response rate) responded to the pre-APPE questionnaire and n = 44 (18%) to the post-APPE. Over 90% demonstrated MTM knowledge and 68.2% completed MTM learning activities. APPE experiences significantly improved students’ overall self-confidence (pre-APPE = 3.27 (0.85 SD), post-APPE = 4.02 (0.88), p < 0.001). Students engaging in MTM learning opportunities had higher self-confidence post-APPE (4.20 (0.71)) vs. those not reporting MTM learning opportunities (3.64 (1.08), p = 0.05). Post-APPE, fewer students reported MTM was patient-centric or anticipated engaging in MTM post-graduation. APPE learning opportunities increased student self-confidence to provide MTM services. However, the reduction in anticipated engagement in MTM post-graduation and reduction in sensing the patient-centric nature of MTM practice, may reveal a gap between practice expectations and reality.

Objectives To explore whether the health status of intimate partner violence (IPV) victims warrants pharmacies to be portals for public health promotion. Specific objectives included (1) identifying prevalence of IPV including domestic violence (DV) and sexual assault (SA) in a community sample, (2) describing characteristics and correlates of DV/SA between participants who reported and did not report DV/SA, and (3) exploring whether DV/SA status is related to mental health medication use. Design Cross sectional. Setting Upstate New York during 2006. Participants English- and Spanish-speaking respondents younger than 65 years of age answering four questions to assess DV/SA. Intervention Secondary analysis of a countywide random telephone survey, the 2006 Monroe County Adult Health Survey, which collects prevalence data on health behaviors and health status indicators. Main outcome measure To determine whether those reporting DV/SA are at increased odds for mental health medication use, controlling for other sociodemographic- and health-related variables. Results The survey response rate was 30.3%, with 1,881 respondents meeting inclusion criteria. Those reporting DV/SA were almost twice as likely to use mental health medications. However, when controlling for other variables, only poor mental and physical health were significant in increasing the odds of mental health medication use. Conclusion The analyses reported here suggest that DV/SA victims in a community sample use mental health medications. When controlling for other variables, survey respondents reported worse physical and mental health. If pharmacies are suitable portals for DV/SA outreach, curricula would need to provide the knowledge and skills needed to take an active role in this public health promotion.

Background and purpose Medication therapy management (MTM) is a comprehensive, patient-centered approach to improving medication use, reducing the risk of adverse events and improving medication adherence. Given the service delivery model and required outputs of MTM services, communication skills are of utmost importance. The objectives of this study were to identify and describe communication principles and instructional practices to enhance MTM training. Educational activity and setting Drawing on formative assessment data from interviews of both pharmacy educators and alumni, this article identifies and describes communication principles and instructional practices that pharmacy educators can use to enhance MTM training initiatives to develop student communication strategies. Findings Analysis revealed five key communication challenges of MTM service delivery, two communication principles that pharmacy teachers and learners can use to address those challenges, and a range of specific strategies, derived from communication principles, that students can use when challenges emerge. Implications of the analysis for pharmacy educators and researchers are described. Summary Proactive communication training provided during MTM advanced pharmacy practice experiences enabled students to apply the principles and instructional strategies to specific patient interactions during the advanced pharmacy practice experiences and in their post-graduation practice settings.

Objectives This paper describes the first step toward creating training tools to improve pharmacy students’ and pharmacists’ ability to identify intimate partner violence (IPV) among patients and facilitate referrals. The objectives were to evaluate an IPV didactic session adapted for pharmacy students and describe student quantitative and qualitative feedback on the session. Methods 237 students participated in a 1.5-hour evidence-based IPV lecture and completed an anonymous, nine question follow-up questionnaire. The first seven questions provided the quantitative data and the last two open-ended questions provided data for the qualitative analysis; for these, grounded theory was used to see what themes emerged. Results Almost 90% of students believed IPV was relevant to their pharmacy careers and that the session improved their ability to recognize IPV. Twenty one percent believed they had encountered a patient they suspected was a victim of IPV. Legal and liability issues, course logistics, skill development, greater specificity and student engagement were themes that emerged. Conclusions Greater specificity toward pharmacy was recommended to understand the intricacies of legal and professional responsibilities, patient and personal safety risks, and maintaining strong provider/patient relationships. To overcome barriers to screening, assessment and referral, students need opportunities to engage in role-playing and practical application of the knowledge gained.

Objective To identify the rate of aspirin or antiplatelet/anticoagulant use in persons with diabetes presenting to community pharmacies and determine whether a student pharmacist–driven Target Intervention Program (TIP) could increase the number of eligible persons with diabetes receiving aspirin therapy in accordance with American Diabetes Association (ADA) recommendations. Design Unblinded, single intervention. Setting Eight Community Pharmacy Advanced Practice Experience (CPAPE) sites in New York State. Participants Persons having prescriptions filled for diabetes medications or supplies who were not receiving antiplatelet/anticoagulant medications. Interventions Assessment sheets were completed by student pharmacists for eligible patients to determine appropriateness for aspirin therapy. Recommendations for aspirin therapy were faxed to physicians when indicated, and physicians responded via fax for aspirin therapy implementation. The student pharmacists contacted patients, informed patients of physician decisions, and provided appropriate counseling. Main Outcome Measures Number of persons with diabetes currently receiving aspirin or antiplatelet/anticoagulant medications and the number initiated on aspirin as a result of the TIP. Results A total of 436 persons with diabetes were identified. Of those contacted, 322 agreed to participate and 31 declined; 228 were taking aspirin or other antiplatelet/anticoagulant agents at baseline. Students completed assessment sheets, which were forwarded to physicians, for 79 subjects potentially eligible to receive aspirin therapy; 65 physician responses were received (82% response rate). Aspirin therapy was initiated in 53 patients (67%). Conclusion The TIP enabled CPAPE students to increase aspirin use among eligible persons with diabetes in accordance with ADA guidelines.

Introduction Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently associated with community-acquired acute kidney injury (AKI), a strong risk factor for development and progression of chronic kidney disease. Using access to prescription medication profiles, pharmacists can identify patients at high risk for NSAID-induced AKI. The primary objective of this analysis was to evaluate the effectiveness of a community pharmacy–based patient education program on patient knowledge of NSAID-associated renal safety concerns. Methods Patients receiving prescription medications for hypertension or diabetes mellitus were invited to participate in an educational program on the risks of NSAID use. A patient knowledge questionnaire (PKQ) consisting of 5 questions scored from 1 to 5 was completed before and after the intervention. Information was collected on age, race, sex, and frequency of NSAID use. Results A total of 152 participants (60% women) completed both the pre- and post-intervention questionnaire; average age was 54.6 (standard deviation [SD], 17.5). Mean pre-intervention PKQ score was 3.3 (SD, 1.4), and post-intervention score was 4.6 (SD, 0.9) (P = .002). Participants rated program usefulness (1 = not useful to 5 = extremely useful) as 4.2 (SD, 1.0). In addition, 48% reported current NSAID use and 67% reported that the program encouraged them to limit their use. Conclusion NSAID use was common among patients at high risk for AKI. A brief educational intervention in a community pharmacy improved patient knowledge on NSAID-associated risks. Pharmacists practicing in the community can partner with primary care providers in the medical home model to educate patients at risk for AKI.

Medication use in clinical nutrition patients is affected by concomitant disease states and alterations in medication administration and delivery. The purpose of this evaluation was to document the number and type of drug-related problems that occurred and to evaluate the effect pharmacists had on the care of nutrition patients.Patients were evaluated by a pharmacist who was part of the clinical nutrition team. Drug-related problems were identified and recommendations were made to resolve them. Acceptance of the recommendations and patient outcomes were documented.After the evaluation of 440 patients, 220 pharmacist interventions were made. Interventions included 35 drug information requests and 185 recommendations made to solve identified drug-related problems in 126 patients. The most frequent drug-related problems were drug interactions (33/185) and untreated indications (24/185). Of 185 recommendations, 166 were accepted, and 19 were accepted with a modification. A total of 132 of 155 recommendations that were accepted or accepted with modification had a positive outcome: 45 patients responded, and 87 patients developed no complications. Six patients did not respond to the recommendation, and in 17 patients the outcome was unknown. Fifty-eight recommendations avoided potential adverse drug events.Pharmacist intervention identified drug-related problems in almost 30% of clinical nutrition patients. The identification and resolution of the problems had a positive effect on patient care, as indicated by patient outcome and the avoidance of adverse drug events. The drug-related problem approach identified areas in which pharmacists can educate the health care team and ensure proper medication use in this patient population.

OBJECTIVE To review recent developments in the pharmacotherapy of obesity, including the agents currently approved for use in the management of obesity and those under development. DATA SOURCES A MEDLINE search from January 1990 to July 1997 was conducted to identify English literature available on the pharmacotherapy of obesity. The search was supplemented by a review of the bibliographies of identified literature. STUDY SELECTION All controlled and uncontrolled trials were reviewed. When available, double-blind, placebo-controlled trials were used preferentially. DATA EXTRACTION Agents were reviewed with regard to mechanism of action, clinical trial data regarding efficacy, adverse effects, pharmacokinetics, drug interactions, and contraindications where information was available. Study design, selected population, results, and adverse effect information were included. DATA SYNTHESIS: The anorexiants currently available or under development for the management of obesity regulate food intake and satiety via the adrenergic and/or serotonergic pathways. Clinical trials have shown a 10–15% weight loss can typically be anticipated; however, little long-term safety and efficacy data are available. Adverse events tend to be mild and self-limiting, but serious adverse events can occur. Treatment options under development include thermogenic agents, digestive inhibitors, and analogs and antagonists of hormones that regulate food intake and satiety. CONCLUSIONS Several mechanisms to control weight are currently under investigation for the management of obesity. Since obesity is a chronic condition, further studies should be conducted to evaluate the long-term safety and efficacy of these agents and the role of combination therapy using different modalities. OBJETIVO Revisar los recientes avances farmacológicos en el tratamiento de la obesidad, incluyendo aquellos medicamentos actualmente aprobados para este uso y otros que todavía se encuentran en desarrollo. FUENTES DE INFORMACION Se realizó una búsqueda computarizada de MEDLINE para determinar artículos publicados en la literatura inglesa entre enero de 1990 a julio de 1997. Además, se utilizarón las referencias citadas en los artículos identificados en la búsqueda. SELECCION DE ESTUDIOS Estudios clínicos de tipo controlados y no-controlados fueron incluidos en el análisis. Se le dió preferencia a aquellos estudios clínicos que eran de diseño doble ciego, controlados, y que usaron un grupo control de placebo. EXTRACCIÓN DE DATOS Los medicamentos fueron evaluados de acuerdo al mecanismo de acción farmacológica, la información ciéntifica relacionada con su eficacia, efectos secundarios, farmacocinética, interacciones de medicamentos, y contraindicaciones de uso. El disefio ciéntifico utilizado en los estudios clínicos, el grupo de pacientes incluido en los estudios, los resultados obtenidos, y los efectos adversos fueron además incluidos en el análisis. SINTESIS Los medicamentos anoréxicos actualmente disponibles para el tratamiento de la obesidad regulan la cantidad de alimentos ingeridos y la sensación de saciedad através de los mecanismos adrenérgicos y de serotonina. Los estudios clínicos disponibles han demostrado que usualmente se puede esperar de un 10–15% de perdida de peso con el uso de estos medicamentos. Sin embargo, no existe mucha información relacionada al uso seguro y la eficacia de estos medicamentos a largo plazo. Los efectos adversos observados con estos medicamentos tienden a ser leves y de corta duración, pero efectos adversos severos pueden ocurrir. Otras opciones de tratamiento incluyen medicamentos termogénicos, inhibidores digestivos, y análogos y antagonistas de diferentes hormonas que regulan la ingestión de alimentos y la sensación de saciedad. CONCLUSIONES Actualmente, algunos de los mecanismos relacionados con el control de peso están siendo investigados para poder determinar futuros tratamientos de la obesidad. Debido a que la obesidad es un problema crónico, se tienen que realizar estudios clínicos adicionales disefiados para evaluar la eficacia y el uso seguro de estos medicamentos a largo plazo. Además, el uso de estos medicamentos en combinación tiene que ser evaluado. OBJECTIF Réviser les développements dans la pharmacothérapie de l'obésité ainsi que les médicaments actuellement utilisés et ceux qui sont en développement. REVUE DE LITTÉRATURE Une recherche sur MEDLINE a été entreprise pour identifier les publications en langue anglaise concernant le traitement de l'obésité et publiées entre janvier 1990 à juillet 1997. Les bibliographies des références pertinentes ont aussi été scrutées. SÉLECTION DES ÉTUDES Toutes les études, contrôlées ou non, ont été révisées. Cependant, les études à double insu ou contrôlées par placebo ont été préférées. EXTRACTION DE L'INFORMATION: Chaque médicament a été révisé pour le mécanisme d'action, les données d'efficacité clinique, les réactions indésirables, la pharmacocinétique, les interactions médicamenteuses, et les contre-indications. Le devis des études, la population à l'étude, les résultats, et les réactions indésirables sont présentes. RÉSUMÉ Les anorexigènes disponibles sur le marché contrôlent l'apport alimentaire et la satiété par une action sur les voies adrénergiques et sérotoninergiques. Les études cliniques ont démontré qu'une perte de poids de 10–15% est un objectif réaliste. Cependant, peu d'études d'efficacité et de sécurité à long terme sont disponibles. Les réactions indésirables sont généralement mineures et se résolvent spontanément. Cependant, des réactions sévères peuvent aussi survenir. De nouvelles avenues thérapeutiques sont en développement. Elles comportent des agents thermogéniques, des inhibiteurs de la digestion, des analogues et antagonistes hormonaux qui régissent l'apport alimentaire et la satiété. CONCLUSIONS Plusieurs stratégies de contrôle de l'obésité sont actuellement en investigation. Puisque l'obésité est une maladie chronique, des études devraient être réalisées pour évaluer l'efficacité et la sécurité des médicaments ainsi que le rôle des thérapies combinées.

The purpose of this article is to review the data from pharmacotherapeutic and surgical intervention studies for the management of obesity. Clinical outcomes assessed include weight changes over time and the effects of weight loss on blood pressure, serum lipid profiles and blood glucose control. Quality of life and economic data have been incorporated where available. Double-blind, randomised controlled trials were used preferentially over shorter term open studies. The literature evaluation was based on a Medline search of published data between January 1990 and January 1998. Obesity affects 65 million adults in the US. Estimates based on 1990 data suggest that obesity and comorbid illness contributed to $US46 billion in direct costs and $US23 billion in indirect costs in the US. Obesity is a chronic condition which requires long term management. The risk of developing cardiovascular disease, hypertension, type 2 (non-insulin-dependent) diabetes mellitus, osteoarthritis, Pickwickian syndrome and cancer is increased in the obese population, resulting in excess morbidity and mortality. There are no long term prospective studies that have demonstrated that weight reduction in obese patients improves survival. However, on the basis of epidemiological data using the prevalence of disease and associated body mass index, it is generally accepted that weight reduction of 5 to 10% in obese patients is associated with significant health benefits. Current treatment modalities include diet and behaviour modification, exercise and, where indicated, pharmacological intervention. Surgical intervention is reserved for the clinically severe obese patient [body mass index (BMI) > 40 kg/m2]. Many studies have demonstrated weight loss and improved metabolic fitness over 6 to 12 months. Few studies have been conducted over a longer period. Limited data are available regarding reduced morbidity and mortality, improved quality of life and functional or employment status and even fewer have incorporated any economic assessments of the impact of medical or surgical intervention. Although prospective data have demonstrated reduced morbidity following surgical intervention, only retrospective data have demonstrated reduced mortality. Studies of new drugs and interventions under development should demonstrate long term safety and efficacy in terms of sustained weight loss and subsequent weight maintenance. Future studies should incorporate assessment of patient perceived satisfaction with weight loss, health status and quality-of-life evaluations and pharmacoeconomic data to aid clinicians in the decision-making process in terms of weight management of their obese patients.

Objectives To assess patient knowledge about H1N1 influenza pandemic and vaccine availability, evaluate the effectiveness of student pharmacist education about H1N1 influenza, assess patient comfort with pharmacists as immunization providers, and identify patients preferred location for H1N1 vaccination. Design Descriptive, nonexperimental, cross-sectional study. Setting 18 community pharmacy advanced pharmacy practice experience (CP-APPE) sites located across New York State, from September 2009 to February 2010. Participants Convenience sample of adult (≥18 years of age) patients of CP-APPE sites. Intervention Student pharmacists delivered an education intervention to patients and patients completed anonymous surveys. Main outcome measures Patient knowledge and comfort with pharmacists as immunizers. Results 19 student pharmacists at 18 CP-APPE sites engaged in 215 interventions. The majority of respondents were women (60.9%) who were older than 60 years (43.7%) and white (83.7%). Patient knowledge and comfort with pharmacists as immunizers improved significantly. Compared with baseline, student pharmacist education interventions significantly increased the number of patients who were comfortable receiving the H1N1 influenza vaccination from a pharmacist (from 69.3% to 81.4%, P = 0.012). Conclusion Student pharmacists served as an effective education resource for patients regarding the H1N1 pandemic. Patient comfort with pharmacist provision of the H1N1 vaccination can enable pharmacists to serve as frontline health professionals in the time of a pandemic outbreak.

Objectives To (1) determine the public's current method of medication disposal, (2) identify the public's knowledge of the environmental impact of inappropriate medication disposal, (3) determine whether student-facilitated education improves the public's awareness of safe medication disposal, and (4) determine whether the public recognizes student pharmacists as a public health information resource for issues such as safe disposal of medications. Design Cross sectional. Setting Albany, NY, pharmacies during August and September 2009. Participants 242 patrons at 13 Albany College of Pharmacy and Health Sciences Community Pharmacy Advanced Pharmacy Practice Experience (CPAPPE) sites (2 mass merchandiser, 5 community chain, and 6 grocery store pharmacies). Intervention Nine-question baseline and five-question postintervention anonymous surveys were administered to a convenience sample of store patrons 18 years of age or older. Main outcome measures Medication disposal practices before and after education, beliefs on the environmental importance of inappropriate disposal practices, and perceptions of student pharmacists as sources of information. Results Students from CPAPPE sites completed 242 educational interventions. Respondents were primarily women (72%). At baseline, 12.8% of patients disposed of medication appropriately. Respondents frequently flushed medications down the toilet (27.2%) or incorrectly dumped medications in the trash (34.6%). Only 30.9% had received previous advice on safe medication disposal. Posteducation survey results indicated that 80.1% of respondents were willing to change their disposal methods. Increased numbers of respondents viewed inappropriate medication disposal as a moderate to substantial problem (from 57.2% preeducation to 83.9% posteducation). Of participants, 59.7% strongly agreed that student pharmacists were a good resource for information on safe medication disposal. Conclusion Additional public education on safe medication disposal is needed. Student pharmacists produced positive outcomes toward reducing this environmental and potential public health risk.

Objective To survey practicing pharmacists regarding their use of and familiarity with six dietary supplement information references. Methods Pharmacists attending a March 2005 continuing education program at the Albany College of Pharmacy on interactions between drugs and dietary supplements were surveyed about their use of and views on dietary supplement information references. Included in the survey were six references: Physicians Desk Reference (PDR) for Herbal Medicines; Facts and Comparisons: Review of Natural Products; German Commission E Monographs; Natural Medicines Comprehensive Database (online or textbook format); Micromedex: AltMedDex; and The Natural Therapeutics Pocket Guide. The survey was repeated by mail 1 year after the program. Results Of the 91 attendees at the program, 58 completed the survey, and 25 individuals returned the 1-year survey. Of those completing the surveys, 80% had more than 10 years in practice, 95% had bachelor's degrees, and most practiced in community or institutional pharmacies. At baseline, fewer than 40% had "heard of" four of the six references. Pharmacists were most familiar with PDR for Herbal Medicines and Facts and Comparisons: Review of Natural Products . Familiarity rates increased at 1 year for five of the six references, though, again, overall rates were low and differences from baseline were not statistically significant for any of the six references. Usage rates increased for two references ( Facts and Comparisons: Review of Natural Products and Natural Medicines Comprehensive Database) at 1 year and declined for the remaining four. Conclusion Experienced pharmacists in both community and institutional settings infrequently use and are unfamiliar with dietary supplement information references, including those found in studies to be of the highest quality. Education on the availability and features of these references could benefit pharmacists and potentially change usage patterns.

To establish low-cost easily conducted health promotion interventions for advanced pharmacy practice experience (APPE) students in community pharmacy settings that would increase women's awareness about health issues using Food and Drug Administration (FDA) educational materials.Students distributed fact sheets on medication use, heart disease, and diabetes to women over 45 years of age at 6 community pharmacy APPE sites. Interventions completed were either personal medication records (PMR) to identify medication-related problems (MRP) or heart health screenings followed by completion of an anonymous patient satisfaction survey instrument.Over 1500 fact sheets were distributed. Fifty-eight women (age 61 +/- 15 years) completed PMRs, which identified 57 MRPs in 42 patients. Twenty-four women indicated the screening was "useful/very useful" for increasing medication understanding. Sixty-three women completed heart health screenings. Thirty-one of the 40 who completed the survey instrument indicated the screening was "useful/very useful" for learning heart disease risk.Community pharmacy APPE students interventions identified MRPs and patients at risk for heart disease. These health promotion interventions enhanced women's awareness of these topics while guiding students to achieve the desired curricular outcomes.

As our profession and the number of colleges of pharmacy continue to expand, the need for exceptional preceptors to guide the development of student pharmacists is great, particularly in the community pharmacy setting. In this challenging work environment, pharmacists are expanding their practice towards pharmaceutical care and medication therapy management opportunities. To prepare for tommorow's practice environment, pharmacy students must engage in advanced pharmacy practice experiences (APPEs) that are grounded in the realities of today's pharmacy environment, but also prepare them for their enhanced role in patient care. The goal of this supplement is to aid community pharmacy preceptors with developing and sustaining model experiential learning opportunities. This supplement to the American Journal of Pharmaceutical Education is intended to provide guidance to community pharmacy preceptors. It begins with 2 articles describing the recent changes in pharmacy education and the rationale for advanced pharmacy practice experiences in the community setting. The next 2 articles walk preceptors through the development of an advanced pharmacy practice experience, from orientation day to the final evaluation, and what to do in between. Four articles, which will be published with Volume 70, Issue 2, of the Journal, are designed to help preceptors develop students' knowledge and skills in the areas of communication, wellness and disease prevention, health information resources, and practice management. Each article provides preceptors with tangible projects and suggestions to apply to their experiential education rotation. The community pharmacy setting is unique in that it involves the constant interaction of our profession with the general public and other health care providers. Therefore, the impression these interactions convey to others on a daily basis is critical. The final article in the series reviews the topic of professionalism. Preceptors and experiential learning environments serve a critical role in the professional development of student pharmacists. Therefore, continuous examination of these environments is needed to ensure they emulate the standards of professionalism we hope to see reflected in student pharmacists. Serving as a community pharmacy preceptor is both rewarding and challenging. The rewards can be found in many places – mainly among the patients and students with whom you work and the feeling obtained when you make an impact on either. The challenge faced by community pharmacy preceptors is in balancing a busy work environment with providing a quality learning experience for students. We hope these articles help preceptors manage that balance. We are grateful to all preceptors for taking on the challenge and hope your commitment brings you many rewards.

Background: Quantitative ultrasound (QUS) devices provide portable, easy-to-operate, low-cost options for point-of-care screening of bone mineral density (BMD). Community pharmacists should be aware of the precision, sensitivity, and specificity of these devices prior to their purchase. Objective: To determine the precision, sensitivity, and specificity of the Achilles Express ultrasonometer compared with central dual-energy X-ray absorptiometry (cDXA) as well as its utility as a bone density screening device in the community pharmacy setting. Methods: A prospective study in a community pharmacy and outpatient ambulatory clinic was conducted with 2 groups of white women. Group 1 participants were 25–35 years of age (young, healthy), and those in Group 2 were 45 years of age or older (postmenopausal). BMD assessments of the spine and the nondominant wrist and hip were performed using cDXA. Assessments of the heel were performed using the Achilles Express, a QUS device. The main outcome measures were correlation of t-scores between cDXA and QUS measurements using the Pearson correlation test. Results: Twenty-two (30 ± 4 years of age) and 31 (55 ± 17 years of age) women were enrolled into Groups 1 and 2, respectively. Significant correlations between QUS and hip and spine cDXA t-scores were found in both groups. Correlation coefficients for QUS versus hip cDXA were 0.51 (95% CI 0.11 to 0.77) and 0.70 (95% CI 0.46 to 0.85) in Groups 1 and 2, respectively. Correlation coefficients for the QUS versus spine cDXA were 0.64 (95% CI 0.31 to 0.84) and 0.60 (95% CI 0.31 to 0.79) in Groups 1 and 2, respectively. The QUS device has a sensitivity level of 88% and specificity of 71% to detect a hip cDXA t-score of less than –1. Conclusions: The Achilles Express ultrasonometer is a reasonable screening tool to detect low BMD in postmenopausal women.

This study examined the effect of a community pharmacy-based menopause education program on scores of the Management of Menopause (MoM) survey. The MoM survey is a tool administered to managed care organization members by the National Committee for Quality Assurance to determine the level of menopause-related education offered by their health care providers. The primary outcome was comparison of the median MoM survey scores of participants at baseline, 3 months, and 1 year posteducation.Women aged 47 to 55 years who were able to provide informed consent were enrolled. Subjects completed a baseline MoM survey. Trained pharmacists working in 7 pharmacies conducted one-on-one education sessions regarding the consequences of menopause, treatment options, and the known risks and benefits of each option. Follow-up MoM surveys were administered by mail at 3 months and 1 year posteducation. The survey is scored on a 100-point scale for an overall composite score and includes 3 subsections: exposure, breadth, and personalization of counseling.A total of 31 subjects were enrolled, with 24 and 16 completing both baseline and 3-month or 1-year MoM follow-up surveys, respectively. Median 3-month composite MoM survey scores (86.1; 95% CI, 61.1-93.1) were significantly improved from baseline (54.2; 95% CI, 36.1-62.5; P0.001). Scores on each subsection of the MoM survey also improved at 3 months, and median 1-year composite scores were significantly improved from baseline. (54.2 to 89, P = 0.001). Patient satisfaction with the education session was high, with a median satisfaction rating of 5 (a range of 4 to 5) on a 5-point satisfaction rating scale.A community pharmacy-based menopause education program significantly increased scores on the MoM survey, and subjects were satisfied with this program.

Objective To assess the impact of a community pharmacy-based bone mineral density (BMD) screening and education program and determine the feasibility of providing such a service in community pharmacies. Design Uncontrolled study using convenience sample combined with economic feasibility analysis. Setting Two independent and four chain community pharmacies. Participants Women age 18years and older. Intervention Pharmacy patrons were invited to a free BMD screening. Demographic information was collected, and patients were screened using an ultrasound BMD analyzer. BMD results were reviewed with the participant during an education session and forwarded to primary care providers. Questionnaires were completed at baseline and after 3months. Main Outcome Measures Time spent with each participant, project costs, and willingness to pay for screenings were used to estimate feasibility; questionnaire responses assessed impact of the intervention on participants' health care decisions, lifestyle modifications, and communications with their prescribers about osteoporosis. Results Of the 140 women screened at baseline, 82% indicated the screening was "very useful" for making health care decisions, and 91% believed it encouraged them to talk with their physicians about osteoporosis. At 3months, 11% of patients reported having improved exercise habits, and 30% had increased their calcium and vitamin D intake. A total of 41% of respondents indicated a willingness to pay $20 or more for the BMD screening service. The average screening time was 23minutes. Based on fixed costs of the screening device and materials and variable costs associated with personnel time, a community pharmacy could generate a positive net income with a BMD screening program. Cost of the BMD analyzer could be recovered through revenue generated in 24–35 screening days, depending on the fees charged. Conclusion A community pharmacy osteoporosis program had a positive impact on patient health care by influencing lifestyle modifications, increasing use of medications, and encouraging participants to discuss osteoporosis with their physician. Patients are willing to pay for this service; feasibility varies depending on available resources and patient population served.

ALGER, SHARON A., MARGARET MALONE, JENNIFER CERULLI, STEVEN FEIN, LYN HOWARD. Beneficial effects of pharmacotherapy on weight loss, depressive symptoms, and eating patterns in obese binge eaters and non-binge eaters. Obes Res. Objective: The purpose of this study was to compare the impact of drug therapy on weight loss, Beck Depression Inventory (BDI) scores, and binge eating patterns (BES) between obese binge eaters and non-binge eaters. Research Methods and Procedures: 22 severe binge eaters, 17 moderate binge eaters, and 16 non-binge eaters received phentermine resin 15mg/day and dl-fenfluramine 20mg three times daily over a 6 month period for weight loss. All data are reported as mean±S. Results: The percent weight loss compared to baseline within the 3 groups ranged from 8. 9% to 11. 3% at 3 months and 10. 6% to 14. 9% at 6 months. After 6 months, 73% of the severe binge eaters, 59% of moderate binge eaters and 69% of non-binge eaters had experienced more than 10% weight loss. BDI scores were significantly higher in the severe group at baseline when compared to non-binge eaters (p

OBJECTIVE: To describe a case of toxicity secondary to chronic ingestion of 6–12 times the recommended daily allowance of over-the-counter (OTC) chromium picolinate. CASE SUMMARY: A 33-year-old white woman presented with weight loss, anemia, thrombocytopenia, hemolysis, liver dysfunction (aminotransferase enzymes 15–20 times normal, total bilirubin 3 times normal), and renal failure (serum creatinine 5.3 mg/dL; blood urea nitrogen 152 mg/dL). She had ingested chromium picolinate 1200–2400 μg/d for the previous 4–5 months to enhance weight loss. The patient had chromium plasma concentrations 2–3 times normal. Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome were ruled out by clinical findings, peripheral blood smears, and a bone marrow biopsy. The patient was managed with supportive measures and received blood product transfusions and hemodialysis. Hemolysis stabilized and liver function improved over 6 days. Liver function returned to normal prior to discharge. Renal function began to return on day 12 and her serum creatinine on discharge was 1.3 mg/dL. One year later, all laboratory values were within normal limits. DISCUSSION: Trivalent chromium is an essential trace element that is considered safe when ingested in normal quantities. Trivalent chromium compounds are used by patients to enhance weight loss, increase lean body mass, and/or improve glycemic control. Information regarding the toxicity of chromium picolinate is limited. CONCLUSIONS: Chromium supplements may cause serious renal impairment when ingested in excess. Medication histories should include attention to the use of OTC nutritional supplements often regarded as harmless by the public and lay media. OBJETIVO: Describir un caso de toxicidad producida por la ingestión crónica de picolinato de cromio, producto que no requiere prescripción médica, en cantidades de 6–12 veces mayores que las recomendadas. RESUMEN DEL CASO: Una mujer de 33 años presentaba pérdida de peso, anemia, trombocitopenia, hemólisis, disfunción hepática (aminotranferasas 15–20 veces el valor normal, bilirubina total tres veces el valor normal), y fallo renal (creatinina sérica = 5.3 mg/dL, nitrógeno ureíco sanguíneo = 152 mg/dL). Esta paciente había ingerido 1200–2400 μg diarios de picolinato de cromio durante los pasados 4–5 meses para bajar de peso. La paciente tenía una concentración de cromio en el plasma 2–3 veces lo normal. Se descartaron los síndromes de trombocitopenia púrpura trombótica y uremia hemolítica mediante hallazgos clínicos, cultivo de sangre, y biopsia de médula ósea. La paciente se manejó con medidas de apoyo, transfusiones con productos de sangre y hemodiálisis. La hemólisis se estabilizó y la función hepática mejoró a los 6 días de tratamiento. La función hepática regresó a los limites normales antes de ser dada de alta. La función renal comenzó a normalizarse el día 12 de la hospitalización y la creatinina sérica disminuyó a 1.3 mg/dL el día que la paciente fue dada de alta. Un año más tarde, todos los valores de laboratorio se encontraban dentro de los límites normales. DISCUSION: El cromio trivalente es un elemento traza esencial que se considera seguro cuando se ingiere en cantidades recomendadas. En la actualidad, los compuestos de cromio trivalente son utilizados para ayudar en la pérdida de peso, aumentar el peso magro y/o mejorar el control glucémico. La información disponible relacionada con la toxicidad del picolinato de cromio es aún muy limitada. CONCLUSIONES: Los suplementos de cromio pueden causar impedimentos renales serios cuando se ingieren en cantidades excesivas. Es importante que el historial médico incluya información sobre los suplementos nutricionales que pueda estar utilizando el paciente. Estos productos se adquieren sin prescripción médica y muchas veces el público y los medios de información no especializados los consideran inofensivos. OBJECTIF: Décrire un cas de toxicité associee à l'ingestion chronique d'un produit de comptoir, le picolinate de chromium, à une dose de 6–12 fois celle recommandée quotidiennement. RÉSUMÉ DU CAS: Une femme âgée de 33 ans se présente à l'urgence où on constate une perte de poids, une anémie, une thrombocytopénie, une hémolyse, un problème hépatique (le taux des aminotransférases est de 15–20 fois la normale, le taux de la bilirubine totale est de 3 fois la normale), et une insuffisance rénale (créatinine sérique = 5.3 mg/dL, azote uréique sanguine = 152 mg/dL). Elle a ingéré 1200–2400 μg par jour de picolinate de chromium pendant les 4–5 mois précédents pour stimuler une perte de poids. Les concentrations plasmatiques de chromium sont de 2–3 fois la normale. Un purpura thrombotique thrombocytopénique et un syndrome hémolytique urémique ont été éliminés à l'aide des données cliniques, des prélèvements sanguins et d'une biopsie de la moëlle épinière. Un traitement de support a été administré à la patiente; elle a reçu des transfusions sanguines et une hémodialyse a été réalisée. L'hémolyse s'est stabilisé et la fonction hépatique s'est améliorée en 6 jours. La fonction hépatique s'est normalisée avant le départ de la patiente. La fonction rénale a commencé à s'améliorer au jour 12 et la créatinine sérique était de 1.3 mg/dL à son départ. Un an plus tard, toutes les valeurs de laboratoire sont à l'intérieur de la limite de la normale. DISCUSSION: Le chromium trivalent est un oligo-élément essentiel considéré sécuritaire lorsqu'il est ingéré en quantité normale. Des produits à base de chromium trivalent sont utilisés couramment par les patients pour favoriser la perte de poids, pour augmenter la masse maigre et/ou pour améliorer le contrôle glycémique. Les données concernant la toxicité du picolinate de chromium sont limitées. CONCLUSIONS: Les suppléments de chromium peuvent causer une altération grave de la fonction rénale s'ils sont ingérés en quantité excessive. Lors des entrevues avec les patients, une attention particulière devrait être portee à l'utilisation des suppléments nutritionnels disponibles sans ordonnance et considérés sans danger par le public et la presse.

Objective. To document drug information questions received by students during community pharmacy advanced practice experiences (CPAPEs) in order to categorize the types of inquiries received and to identify the references used and the student-reported usefulness of those resources. Methods. Fifty-one CPAPE students were asked to document 10 drug information questions on a standard form, indicating the references used and the usefulness of that resource. The data were entered into a database. Results. Most of the 272 inquiries documented concerned prescription medications and were initiated by patients (55%) or pharmacists (35%). Adverse events (n = 78) and pharmacotherapy (n = 73) were the most frequent question classifications encountered. The most common references cited were Micromedex (Thompson Scientific and Health Care Group, Greenwood Village, Co), Drug Facts and Comparisons (Facts and Comparisons, St. Louis, Mo), and package inserts. Although Micromedex and package inserts were found useful in 71%...

Purpose. To expand Community Pharmacy Advanced Practice Experiences (CPAPEs) through implementation of a practical, succinct preceptor training program designed to enhance preceptor ability to provide a viable learning opportunity. Methods. A 12-hour training program was developed to enhance both patient care and precepting skills concurrently. Each interactive 6-hour session included a combination of presession assignments, lectures, discussion groups, hands-on activities, and role-playing exercises. Results. Twenty-eight community pharmacists completed training and significantly improved their comfort level for providing patient care and offering CPAPEs. Nine pharmacists at 5 sites accommodated 42 students over 2 academic years, receiving positive student evaluations. Summary. The program provided preceptors with increased confidence in their abilities to provide patient care and precept pharmacy students. The CPAPEs have made an impact by successfully exposing students and pharmacists to an elevated le...

Objectives. The purpose of this project was to develop and implement CAPE outcome-based goals, objectives, and assessment tools for community pharmacy advanced practice experiences (CPAPE). Methods. A focus group of preceptors was convened to conduct a needs assessment. The number and types of experiential activities from faculty-based CPAPE and examples of objectives from other colleges of pharmacy were reviewed. Key CAPE outcomes to be achieved and assessed during the CPAPE were identified and linked with specific student activities. Assessment tools were adapted or developed. A new document was developed, pilot tested, and revised prior to implementation. Results. The resulting document combines CAPE-based objectives with specific clerkship activities and assessment tools, as well as a midpoint and final evaluation form. The document has been used for 55 experiences, resulting in positive feedback from preceptors and students. Conclusion. The standardized outcomes and assessment document that was devel...