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This study assessed rural community pharmacists' attitudes about COVID-19 vaccine booster doses and explored whether rural pharmacies offered these booster doses. Of the 80 rural Southeastern U.S. pharmacists who completed the online survey, the majority (n = 68, 85 %) offered boosters and 42 (52.5 %) had received the booster themselves. Alabama and Mississippi offered boosters less often than other states, and pharmacists who had foregone receiving COVID-19 vaccination or booster doses were less likely to offer the booster to their patients. Additionally, many pharmacists reported that they and their patients felt the booster was not needed. Community pharmacies provide access points for the COVID-19 booster in rural areas. Interventions for both pharmacists and patients are needed to address hesitancy and improve booster uptake in these communities.

Objectives To evaluate the effects of a community pharmacy-based fall prevention intervention (STEADI-Rx) on the risk of falling and use of medications associated with an increased risk of falling. Design Randomized controlled trial. Setting A total of 65 community pharmacies in North Carolina (NC). Participants Adults (age ≥65 years) using either four or more chronic medications or one or more medications associated with an increased risk of falling (n = 10,565). Intervention Pharmacy staff screened patients for fall risk using questions from the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. Patients who screened positive were eligible to receive a pharmacist-conducted medication review, with recommendations sent to patients' healthcare providers following the review. Measurements At intervention pharmacies, pharmacy staff used standardized forms to record participant responses to screening questions and information concerning the medication reviews. For participants with continuous Medicare Part D/NC Medicaid coverage (n = 3,212), the Drug Burden Index (DBI) was used to assess exposure to high-risk medications, and insurance claims records for emergency department visits and hospitalizations were used to assess falls. Results Among intervention group participants (n = 4,719), 73% (n = 3,437) were screened for fall risk. Among those who screened positive (n = 1,901), 72% (n = 1,373) received a medication review; and 27% (n = 521) had at least one medication-related recommendation communicated to their healthcare provider(s) following the review. A total of 716 specific medication recommendations were made. DBI scores decreased from the pre- to postintervention period in both the control and the intervention group. However, the amount of change over time did not differ between these two groups (P = .66). Risk of falling did not change between the pre- to postintervention period or differ between groups (P = .58). Conclusion We successfully implemented STEADI-Rx in the community pharmacy setting. However, we found no differences in fall risk or the use of medications associated with increased risk of falling between the intervention and control groups. J Am Geriatr Soc 68:1778-1786, 2020.

The monitoring of bats across the world is mostly conducted using invasive mist-netting, whereby vertical nets are placed to capture bats mid-flight. Many studies have demonstrated how this approach causes sampling bias, is labor-intensive and increases the risk of white-nose syndrome fungus, Pseudogymnoascus destructans, transmission among bats. Increasingly, acoustic devices are being employed to collect data on bat activity and richness. Community-based monitoring is an important data collection source for bat monitoring programs in countries such as the UK (National Bat Monitoring Program), whereby walking bat transects are conducted using bat detectors. Since the launch of smartphone devices to record and auto-identify bat echolocation calls, the quality of data collection that community members can collect has increased significantly, however, this approach is seldom used to generate data in scientific studies. In our study, we have showcased how our study design paired with state of the art acoustic monitoring devices, can be applied to community-based monitoring of bats across the world. Through employing smartphone acoustic devices, we have determined how primary and secondary vegetation cover are predictors of bat species occurrence and identified the importance of riverine and deciduous swamp habitats for rare bat species in southwestern Ontario.

Community pharmacies are an ideal setting to manage high-risk medications and screen older adults at risk for falls. Appropriate training and resources are needed to successfully implement services in this setting. The purpose of this paper is to identify the key training, tools, and resources to support implementation of fall prevention services. The service was implemented in a network of community pharmacies located in North Carolina. Pharmacies were provided with onboard and longitudinal training, and a project coach. A toolkit contained resources to collect medication information, identify high-risk medications, develop and share recommendations with prescribers, market the service, and educate patients. Project champions at each pharmacy received a nine-question, web-based survey (Qualtrics) to identify usefulness of the training and resources. The quantitative data were analyzed using descriptive statistics. Thirty-one community pharmacies implemented the service. Twenty-three project champions (74%) completed the post-intervention survey. Comprehensive onboard training was rated as more useful than longitudinal training. Resources to identify high-risk medications, develop recommendations, and share recommendations with prescribers were considered most useful. By providing appropriate training and resources to support fall prevention services, community pharmacists can improve patient care as part of their routine workflow.

Background: Certain medications place older adults at higher risk for experiencing falls. This is a modifiable risk factor that may be managed by community pharmacists, but requires prescriber acceptance of recommendations. Previous studies indicate that prescriber acceptance of pharmacist recommendations may be impacted by patient-reported concerns. Objective: To examine the relationship between patient-reported fear of falling and prescriber acceptance of pharmacist recommendations. Methods: A prospective, observational study design was used. Eligible patients were age 65 and older and received care at one of 31 participating pharmacies. Patients were screened for falls risk using three evidence-based questions; patients screening positive were eligible for a comprehensive medication review. Data were collected via a prescriber response form. The primary outcome was the prescriber acceptance of pharmacist recommendations. Results: Pharmacists communicated 562 recommendations to prescribers, with 338 (60%) for patients who worried about falling. There was no significant difference in prescriber acceptance rate between those who worried about falling and those who did not (36.1% vs. 41.1%, X2 = 0.23, p = 0.43). However, patient pharmacy was a significant predictor of recommendation acceptance (p = 0.047). Conclusion: Prescribers were not more likely to consider a pharmacist’s recommendations regarding medications that contribute to falls risk for patients who worried about falling.

Objectives This mixed methods study had 2 aims: (1) to describe the frequency of care coordination between pharmacists, prescribers, and care managers and (2) to identify pharmacists' strategies for care coordination and follow-up in a community pharmacy setting. Design This study used a mixed methods design. Setting and participants Pharmacists who were responsible for implementing North Carolina community pharmacy enhanced services network (NC CPESN®) activities in their pharmacy during the first or second year of the 3-year program (September 2014–August 2016). Outcome measures A survey was administered to gather data on care coordination in community pharmacies and for follow-up. In-depth interviews were conducted to expand on the findings from the quantitative data. Descriptive statistics were calculated for survey data. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Results Surveys were received from 101 pharmacies (82.1% response rate). Fourteen pharmacies with missing responses were removed, resulting in 87 pharmacies being included in the analysis. The majority of pharmacies were single, independent pharmacies (46.5%), and approximately one-third of pharmacies had a clinical pharmacist on the staff (31.1%). To communicate with prescribers, pharmacists most frequently used facsimile (fax) (82.1%) or phone (65.5%). A total of 12 pharmacists participated in the semistructured interviews. Pharmacists defined care coordination as interdisciplinary collaboration and communication among the members of the health care team to provide the best possible patient-centered care. All pharmacists agreed that good health care provider (i.e., care manager and prescriber) relationships are crucial to the success of patient care; however, participants mentioned that building these relationships has been or is currently difficult to establish. Conclusion Care coordination among pharmacists, prescribers, and care managers is important for improving patients' medication management and overall outcomes. To our knowledge, this is the first study to quantify care coordination between pharmacists, prescribers, and care managers and to identify strategies to facilitate care coordination. Results from this study have the potential to inform how care coordination and longitudinal follow-up are best implemented within the community pharmacy setting.

Falls among older adults (age 65 and older) cause roughly 3 million emergency department visits and $50 billion in medical costs annually. The Centers for Disease Control and Prevention (CDC) developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to increase clinical fall prevention. STEADI encourages screening for fall risk annually, assessing modifiable risk factors, and intervening to reduce risk using effective strategies like medication management. Medication management is critical given new data on the increased use of medications linked to falls. In 15 years, opioid use among older adults increased from 15% to 35% and anticonvulsant use tripled from 4% to 14%. To address the issue, CDC partnered with the University of North Carolina who 1) adapted STEADI tools for use in community pharmacies and 2) piloted and assessed their use in 31 North Carolina pharmacies. The adapted tools and processes were branded STEADI-Rx. Community pharmacists following the STEADI-Rx initiative, screen older patients for fall risk in the pharmacy, perform a medication review to identify medications that could increase fall risk, and intervene to reduce risk by sharing information with the patients’ healthcare providers. Providers can then optimize medications to reduce fall risk and improve health. STEADI-Rx tools include 1) a community pharmacy algorithm, outlining how pharmacists can conduct fall risk screening, assessment, and care coordination; 2) a community pharmacy fall risk checklist; and 3) communication materials to help pharmacists share information with patients’ providers. STEADI-Rx was launched in July 2019. More information is available at www.cdc.gov/STEADI.

With the advent of combinatorial chemistry and high throughput screening, a major bottleneck in the pharmaceutical industry has changed from quickly finding active compounds to limiting them to a manageable number for proper follow-up. With hundreds to thousands of active compounds identified by a multitude of biological screens, there need to be rapid and unambiguous methods for eliminating false positive, toxic, or otherwise difficult compounds from further scrutiny. We have used electrospray ionization mass spectrometry as a rapid screening method to identify compounds from viral screens that yield a positive assay response by interaction with DNA rather than inhibiting the target enzyme. Both the sample preparation and data acquisition have been automated, allowing the screening of all hits from relevant biological screens (up to 1,000/week). The assay was validated using several known DNA intercalators and minor groove binders. These "standards" and many but not all of our "active compounds" were shown to form noncovalent complexes with a variety of different DNA:DNA and DNA:RNA duplexes.