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Pain is one of the most common symptoms experienced by patients living with cancer. Guidelines recommend opioids as the mainstay in the management of cancer-related pain. However, the opioid epidemic has resulted in policymakers recommending limitations on opioid prescribing which led to community pharmacies implementing various parameters. These restrictions have created barriers for patients with cancer-related pain attempting to fill opioid prescriptions from their community pharmacies. Additionally, in the setting of the opioid epidemic, there have been reports of systemic bias within community pharmacies, leading to experiences with embarrassment and shame for patients with cancer-related pain. This case series presents specific examples of community pharmacies declining to fill opioid prescriptions for patients with cancer-related pain and associated patient suffering., Competing Interests: Disclosures and Acknowledgments This research received no specific funding/grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare no conflicts of interest., (Copyright © 2023. Published by Elsevier Inc.)

The high degree of complexity of the product-review process and differences in procedures between organizations have resulted in a need for best practices and an overall product-review process to create efficiencies for health care decision makers. In an effort to streamline product-review concepts, this article outlines the different components of the review process, including clinical and economic review, formulary placement determination, and evaluation of alternatives within a drug class. The article also details opportunities for the near future, as technology continues to advance and alignment between medical and pharmacy benefits is desired. DISCLOSURES: Drs Linnerooth, Penley, Ha, and Craven report employment with Xcenda, which provided funding for the manuscript. Drs Sauvageau and Hydery report employment Xcenda, which provided funding for the manuscript, and stock holdings with AmerisourceBergen. Dr Feeney reports support for attending meetings and/or travel provided by Highmark, Inc. Dr Thomas reports receipt of consulting fees from ActiveRADAR, board member roles with ActiveRADAR and RoundtableRx, an adjunct professor role with the University of Minnesota, and stock options and pensions with Eli Lilly and Aetna/CVS. Dr Watkins reports payment or honoraria from ISPOR and for articles written for Value and Outcomes Spotlight, and support for attending meetings and/or travel by AMCP.

To advance their research agenda, the Academy of Managed Care Pharmacy (AMCP) and the AMCP Foundation (AMCPF) invited a sample of AMCP membership to participate in focus groups and tasked them with developing tangible research aims for each of the top 2 previously identified AMCP/AMCPF research priorities: generating real-world evidence (RWE) to support US Food and Drug Administration (FDA) Accelerated Approvals and improving benefit design to address health inequities. The resulting research aims, which were further refined per feedback from additional stakeholders, will serve to guide requests for proposals for funding of specific research projects to address these top managed care priorities. Research aims identified by focus group participants related to generating RWE for FDA Accelerated Approvals include (1) creating a data survey tool for managed care to make RWE more readily available, (2) linking surrogate endpoints to meaningful clinical outcomes for drug development, and (3) improving patient outcomes by determining the optimal sequence of clinical pathways. Research aims identified by focus group participants related to improving benefit design to address health inequities include (1) identifying how the ability to navigate managed care benefit designs may impact inequities, (2) understanding the connection between health inequities and medication adherence, and (3) evaluating the impact of social determinants of health on medication affordability. DISCLOSURES: These proceedings were supported by Bridget Flavin, PharmD, Founder, Connected Content, Ltd. Connected Content, Ltd. received payment from AMCP for the preparation of this manuscript. Flavin is also an adjunct associate professor at the University of Florida College of Pharmacy. Diana Brixner received AMCP Foundation support of sabbatical to conduct this work, support of a medical writer to assist in putting the manuscript together, consulting fees from Millcreek Outcomes Group, Elevar, Sage, Haymarket, and AMCP funding of one trip to Alexandria, VA. This research and the development of this manuscript were funded by AMCP and the AMCP Foundation.

The chair of chymiatria created at the University of Marburg was among the earliest academic initiatives aiming to integrate chymistry into the medical curriculum. If its practical applications in pharmacy and its relationship with patronage have been examined by historians, the theoretical part of the chymiatria programme still remains to be explored. In the form of student disputations and dissertations held or presided over by Heinrich Petraeus, a professor of medicine at Marburg and Johannes Hartmann's son-in-law, "chymiatric" essays expounded various medical issues. Centred on pathology, therapy, and physiology, these theoretical explanations proposed a "hermetic-dogmatic" interpretation merging the views of Paracelsus and Galen. This article examines these disputations and their stance concerning the living body, sickness, and treatment, and how they shaped the status of chymistry as an art and a science on the verge of institutionalisation.

Background: Globally, the safety of patients and healthcare providers is at risk due to health care-associated infections (HCAIs). World Health Organization and the Centers for Disease Control and Prevention recommend using alcohol-based hand rub (ABHR) for hand hygiene in healthcare settings to prevent HCAIs. Irrational use of ABHR will have undesirable consequences including wastage of products, exposure of healthcare providers to infections and emergence of microbial resistance to the alcohol in hand sanitizers. This study aimed to explore the perspective and experiences of compounding pharmacists on production and utilization of ABHR solution for coronavirus disease in 2019 (COVID-19) prevention in public hospitals of Addis Ababa, Ethiopia., Methods: A descriptive qualitative study using in-depth interview of 13 key-informants serving as compounding pharmacists in public hospitals of Addis Ababa, Ethiopia, was conducted. The study participants were identified and selected by purposive sampling. All transcribed interviews were subjected to thematic analysis and transcripts were analyzed manually., Findings: The compounding pharmacists in this study had a mean age of 30.6 (±3.1) years and nine of the thirteen participants were men. Ten participants believed that the compounding practice in their respective sites followed the principles of good compounding practice. More than half of the participants did not believe that ABHR products were used rationally in health facilities. They argued that users did not have enough awareness when and how to use sanitizers. Most of the interviewees reported that compounding personnel had no formal training on ABHR solution production. Study participants suggested incentive mechanisms and reimbursements for experts involved in the compounding of ABHR solutions., Conclusion: Three of the compounding pharmacists indicated that ABHR production in their setting lack compliance to good compounding practice due to inadequate compounding room, quality control tests, manpower and equipment. Despite this, most study participants preferred the in-house ABHR products than the commercially available ones. Thus, training, regular monitoring and follow-up of the hospital compounding services can further build staff confidence., Competing Interests: The authors have declared that no competing interests exist.

The Coronavirus disease (COVID-19) pandemic is disrupting our health environment. As expected, studies highlighted the great susceptibility of cancer patients to COVID-19 and more severe complications, leading oncologists to deeply rethink patient cancer care. This review is dedicated to the optimization of care pathways and therapeutics in cancer patients during the pandemic and aims to discuss successive issues. First we focused on the international guidelines proposing adjustments and alternative options to cancer care in order to limit hospital admission and cytopenic treatment in cancer patients, most of whom are immunocompromised. In addition cancer patients are prone to polypharmacy, enhancing the risk of drug-related problems as adverse events and drug-drug interactions. Due to increased risk in case of COVID-19, we reported a comprehensive review of all the drug-related problems between COVID-19 and antineoplastics. Moreover, in the absence of approved drug against COVID-19, infected patients may be included in clinical trials evaluating new drugs with a lack of knowledge, particularly in cancer patients. Focusing on the several experimental drugs currently being evaluated, we set up an original data board helping oncologists and pharmacists to identify promptly drug-related problems between antineoplastics and experimental drugs. Finally additional and concrete recommendations are provided, supporting oncologists and pharmacists in their efforts to manage cancer patients and to optimize their treatments in this new era related to COVID-19., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective. To examine the effect size of third professional (P3) year students' grade point average (GPA) on Pharmacy Curriculum Outcomes Assessment (PCOA) scores and to summarize the effect size of PCOA scores on North American Pharmacist Licensure Examination (NAPLEX) scores. Methods. To accomplish the objective, meta-analyses were conducted. For inclusion in the meta-analysis, studies were required to compare PCOA scores to and report data that permitted calculation of a numeric effect size for the chosen outcome variables. Multiple databases were searched, including PubMed, CINAHL, EMBASE, ProQuest Dissertations and Thesis (abstract limited), Academic Search Complete, and Google Scholar. Correlations were used as the effect size metric for all outcomes. All analyses used an inverse variance weighted random effects model. Study quality was reviewed for each study included in the meta-analyses. Results. This study found that PCOA scores were moderately correlated with P3 GPAs, accounting for 14% to 48% of the variability in PCOA scores. The meta-analyses also showed that PCOA scores were moderately correlated with NAPLEX and accounted for 25% to 53% of the variability in NAPLEX scores. Both meta-analyses showed a high degree of heterogeneity and many studies included were of low quality. Conclusion. This first set of meta-analyses to be conducted on the PCOA showed that third professional year GPA does correlate with PCOA results and that PCOA scores correlate with NAPLEX results. Though there are significant limitations to interpretation of the results, these results do help further elucidate the role of the PCOA as a benchmark of progress within the pharmacy curriculum., (© 2020 American Association of Colleges of Pharmacy.)

Providing health care for children is a unique specialty, and pediatric patients represent approximately 25% of the population. Education of pharmacy students on patients across the lifespan is required by current Accreditation Council for Pharmacy Education standards and outcomes; thus, it is essential that pharmacy students gain a proficiency in caring for children. A collaborative panel of pediatric faculty members from schools and colleges of pharmacy was established to review the current literature regarding pediatric education in Doctor of Pharmacy curricula and establish updated recommendations for the provision of pediatric pharmacy education. This statement outlines five recommendations supporting inclusion of pediatric content and skills in Doctor of Pharmacy curricula., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To identify the specific study behaviors that promoted student pharmacists' success in an active-learning pharmacy curriculum. Methods. The Washington State University College of Pharmacy and Pharmaceutical Sciences implemented an active-learning, flipped classroom model for instruction to equitably deliver course content to Doctor of Pharmacy students on both its main and extended campuses. Students' ability to adapt to the new model and its impact on their study behaviors were unknown. A qualitative descriptive design that included semi-structured interviews was applied to evaluate the study behaviors of high-performing students. The study sample included 13 third and fourth professional year pharmacy students in the top 20% of their respective classes. Results. Interview responses were unaffected by baseline demographics such as gender and year of graduation. Content analysis generated five primary themes related to the behavioral strategies used by high performers: preparing for class, preparing for testing, seeking help, knowing yourself, and building on strengths. These were mapped to the four tenants of Wenger's social learning theory in the representation of findings: learning as doing, learning as belonging, learning as becoming, and learning as experience. Conclusion. High-performing students demonstrated a refined ability to select and modify study behaviors that aided in their academic success, demonstrating a high degree of metacognition. The results of this research may assist pharmacy faculty members in identifying critical elements for success of students enrolled in pharmacy programs using an active learning model., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To review the literature regarding the use of learning style frameworks in health science education, with particular attention to learning outcomes and use for self-awareness. Findings. Of the 415 articles identified in an initial search of the literature, 31 articles involving learning style frameworks were included after screening titles, abstracts, and full texts. Multiple learning style frameworks, including VARK, Kolb Learning Style Inventory, Honey and Mumford Learning Style Questionnaire, and Pharmacist Inventory of Learning Styles, have been used in various health science education disciplines, including medicine, nursing, and pharmacy. Most publications were descriptive in nature, reporting the learning styles of the given student cohort. Most studies that attempted to find a correlation between learning style and learning outcomes found none. In cases where a correlation was found, it was weak or inconsistent with findings from other published studies. No identified studies described use of learning style frameworks for increasing self-awareness in learners. Summary. While several different learning style inventories have been used to assess health science education students, their utility for predicting learning outcomes appears to be weak. Using learning style inventories to improve learner self-awareness is an unexplored area of education and research., (© 2020 American Association of Colleges of Pharmacy.)

Introduction: To evaluate the design of an interprofessional introductory pharmacy practice experience (IP-IPPE) designed to integrate third-year pharmacy students in patient care workflow under the direct supervision of non-pharmacist practitioners in a federally qualified health center., Methods: Data was gathered to evaluate the success of the IP-IPPE from the students', providers', and clinic's perspectives. Preceptors completed a mixed-methods survey to determine satisfaction and value of the IP-IPPE. Students completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) post-IP-IPPE to assess change in interprofessional outcomes. Student performance and competency demonstration was assessed using a modified interprofessional professional assessment scoring tool. Finally, a retrospective patient chart review was conducted to determine student value to the clinic., Results: During a 12-week period at the studied clinic, 32 students were supervised by eight primary care providers (PCPs) and cared for 516 patients. Six providers (75%) endorsed students' ability to provide value-added interventions during clinical care. A chart review of 200 patient records indicated students provided medication education to 12% of patients engaged with, in addition to other contributions. Students' ICCAS self-assessments indicated significant improvement across all outcomes following the IP-IPPE. Qualitative provider responses indicated meaningful investment into the IP-IPPE and appreciation for pharmacy student's collaboration during patient care., Conclusion: All 32 students in this study were able to earn the trust of their assigned PCP preceptors. The IP-IPPE design created value for learners, patients, and providers., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: Workplace-related burnout is a state of mental and physical exhaustion caused by one's professional life. Literature demonstrates the link between physician burnout and serious consequences (reduced productivity, medical errors, and clinician suicide), but assessment of burnout in other healthcare professions is limited, especially in pharmacy. A quality improvement study was conducted to quantify burnout in a diverse health-system pharmacy department and identify potential strategies to improve well-being., Methods: A survey was distributed to assess the perception and drivers of burnout within a health-system pharmacy. All associates received a survey comprised of the Maslach Burnout Inventory (MBI), demographic questions, and items affording respondents the opportunity to list stressors and potential solutions. Email reminders were sent weekly and site visits were conducted to encourage survey completion. Results were analyzed via descriptive statistics., Results: Two hundred seventy-seven associates completed the survey (response rate, 40.5%). Seventy percent of those participants were experiencing moderate to high levels of burnout, with survey results indicating moderate levels of personal accomplishment and emotional exhaustion and low levels of depersonalization; there were no statistically significant differences in mean MBI scores by shift type, hours worked per week, or years of service. There were statistically significant differences in scores for personal accomplishment between males and females, as well as among positions and regions (P < 0.05). Participants identified issues related to workflow, control, and community as the greatest contributors to stress., Conclusion: The diverse staff of a health-system pharmacy department reported a moderate amount of burnout, with the greatest variation in the dimension of personal accomplishment. The mitigation strategies most commonly cited were staffing/workflow adjustments and creating a culture of well-being., (© American Society of Health-System Pharmacists 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The rational use of medicines to achieve better patient outcomes is a global concern. This need has pressured the practice of pharmacy to move away from focusing only on dispensing of the drug product towards the patient's appropriate utilization of the medicine. PharmAlliance, a unique partnership among three leading schools of pharmacy at the University of North Carolina at Chapel Hill (United States), Monash University (Australia), and University College London (United Kingdom), convened a Global Summit of Pharmacy Practice Innovation in November 2017 to bring together the leaders of the professional associations of the three countries to dialogue about how to lead the identified changes. A framework of "One Pharmacy Community" resulted from the discussions and was conceptualized from the overarching theme of the Summit. Recognizing and articulating these similarities into a One Pharmacy Community framework enables the development of a consistent global nomenclature of pharmacy services. The four pillars that resulted from the conversation are education, research, practice, and collaboration. Each of these are essential and dependent on the other in order to enable pharmacy practice to meet the global requirements of patient-focused health care design and delivery. This article describes the framework and each of the pillars., (Copyright © 2019. Published by Elsevier Inc.)

In spite of concerns about the lack of recognition for its conduct, peer review remains the backbone of scientific evaluation and advancement of scientific knowledge. Given the challenges and evolution in the peer review system, collegiality among authors, reviewers, editors, and even consumers of content is more important than ever. While general guidance has been provided recently in the pharmacy literature, this commentary provides both philosophical underpinnings and specific mechanics for enhancing effectiveness of reviews and improving the quality of writing for authors concurrently, thus examining each major section in an original research contribution. Generosity, courtesy, diligence, thoroughness, and empathy are required of us all to advance the scientific paradigm of our discipline and profession., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective. To explore how participation as a pharmacy camp counselor impacted pharmacy students' professional identity and views on professionalism. Methods. A pharmacy camp was developed to introduce rising high school juniors and seniors to the pharmacy profession. First- and second-year student pharmacists were invited to serve as counselors and, afterward, to participate in a focus group to share their experiences. Researchers used the focus group data to explore the impact of the camp experience on the student pharmacists. A direct interpretation approach was used to examine data as it allowed the research team to assess this single instance and draw meaning from focus group findings. Categories/themes were constructed through the interpretations of patterns and relationships discovered within the deconstructed results. Results. Ten student pharmacists participated in the focus group. The students provided their perspectives on the camp experience, including their role as camp counselors, the campers attending the camp, and the differences observed between student pharmacists and non-pharmacy camp counselors. Student pharmacists' comments gravitated toward the topic of professionalism. Student pharmacist counselors recognized positive and negative models of professionalism and made personal judgments concerning these concepts. Conclusion. Inclusion of student pharmacists in leadership roles such as this proved to be an effective means for further developing professional attributes. The focus group feedback provided novel insights into the professional mindset of student pharmacists. After serving as camp counselors, student pharmacists described their new perspectives on the importance of professionalism in their individual journeys, among their peers, and as future student pharmacists., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To explore whether metacognition can be improved in Doctor of Pharmacy (PharmD) students through routine self-assessment over a year-long advanced pharmacy practice experience (APPE) sequence. Methods. Differences between self-assessment scores and preceptors' scores for three cohorts of pharmacy students between 2015 and 2018 were compared between the first, second, and third trimester to determine whether students more accurately evaluated their performance over time. The primary endpoint was change in the absolute difference between student and preceptor evaluation (rubric and composite scores) between trimesters. Results. Of 2577 student and preceptor evaluations eligible for inclusion, 1713 were completed, matched, and analyzed. Using the same rubric as preceptors, students overestimated their performance by an average of 16 points during the first trimester, followed by 14 and 12 points during the second and third trimester, respectively. This reflected a significant improvement over time. No significance difference was found between student and preceptor composite scores. Faculty preceptorship, students' pre-APPE grade point average, and type of APPE were not associated with any difference in rubric or composite scores. Conclusion. This analysis revealed that the difference between student self-evaluation grades and preceptor evaluation grades was greatest during the first trimester and significantly decreased in the second and third trimesters. This could reflect students' development of metacognitive processes over time. Metacognition is a vital skill for pharmacy students to learn, and opportunities to develop this skill should be incorporated throughout the pharmacy curricula., (© 2020 American Association of Colleges of Pharmacy.)

The appropriateness of term limits for administrative appointments is a subject of much discussion, not just within pharmacy programs, but in organizations of all types. The prospect of term limits for involves a wide variety of important organizational issues, including succession planning, institutional memory, strategic decision-making, and concepts regarding leadership styles overall. This paper examines both sides of the debate regarding the appropriateness of term limits for administrative appointments. Arguments supporting term limits include the ability for strategic changes in the diversity of leaders as well as a more focused effort on continuous quality improvement. The arguments against term limits focus around the need for stability and the time involved in the development of effective leaders., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To deliver a brief, applied workshop in improvisational communication skills during the new student orientation for first-year Doctor of Pharmacy students and to assess students' perceptions about the experience. Methods. Communication instructors developed a two-hour communication "boot camp" based on established principles of clear, responsive, flexible communication. They taught core skills through interactive applied improvisational exercises and facilitated debriefings. A questionnaire was administered following the workshop that asked students to rate the quality of the session and comment on its strengths and weaknesses. Results. Of the 124 students who participated in the workshop, 95 (77%) completed evaluations at the end. Their feedback was generally favorable: 90% of participants indicated that the boot camp improved their communication skills and 92% agreed that the activities were realistic and relevant to real-life scenarios. The students reported that they valued the chance to connect with classmates, learn how to adapt to different audiences, and explore how communication skills would be useful in professional settings. Conclusion. This interactive program delivered valuable content in a short period of time. Student feedback suggested that they valued the expertise of communication instructors and the playful, active method of learning. The creation of the workshop was labor-intensive because of the formative research that guided it., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To provide an overview of autoethnography as a valuable qualitative methodology in the human and health sciences and to endorse its use to answer meaningful research questions in pharmacy education and assist with the preparation of person-centered pharmacists. Findings. Today, pharmacists must participate in the health care system as care providers rather than simply drug dispensers. The call for change, which began with the evolution of clinical pharmacy and continued with the introduction of pharmaceutical care practice in the 1990s, is still proving to be dramatic for the profession. Thus, new problems are surfacing demanding new types of research questions and new ways of answering them. Autoethnography is a qualitative methodology that combines the principles of ethnography and autobiography in a way that highlights researchers' reflexivity and subjectivity. The paper describes autoethnography, its diverse forms (eg, evocative or analytical), the process of producing it, and associated standards of high-quality work. It presents autoethnographies carried out in health care research as well as in pharmacy, pointing to the usefulness of this methodology to produce meaningful investigations that can enrich the preparation of future pharmacists and advance the profession. Summary. Autoethnography is gaining recognition in many disciplines in health care. Even though it is still incipient in pharmacy, autoethnography can expand pharmacy students' and pharmacists' consciousness regarding their own situation and open the possibility for pursuing research that might enhance the lives of others and themselves., (© 2020 American Association of Colleges of Pharmacy.)

Gender disparity exists in leadership roles within healthcare. While the majority of the healthcare workforce is comprised of women, significantly fewer women occupy leadership positions, particularly at executive and board levels. As the field of oncology pharmacy continues to rapidly expand and evolve, an assessment of the current state of women in oncology pharmacy leadership roles is vital to the growth and development of the profession. In the fall of 2017, the Hematology/Oncology Pharmacy Association (HOPA) hosted a summit to explore leadership issues facing women in oncology pharmacy which have the potential to affect our membership and our profession. This meeting included invited participants from across the fields of oncology and pharmacy and was part of HOPA's strategic leadership initiative developed through the work of the HOPA Leadership Development Committee in 2016. This promotes a primary goal of HOPA, which is to support oncology pharmacists as they assume leadership roles within their practices and within healthcare to assure oncology pharmacy is integrated into cancer care. The purpose of this white paper is to (1) summarize key issues that were identified through a membership survey; (2) review ongoing efforts to address the needs of female oncology pharmacists in leadership development; (3) serve as a call to action for individuals and professional organizations to assist with and disseminate these efforts and highlight available resources, and (4) to provide practical steps to meet the needs of individuals, training programs, and institutions/employers.

Objective. To explore the use of artifacts and material objects in accessing what learning means to pharmacy students, what their learning practices are, and their assumptions about what it means to master the pharmacy curriculum. Methods. Data collection was qualitative and took the form of individual semi-structured interviews with students in a Master of Pharmacy program. Participants were asked to select three artifacts (a photograph, an object, a song, a picture, or something else) that represented what learning as a pharmacy student meant to them and bring them to the interview. The interviews were conducted using both the abstracts and a semi-structured interview plan constructed as a mind map. Flexibility was applied to changing the sequence of themes, and additional probing questions were asked. Data were analyzed thematically using mind mapping and, subsequently, theoretical constructs were applied to make sense of the analysis. Results. Nineteen interviews were conducted. Findings were grouped into five distinct themes: study practices or strategies adopted, rituals associated with learning and studying, pharmacy knowledge, motivation for learning, and ways of learning. Each of these identified themes was summarized and illustrations from the data given. The affective dimensions of learning were a strong emergent theme throughout the data. Conclusion. The use of artifacts in the research process afforded in-depth insight into the specific study practices adopted by a group of pharmacy students. Qualitative methods can be useful in surfacing students' learning practices and difficulties faced in their negotiation of the pharmacy curriculum., (© 2020 American Association of Colleges of Pharmacy.)

Purpose: Pharmacy departments and schools of pharmacy have long held professional affiliations. However, the success of each entity is often not interdependent and aligned. In 2010, our institutions found ourselves in a position where the complementary motivations of each aligned to support a more meaningful and committed engagement, leading to the development of the Partnership in Patient Care. The impact of the partnership was evaluated 7 years postimplementation, and both the successes realized and the lessons learned are described., Summary: The partnership provided many advantages to our pharmacy department and the school of pharmacy. This initial iteration of the partnership was a strong proof of concept that an intentional approach to the relationship between a school of pharmacy and a pharmacy department can lead to substantive improvements in a wide array of meaningful outcomes. We experienced an increase in the number of student rotation months completed, growth in the American Society of Health-System Pharmacists-accredited residency programs, and enhanced clinical services. However, the partnership was not without challenges. For instance, lack of a formalized tracking method made certain outcomes difficult to track., Conclusion: The purposeful establishment of the Partnership in Patient Care, built on the needs of a school of pharmacy and an academic medical center pharmacy department, allowed our institutions to develop an intertwined mission and vision. Over the initial years of the partnership, many successes were realized and lessons were learned. Both the successes and the challenges are serving as the foundation for future iterations of the partnership., (© American Society of Health-System Pharmacists 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective. To create an IPE course that improved knowledge related to HIV history, prevention, and therapy, in health professions students and improved their interest and confidence in becoming interprofessional collaborative clinicians, specifically involved in the care of people living with HIV. Methods. A motivational design framework was used to create an interprofessional course that incorporated whole-task complex scenarios, team-based application, and experiential components. Multiple sources of quantitative and qualitative data, including the AIDS Education and Training Center evaluation tool and Interprofessional Collaborative Competency Attainment Scale instrument, as well as assignments and course evaluations, were collected and analyzed. Results. Fifteen students from medicine, nursing, and pharmacy participated in 2017, and 21 students from medicine, nursing, pharmacy, and social work participated in 2018. In both offerings, students rated the course experience positively and self-reported increases in confidence related to interprofessional competencies. Ninety-three percent and 68% of the students in 2017 and 2018, respectively, stated they planned to be involved in HIV care to some degree in the future. Students demonstrated high levels of knowledge of the AIDS Training & Education Center National HIV Curriculum at the end of the 2018 course offering. Conclusion. This educational course design provided an effective interprofessional learning experience and establishes a sustainable interprofessional format for teaching health professions students about HIV., (© 2019 American Association of Colleges of Pharmacy.)

Objective. To determine the role of entrepreneurism within the broader missions of schools of pharmacy and develop an educational framework to produce pharmacist entrepreneurs. Methods. Following a systematic review and six semi-structured interviews, a three-round Delphi process was conducted with an expert panel comprised of successful entrepreneurs, pharmacy faculty members and administrators, students, and community members. Participants were asked about the role of entrepreneurship in a pharmacy school's mission, how they would define a pharmacist entrepreneur, and to identify the knowledge, skills, and attitudes (KSAs) expected to be successful as a pharmacist entrepreneur. A model for entrepreneur education was also developed in accordance with Bloom's taxonomy. Participant agreement and rankings were reported. Results. Based on the semi-structured interviews and the results from the Delphi process, the following framework for a pharmacist entrepreneur was proposed along with a list of KSAs: identifies, creates, and pursues new opportunities; successfully implements new ideas into practice; is willing to take risks; fills unmet needs; creates new value through innovation; is responsive to change; makes sacrifices; includes social and intrapreneurship; leverages existing knowledge, skills, and resources; goes beyond traditional roles for pharmacists; and improves patient care. Recommendations for entrepreneurship instruction, guided by Bloom's taxonomy of cognitive processes, were created. Conclusion. According to our expert panel, a pharmacist entrepreneur combines several characteristics identified with a more traditional entrepreneur construct with the characteristics of an individual devoted to achieving outcomes beyond one's personal gain. Additional research to inform implementation and assessment of entrepreneurship within pharmacy curricula would provide more specific guidance for instructional design and accreditation evaluations., (© 2019 American Association of Colleges of Pharmacy.)

Objective. To explore and evaluate pharmacy students' perceptions of the value and relevance of virtual community and virtual hospital on-campus placement programs. Methods. Students enrolled in a Master of Pharmacy program completed the required Virtual Community Placement (VCP) program and/or the Virtual Hospital Placement (VHP) program. A six-item questionnaire was administered to students after completion of each of the virtual programs to elicit students' perceptions of the value and relevance of the virtual programs. Additional data related to the relevance of specific workshops were collected, including students' self-reported confidence levels to undertake placement in a real-world setting following completion of the virtual programs. Results. Surveys were completed by 61 students in the VCP program and 50 students in the VHP program. Students perceived the virtual programs to be beneficial, with the majority (84% of the VCP students and 98% of the VHP students) reporting that the programs should be an essential component of any pharmacy degree. The majority of students (72%) self-reported an increase in their confidence levels in undertaking a real-world experiential placement after they completed their virtual hospital placement. Conclusion. Completing virtual placement programs prior to pharmacy students beginning their first "real world" pharmacy placements had a positive effect on student learning and confidence levels. Pharmacy students' feedback from this study regarding the relevance of specific learning modules and laboratory sessions will inform future curriculum development of the virtual placement programs., (© 2019 American Association of Colleges of Pharmacy.)

Leadership is a critical aspect of residency training; however, little guidance is provided in the literature regarding practical implementation of leadership training within residency programming. Programming was developed within a second-year (PGY-2) critical care residency program to meet the educational and leadership needs of the residents. The format of the meetings has evolved over time from a journal club-style format to an interdisciplinary format discussing far more than literature. With the residents taking the lead in the biweekly educational sessions, there is great opportunity for leadership development. Similar programming has the potential to strengthen residency experiences for residents in other programs., (© 2019 American Association of Colleges of Pharmacy.)

Objectives: To conduct a systematic review of cost-utility studies of community-based services provided by pharmacists and to examine their reporting and methodological quality., Methods: A comprehensive literature search was performed in February 2019 using a replicable search strategy in bibliographic databases MEDLINE, EMBASE, and the NHS Economic Evaluations Database from their inception onwards. Two reviewers independently screened the literature, abstracted data from full-text articles, and assessed reporting and methodological quality using the Consolidated Health Economic Evaluation Reporting Standards and Quality of Health Economic Studies checklists., Results: Twenty studies were included in this review, representing the healthcare systems of the United Kingdom, Spain, France, The Netherlands, Belgium, Italy, Canada, the United States of America, and Brazil. Descriptions of the context in which the studies were done, justification of data sources on patient and process outcomes, choices of model, and generalizability of study findings were often inadequately reported. Seven studies (35%) were deemed of high methodological quality, 11 studies (55%) of fair quality, and 2 studies (10%) of poor quality. In addition, various methodological issues related to the randomized controlled trials and observational studies used to generate effectiveness estimates were identified., Conclusions: In view of the lack of standardized definitions of expanded services, heterogeneity in study objectives, settings, comparators, methodology, outcomes, and the variable quality of these studies, the value of these services (in terms of costs) compared with quality-adjusted survival remains inconclusive., (Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Background: As collaborative team-based healthcare expands, there is a need for effective interprofessional education (IPE). Although the desired outcomes of IPE are defined by the Interprofessional Education Collaborative (IPEC), resources often limit IPE implementation. The purpose of this study is to assess the effectiveness of a novel interprofessional activity in improving health professions students' interprofessional competencies using team-based learning (TBL)., Interprofessional Education Activity: Teams of second year pharmacy and medical students participated in a novel IPE session targeting roles and responsibilities. This activity was designed and implemented by a small number of faculty and used TBL to educate a large number of students using limited resources. Class averages for individual and team readiness assurance test (iRAT/tRAT) scores were collected, and students were invited to complete the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) to evaluate the effectiveness of the activity., Discussion: On average, tRAT scores were 20% higher than iRAT scores. While there was significant improvement for all items on the ICCAS, questions within the roles and responsibilities domain of the ICCAS were most affected., Implications: This novel IPE activity was successful in teaching a large group of professional students in the targeted domain of roles and responsibilities in a single session. This activity was a rich experience in which students learned together using limited resources which can be easily replicated at other institutions to help professional students gain proficiency in interprofessional competencies., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Our objective is to suggest a revised model of health care delivery that emphasizes human connections in patient care and describes the role of pharmacists within the model. Improving the quality of patient experiences is one of the triple aims of health care delivery. Using the patient-centered medical home (PCMH) model as the basis, we describe an enhanced delivery model that adopts Maslow's hierarchy of needs and addresses the current deficiencies of the PCMH model. The model envisions the creation of "community centers for engagement" that employ patient care advocates and health care practitioners who work together in an interdisciplinary manner to improve the quality of patient care experiences. Pharmacists' roles in these centers of engagement are outlined based on Maslow's hierarchy of needs. The model aims to enhance patient-provider interactions and allow pharmacists to play a pivotal role in meeting patients' needs with the goal of developing a self-actualized patient., (© 2019 American Association of Colleges of Pharmacy.)

Introduction: Nurse and pharmacist independent prescribers manage patients with respiratory tract infections and are responsible for around 8% of all primary care antibiotic prescriptions. A range of factors influence the prescribing behaviour of these professionals, however, there are no interventions available specifically to support appropriate antibiotic prescribing behaviour by these groups. The aims of this paper are to describe (1) the development of an intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers and (2) an acceptability and feasibility study designed to test its implementation with these prescribers. METHOD AND ANALYSIS: Development of intervention: a three-stage, eight-step method was used to identify relevant determinants of behaviour change and intervention components based on the Behaviour Change Wheel. The intervention is an online resource comprising underpinning knowledge and an interactive animation with a variety of open and closed questions to assess understanding. Acceptability and feasibility of intervention: nurse and pharmacist prescribers (n=12-15) will use the intervention. Evaluation includes semi-structured interviews to capture information about how the user reacts to the design, delivery and content of the intervention and influences on understanding and engagement, and a pre-post survey to assess participants' perceptions of the impact of the intervention on knowledge, confidence and usefulness in terms of application to practice. Taking an initial inductive approach, data from interview transcripts will be coded and then analysed to derive themes. These themes will then be deductively mapped to the Capability, Opportunity, Motivation-Behaviour model. Descriptive statistics will be used to analyse the survey data, and trends identified., Ethics and Dissemination: Ethical approval for the study has been provided by the School of Healthcare Sciences Research Governance and Ethics Committee, Cardiff University. The findings will be disseminated via publication in peer-reviewed journals and through conference presentations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Cardiovascular disease (CVD) remains a major cause of morbidity and premature mortality globally. Despite the availability of low-cost evidence based medicines, there is a significant treatment gap in those with established or at high risk of CVD in the primary care setting. Pharmacist-based interventions have shown to improve patient outcomes for many chronic diseases including CVD. However, there is little synthesised evidence that has examined the effects of collaborative care between general practitioners (GPs) and pharmacists on patients' cardiovascular risk outcomes. This protocol aims to outline the methods employed in a systematic review of current literature to assess whether interprofessional collaboration between GPs and pharmacists has an impact on improving cardiovascular risk outcomes among patients in the primary care setting., Methods and Analysis: Randomised controlled trials (RCTs) will be identified through database searches, scanning reference lists of relevant studies, hand searching of key journals and citation searching of key papers. Two independent reviewers will screen studies against eligibility criteria and extract data using standardised forms. Databases including MEDLINE, EMBASE, Cochrane, CINAHL and International Pharmaceutical Abstracts, will be searched from the beginning of each database until October 2018. Primary outcome includes improvement in cardiovascular risk factors, such as hypertension, due to GP and pharmacist cooperation. Secondary outcome is to describe the different types of GP and pharmacist collaborative models of care. A narrative synthesis of findings will be presented. A meta-analysis will be performed if the data are homogenous., Ethics and Dissemination: This study does not require ethics approval. The results of the systematic review described within this protocol will be disseminated through presentations at relevant conferences and publication in a peer-reviewed journal. The methods will be used to inform future reviews., Prospero Registration Number: CRD42017055259., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: There is a paucity of studies validating budget impact models. The lack of such studies may contribute to the underuse of budget impact models by payers in formulary decision making., Objective: To assess the face validity, internal verification, and predictive validity of a previously published model that assessed the budgetary impact of antidiabetic formulary changes., Methods: 4 experts with diverse backgrounds were selected and asked questions regarding the face validity of the structure/conceptual model, input data, and results from the budget impact model. To assess internal verification, structured "walk-throughs," unit tests, extreme condition tests, traces, replication tests, and double programming techniques were used. The predictive validity of the model was evaluated by comparing the predicted and realized budget using mean absolute scaled error. "Realized" budgetary impact of the formulary changes was calculated by taking the difference between realized budget in the year after the formulary changes and the budget had there been no formulary changes (i.e., the counterfactual). The counterfactual budget was modeled using the best fit autoregressive integrated moving average model., Results: When assessing the face validity of the model, the 4 experts brought up issues such as how to incorporate other health insurance, recent policy changes, cost inflation, and potential impacts on insulin use. The 6 internal verification techniques caught mistakes in equations, missing data, and misclassified data. The realized budget was found to be lower than the predicted budget, with 13% error and an absolute scaled error of 2.60. After removing the model assumption that past utilization trends would continue, the model's predictive accuracy improved (the absolute scaled error dropped below 1 to 0.48). The "realized" budgetary impact was found to be greater than the predicted budgetary impact, largely because of lower-than-expected utilization., Conclusions: The budget impact model overpredicted utilization in the year after the formulary changes. Discoveries through the validation process improved the accuracy and transparency of the model., Disclosures: This project was supported by grant number F32HS024857 from the Agency for Healthcare Research and Quality (AHRQ). The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ. AHRQ had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or design to submit the manuscript for publication. The findings discussed in this manuscript represent the views of the authors and do not necessarily reflect the views of the Department of Defense, the Defense Health Agency, nor the Departments of the Army, Navy, and Air Force. Hung reports a grant from the AHRQ, during the conduct of the study, and personal fees from CVS Health and BlueCross BlueShield Association, outside the submitted work. Mullins reports grants and personal fees from Bayer and Pfizer and personal fees from Boehringer Ingelheim, Janssen/J&J, Regeneron, and Sanofi-Aventis, outside the submitted work. Mullins, Slejko, and Shaya are employed by the University of Maryland School of Pharmacy. Haines and Lugo have nothing to disclose. Part of this content was previously presented as a poster at the 2017 AMCP Managed Care & Specialty Pharmacy Annual Meeting; March 27-30, 2017; Denver, CO, and as poster and oral presentations at the 2017 AMCP Nexus Meeting; October 16-19, 2017; Dallas, TX. Part of this content was published as Hung's PhD dissertation.

Background: The Biologics Price Competition and Innovation Act (BPCIA) of 2009, which included pathways for FDA approval of biosimilar products, was designed to promote more affordable, expanded patient access to biologic therapies. Achieving these BPCIA goals depends on overcoming formidable barriers to biosimilar adoption. Managed care and specialty pharmacy professionals are uniquely qualified to inform initiatives to address these barriers., Objective: To assess perceptions regarding strategies for overcoming barriers to biosimilar adoption among managed care and specialty pharmacy professionals by conducting a survey study., Methods: Invitations to complete the online survey were emailed by the Academy of Managed Care Pharmacy (AMCP) to members and customers and to contacts sourced from a commercial database. In addition to questions on respondent demographics and perceptions of biosimilars, the survey listed 16 strategies for overcoming key barriers to biosimilar adoption. On a 5-point scale, participants rated their opinion on the likelihood that each strategy would have the potential to assist in achieving BPCIA goals. The survey also listed 6 barriers to biosimilar adoption. On a 5-point scale, participants rated their perceived difficulty in overcoming each barrier. The survey concluded with an open-text item that asked participants to list 3 additional strategies for overcoming biosimilar adoption barriers. Response frequencies were calculated to describe participants' ratings of the strategies and barriers. Statistical analyses were conducted to assess whether the ratings differed among respondents grouped by work organization. For the open-text item, we conducted qualitative content analyses to categorize strategies by stakeholder groups that might take primary implementation roles., Results: A total of 300 managed care and specialty pharmacy professionals completed the survey. There was considerable variation in the preferences, policies, and practices regarding biosimilar adoption among respondents' work organizations. Responses to several survey items reflected positive attitudes about the safety and efficacy of biosimilars; for example, 84% agreed or strongly agreed that FDA-approved biosimilars are safe and effective for patients who switch from a reference biologic. Based on pooled percentages for ratings of likely and extremely likely to overcome barriers to biosimilar adoption, the highest-rated strategies were for prescriber education about evidence from switching studies (91%) and FDA guidance on pharmacy-level substitution of reference biologics with biosimilars (90%). The lowest-rated strategies were for requiring therapeutic drug monitoring for patients who switch to biosimilars (39%) and using quotas to incentivize providers to prescribe biosimilars (40%). For the qualitative analysis, the highest numbers of respondents' suggested strategies indicated primary implementation roles of biosimilar manufacturers (40%), the federal government (26%), and managed care organizations (15%)., Conclusions: Reflecting the unique knowledge, perspectives, and practices of managed care and specialty pharmacy professionals, the study findings are relevant to informing and advancing initiatives for achieving BPCIA goals., Disclosures: The survey study reported in this article was part of a continuing education program funded by an independent educational grant, which was awarded by Sandoz, a Novartis Division, to PRIME Education. The Academy of Managed Care Pharmacy (AMCP) received grant funding from PRIME to assist in developing the survey and writing the manuscript. The grantor had no role in the study design, execution, analysis, or reporting. Greene and Pardo are employed by PRIME. Singh and Carden are employed by AMCP. Greene, Singh, Carden, and Pardo have no other disclosures. Lichtenstein received an honorarium from PRIME for serving as faculty for the continuing education program and has been a consultant for Pfizer, Cellceutix, and Merck.

According to general principles of good practice, adopted at the international level, quality control is a key function in management and not just a simple means of verification. In a clinic or hospital pharmacy, the chief pharmacist has the training and authority to take the control measures necessary to develop and implement an Internal Managerial Control System (IMCS). The present article analyzes and describes the case of the County Hospital of Oradea, Romania, and presents how the IMCS was adopted and integrated. Quality assessment in the health services takes place via an accreditation process and quality certification, as well as through an internal audit of the hospital pharmacy. The authors report a retrospective and descriptive study carried out from 2012 to 2017, analyzing how current legislative standards are applied. The IMCS in the hospital pharmacy is a dynamic process of continuous transformation, permanently adapted to hospital requirements, achieved under the direction of the chief pharmacist and involving all pharmacy employees, as well as through good coordination practices applied by hospital management. In this specific case, the IMCS features 11 annually updated compliance standards, classed under the headings of work procedures, risk register, job descriptions and staff training. The pharmacy's good practice model for IMCS development, was adopted by all of the hospital's sectors, services and departments., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: Redispensing by pharmacies of medication unused by another patient could contribute to optimal use of healthcare resources. This study aimed to assess patient willingness to use medication returned by another patient and patient characteristics associated with this willingness., Design: Cross-sectional survey., Setting: A total of 41 community and 5 outpatient pharmacies in the Netherlands., Participants: Total of 2215 pharmacy visitors., Primary and Secondary Outcome Measures: Patients completed a questionnaire regarding their willingness to use medication returned unused to the pharmacy by another patient, assuming quality was guaranteed. Secondary outcome measures included patient sociodemographic characteristics that were associated with patient willingness, analysed using logistic regression analysis and reported as ORs with 95% CIs., Results: Of the 2215 patients (mean (SD) age 50.6(18.0) years; 61.4% female), 61.2% were willing to use medication returned unused to the pharmacy by another patient. Patients who were unwilling mostly found it risky. Men were more willing to use returned medication (OR 1.3 95% CI 1.1 to 1.6), as did patients with a high educational level (OR 1.8 95% CI 1.3 to 2.5), those who regularly use 1-3 medications (OR 1.3 95% CI 1.1 to 1.7), those who returned medication to the pharmacy for disposal (OR 1.5 95% CI 1.0 to 2.3) and those who ever had unused medication themselves (OR 1.3 95% CI 1.1 to 1.6)). Patients with non-Dutch cultural background were less willing to use returned medication (OR 0.395% CI 0.3 to 0.4))., Conclusions: When quality is guaranteed, a substantial proportion of patients are willing to use medication returned unused to the pharmacy by another patient. This suggests that implementation of redispensing may be supported by patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The assessment of content validity is a critical and complex step in the development process of instruments which are frequently used to measure complex constructs in social and administrative pharmacy research. The aims of this study were to investigate the elements of content validity; to describe a practical approach for assessing content validity; and to discuss existing content validity indices. This is a narrative review of the assessment and quantification of content validity. It describes the key stages of conducting the content validation study and discusses the quantification and evaluation of the content validity estimates. Content validity provides evidence about the degree to which elements of an assessment instrument are relevant to and representative of the targeted construct for a particular assessment purpose. The assessment of content validity relies on using a panel of experts to evaluate instrument elements and rate them based on their relevance and representativeness to the content domain. It is a three-stage process that includes; the development stage, judgment and quantifying stage, and revising and reconstruction stage. To quantify the expert judgments, several indices have been discussed in this paper such as the content validity ratio (CVR), content validity index (CVI), modified-Kappa, and some agreement indices. A practical guide describes the process of content validity evaluation is provided. In summary, content validation processes and content validity indices are essential factors in the instrument development process, should be treated and reported as important as other types of construct validation. Determining item CVI and reporting an overall CVI are important components necessary to instruments especially when the instrument is used to measure health outcomes or to guide a clinical decision making. Content validity deserves a rigorous assessment process as the obtained information from this process are invaluable for the quality of the newly developed instrument., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: A survey of guidelines and current practices was conducted to examine the safe handling procedures for antineoplastic and other hazardous drugs that are used in 24 countries including the Americas, Europe, the Mideast, Far East, and Australia., Methods: Subject experts were asked to complete a brief survey regarding safe handling guidelines and practices for hazardous drugs in their countries. Questions addressed practices for handling monoclonal antibodies, the use of closed-system transfer devices, medical surveillance practices, and measurements of compliance with existing guidelines., Results: Responses from 37 subject experts representing 24 countries revealed considerable variation in the content and scope of safe handling guidelines and pharmacy practices among the participating countries. Guidelines in the majority of countries used the term "cytotoxics," while others referred to "hazardous" or "antineoplastic" drugs. The International Society of Oncology Pharmacy Practice standard was cited by six countries, and five cited the National Institute for Occupational Safety and Health Alert. Others cited international guidelines other than International Society of Oncology Pharmacy Practice, or they have created their own guidelines. Approximately half reported that their guidelines were mandatory under federal, state, or provincial legislation. Only 11 countries reported that monoclonal antibodies were covered in their guidelines. Closed-system drug-transfer devices are widely used, but were not specifically recommended in four countries, while one country required their use. Medical surveillance programs are in place in 20 countries, but only in The Netherlands is surveillance mandatory. Nine countries reported that they have completed recent updates or revisions of guidelines, and the measures for their adoption have been initiated., Conclusions: Although the overall goals in the participating countries were similar, the approaches taken to assure safe handling of hazardous drugs varied considerably in some cases.

Background and Objective: Due to the synergistic effects of drugs, drug combination is one of the effective approaches for treating complex diseases. However, the identification of drug combinations by dose-response methods is still costly. It is promising to develop supervised learning-based approaches to predict potential drug combinations on a large scale. Nevertheless, these approaches have the inadequate utilization of heterogeneous features, which causes the loss of information useful to classification. Moreover, they have an intrinsic bias, because they assume unknown drug pairs as non-combinations, of which some could be real drug combinations in practice., Methods: To address above issues, this work first designs a two-layer multiple classifier system (TLMCS) to effectively integrate heterogeneous features involving anatomical therapeutic chemical codes of drugs, drug-drug interactions, drug-target interactions, gene ontology of drug targets, and side effects. To avoid the bias caused by labelling unknown samples as negative, it then utilizes the one-class support vector machines, (which requires no negative instance and only labels approved drug combinations as positive instances), as the member classifiers in TLMCS. Last, both a 10-fold cross validation (10-CV) and a novel prediction are performed to validate the performance of TLMCS., Results: The comparison with three state-of-the-art approaches under 10-CV exhibits the superiority of TLMCS, which achieves the area under the receiver operating characteristic curve = 0.824 and the area under the precision-recall curve = 0.372. Moreover, the experiment under the novel prediction demonstrates its ability, where 9 out of the top-20 predicted combinative drug pairs are validated by checking the published literature. Furthermore, for each of the newly-validated drug combinations, this work analyses the combining mode of the member drugs and investigates their relationship in terms of drug targeting pathways., Conclusions: The proposed TLMCS provides an effective framework to integrate those heterogeneous features and is trained by only positive samples such that the bias of taking unknown drug pairs as negative samples can be avoided. Furthermore, its results in the novel prediction reveal five types of drug combinations and three types of drug relationships in terms of pathways., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Computational drug repositioning has been proven as a promising and efficient strategy for discovering new uses from existing drugs. To achieve this goal, a number of computational methods have been proposed, which are based on different data sources of drugs and diseases. These methods approach the problem using either machine learning- or network-based models with an assumption that similar drugs can be used for similar diseases to identify new indications of drugs. Therefore, similarities between drugs and between diseases are usually used as inputs. In addition, known drug-disease associations are also needed for the methods as prior information. It should be noted that those associations are still not well established due to the fact that many of marketed drugs have been withdrawn and this could affect the outcome of the methods. In this study, we propose a novel method named RLSDR (Regularized Least Square for Drug Repositioning) to find new uses of drugs. More specifically, it relies on a semi-supervised learning model, Regularized Least Square, thus it does not require definition of non-drug-disease associations as previously proposed machine learning-based methods. In addition, the similarity between drugs measured by chemical structures of drug compounds and the similarity between diseases which share phenotypes can be represented in a form of either similarity network or similarity matrix as inputs of the method. Moreover, instead of using a gold-standard set of known drug-disease associations, we construct an artificial set of the associations based on known disease-gene and drug-target associations. Experiment results demonstrate that RLSDR achieves better prediction performance on the artificial set of drug-disease associations than that on the gold-standard ones in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC). In addition, it outperforms two representative network-based methods irrespective of the prior information of drug-disease associations. Novel indications for a number of drugs are also identified and validated by evidences from a different data resource.

Objective: Numerous barriers prevent patients with type 2 diabetes (T2D) from completing a diabetes self-management program. We investigated whether patients with T2D exhibited improved clinical outcomes after attending a relatively short, interactive diabetes self-management program conducted by pharmacist diabetes educators, compared to a physician's usual care., Results: We retrospectively analyzed the data of adults with T2D who attended a diabetes self-management program (≥ 1 group meeting or individual appointment followed by a telephone interview from a pharmacist diabetes educator between May 2010 and Dec. 2012; n = 513) and compared their outcomes with those of T2D patients who received only their physician's usual care (n = 857). Each patient's A1C was assessed at baseline, 3 months, and 6 months post-intervention. The mean [SD] reduction in A1C percentage points in the T2D patients was significantly greater in the diabetes self-management program group compared to the physician's usual care group at both 3 months (- 0.8% [1.5] vs. - 0.2% [0.9], p < 0.001) and 6 months post-intervention (- 0.6% [1.3] vs. - 0.2% [1.1], p < 0.001). T2D patients significantly improved their glycemic control within 3-6 months of attending the diabetes self-management program compared to patients who only received their physician's usual care.

Objectives: Pharmacy-compounded sterile preparations (P-CSPs) are frequently relied upon in U.S. health care but are increasingly being linked to outbreaks of infections. We provide an updated overview of outbreak burden and characteristics, identify drivers of P-CSP demand, and discuss public health and patient safety lessons learned to help inform prevention., Methods: Outbreaks of infections linked to contaminated P-CSPs that occurred between January 1, 2001, and December 31, 2013, were identified from internal Centers for Disease Control and Prevention reports, Food and Drug Administration drug safety communications, and published literature., Results: We identified 19 outbreaks linked to P-CSPs, resulting in at least 1000 cases, including deaths. Outbreaks were reported across two-thirds of states, with almost one-half (8/19) involving cases in more than 1 state. Almost one-half of outbreaks were linked to injectable steroids (5/19) and intraocular bevacizumab (3/19). Non-patient-specific compounding originating from nonsterile ingredients and repackaging of already sterile products were the most common practices associated with P-CSP contamination. Breaches in aseptic processing and deficiencies in sterilization procedures or in sterility/endotoxin testing were consistent findings. Hospital outsourcing, preference for variations of commercially available products, commercial drug shortages, and lower prices were drivers of P-CSP demand., Conclusions: Recognized outbreaks linked to P-CSPs have been most commonly associated with non-patient-specific repackaging and nonsterile to sterile compounding and linked to lack of adherence to sterile compounding standards. Recently enhanced regulatory oversight of compounding may improve adherence to such standards. Additional measures to limit and control these outbreaks include vigilance when outsourcing P-CSPs, scrutiny of drivers for P-CSP demand, as well as early recognition and notification of possible outbreaks.

EXECUTIVE SUMMARY The 2017-2018 Research and Graduate Affairs Committee (RGAC) was given three charges aimed at helping academic pharmacy address barriers that must be overcome by both students and schools to attract, retain, and support the development of a diverse, well-rounded, and successful graduate student population. These charges were (1) identifying teaching methodologies, tools and opportunities that graduate programs can introduce into curriculum to overcome barriers to success of today's and tomorrow's learners; (2) developing a strategy for achieving member support of the 2016-2017 recommended graduate competencies by identifying gaps in and existing examples of courses or opportunities that achieve competency-based pharmacy graduate education; and (3) identifying potential strategies to address identified barriers to pursuing graduate education, especially among under-represented student populations. This report describes attitudes toward and opportunities related to competency-based education in graduation education in colleges and schools of pharmacy, identifies types of tools schools could use to enhance training towards the competency framework developed by the 2016-2017 RGAC, particularly with regards to the so-called power skills, and outlines a role for AACP in facilitating this training. This report also considers a number of barriers, both perceived and real, that potential students encounter when considering graduate training and suggests strategies to understand the impact of and mitigate these barriers. To strengthen competency-based graduate education, the RGAC puts forth two recommendations that AACP develop a toolkit supporting the training of power skills and that AACP should develop or curate programs or tools to support the use of individual development plans (IDPs). The RGAC also puts forth a suggestion to schools that IDPs be implemented for all students. In considering the barriers to pursuing graduate education, the Committee proposes one policy statement that AACP supports the training and development of an increasingly diverse population of researchers at pharmacy schools through active efforts to promote M.S. and Ph.D. education along with Pharm.D. education. Additionally, the Committee provides recommendations that AACP should expand its efforts in career tracking of graduate students to include collection and/or analysis of data that could inform the Academy's understanding of barriers to pursuing graduate education in pharmacy schools, the AACP Office of Institutional Research and Effectiveness should expand upon graduate program data described in the annual Profile of Pharmacy Students report, and finally that AACP should include graduate programs in efforts to increase diversity of students at pharmacy schools.