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Background Although two thirds of tobacco users express interest in quitting, few pharmacists address tobacco use as part of routine practice. Historically, pharmacy schools provided inadequate tobacco cessation training for students. To address this educational gap, train-the-trainer workshops were conducted between 2003 and 2005 to train pharmacy faculty (n = 191) to teach a shared, national tobacco cessation curriculum at their academic institutions. Objective To characterize faculty perceptions of the train-the-trainer workshops and estimate the long-term reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of the shared curriculum at pharmacy schools. Methods This study is the second phase of a sequential mixed methods study. Results from Phase 1, a qualitative study, informed the development of survey items for Phase 2. Applying the RE-AIM framework, a web-based survey was developed and administered to train-the-trainer participants. Results Of 191 trainees, 137 were locatable; of these, 111 completed a survey (81.0%). Most (n = 87; 78.4%) reported current employment in academia. The most highly rated reason for attending a workshop was to improve teaching of tobacco cessation content, and 98.1% reported moderate or high confidence for teaching tobacco cessation. Among those who practice in a clinical setting, 70.6% reported asking their patients about tobacco use all or almost all the time. Just over three fourths of faculty respondents who work in academia believe that shared curricula should be more broadly considered for use in pharmacy schools, and 79.0% agreed that shared curricula are a cost-effective approach to teaching. Conclusion Evidence is provided for long-term reach, effectiveness, adoption, implementation, and maintenance of the Rx for Change shared tobacco cessation training program. Participants perceived that the workshop resulted in long-term, positive effects on their careers as well as their teaching and clinical practice.

Background Medicaid coverage for smoking cessation medications has expanded; however, little research has been conducted to evaluate patient-level changes in medication use over time and its associated economic impact on health plans. Objective The aim of this study was to characterize trends in smoking cessation medication utilization between 2006 and 2017 within a Medicaid population and estimate per-member per-month (PMPM) costs to the health plan. Methods This study was a retrospective longitudinal analysis conducted among adult members of a Medicaid managed care plan in California. Pharmacy claims data from January 1, 2006 to December 31, 2017 were analyzed to estimate utilization and cost of smoking cessation medications. Additionally, data from 3164 members who filled prescription(s) for cessation medication(s) in 2017 were evaluated to quantify quit attempts and use of combination therapy. For members who had been prescribed bupropion SR, varenicline, or the nicotine patch, the extent to which the durations of therapy were consistent with the manufacturers’ recommended minimum duration of therapy were also assessed. Results The average PMPM expenditures for smoking cessation medications were approximately US$0.15 in 2017, compared with US$0.01–US$0.03 between 2006 and 2013. In 2017, a total of 3164 members initiated an estimated 3850 quit attempts, most commonly using the nicotine patch (57.5%) or varenicline (32.8%). Combination therapy accounted for 2.9% of quit attempts. The median therapy duration for the nicotine patch, varenicline, and bupropion SR was 28, 30, and 33 days, respectively, and for each of these medications, fewer than half of members filled prescriptions for the minimum recommended duration of therapy. Conclusions Pharmacy claims data suggest that despite comprehensive coverage, most beneficiaries are underutilizing smoking cessation agents and are not completing the recommended treatment durations.

Background Because tobacco use is a major cause of morbidity and mortality worldwide, it is essential to prepare health care providers to assist patients with quitting smoking. Created in 1999, the “Rx for Change” tobacco cessation curriculum was designed to fill an educational gap in cessation training of health professional students. In 2004, a website was launched to host teaching materials and tools to support the efforts of educators and clinicians. Objective The objective of this study was to characterize users and utilization of a website hosting shared teaching materials over a period of 15 years. Methods Data from the Rx for Change website have been collected prospectively since its inception. In this study, end-user data were analyzed to determine user characteristics, how they heard about the website, intended use of the materials, and numbers of logins and file downloads over time. Results Total number of website registrants was 15,576, representing all 50 states in the United States and 94 countries. The most represented discipline was pharmacy (6393/15,505, 41.2%), and nearly half of users were students or residents. The most common source of referral to the website was a faculty member or colleague (33.4%, 2591/7758), and the purpose of enhancing personal knowledge and skills was the most commonly cited intended use of the curricular materials. A total of 259,835 file downloads occurred during the 15-year period, and the most commonly downloaded file type was ancillary handouts. Conclusions The Rx for Change website demonstrated sustained use, providing immediate access to tobacco cessation teaching and practice tools for educators and clinicians over the first 15 years of its existence. The website has a broad interprofessional reach, and the consistent utilization over time and large number of downloads provide evidence for the feasibility and utility of a public-access website hosting teaching materials. The shared curriculum approach averts the need for educators to create their own materials for teaching tobacco cessation to students in the health professions.

BACKGROUND: Although tobacco use is the leading cause of numerous preventable diseases, including respiratory illnesses, respiratory therapy students historically have received inadequate education for treating tobacco use and dependence. To address this gap, a respiratory-specific tobacco cessation training program was created and disseminated via a train-the-trainer approach for faculty in respiratory therapy and respiratory care programs across the United States. The purpose of this study was to estimate the impact of the live, web-based, train-the-trainer programs on participating faculty, and to assess changes in the extent of adoption of tobacco cessation content in respiratory therapy curricula across institutions in the United States. METHODS: Five live, 2.5-h web-based train-the-trainer programs for respiratory therapy faculty were conducted. To characterize impact of this national initiative, surveys were administered at baseline, immediately after training, and then at the end of the subsequent academic year. RESULTS: A total of 270 respiratory therapy faculty members participated in a live webinar training, representing 248 of the 402 (61.7%) respiratory therapy schools in the United States. At the end of the subsequent academic year, faculty reported significant improvement in their overall ability to teach tobacco cessation (P < .001). Nearly all (97.4%) agreed that the webinar train-the-trainer format was conducive to learning, and high self-ratings were reported for skills to teach the tobacco cessation content. During the 2016–2017 academic year, 1,248 respiratory therapy students received training. Faculty anticipated teaching a median of 3 h of tobacco cessation in the subsequent academic year. CONCLUSIONS: Training respiratory therapy faculty using a train-the-trainer approach had a positive impact on faculty’s perceived confidence and ability to teach tobacco cessation at their institutions.

BACKGROUND Because tobacco use is a major cause of morbidity and mortality worldwide, it is essential to prepare health care providers to assist patients with quitting smoking. Created in 1999, the “Rx for Change” tobacco cessation curriculum was designed to fill an educational gap in cessation training of health professional students. In 2004, a website was launched to host teaching materials and tools to support the efforts of educators and clinicians. OBJECTIVE The objective of this study was to characterize users and utilization of a website hosting shared teaching materials over a period of 15 years. METHODS Data from the Rx for Change website have been collected prospectively since its inception. In this study, end-user data were analyzed to determine user characteristics, how they heard about the website, intended use of the materials, and numbers of logins and file downloads over time. RESULTS Total number of website registrants was 15,576, representing all 50 states in the United States and 94 countries. The most represented discipline was pharmacy (6393/15,505, 41.2%), and nearly half of users were students or residents. The most common source of referral to the website was a faculty member or colleague (33.4%, 2591/7758), and the purpose of enhancing personal knowledge and skills was the most commonly cited intended use of the curricular materials. A total of 259,835 file downloads occurred during the 15-year period, and the most commonly downloaded file type was ancillary handouts. CONCLUSIONS The Rx for Change website demonstrated sustained use, providing immediate access to tobacco cessation teaching and practice tools for educators and clinicians over the first 15 years of its existence. The website has a broad interprofessional reach, and the consistent utilization over time and large number of downloads provide evidence for the feasibility and utility of a public-access website hosting teaching materials. The shared curriculum approach averts the need for educators to create their own materials for teaching tobacco cessation to students in the health professions.

Background Between 2003 and 2005, pharmacy faculty members (n = 191) participated in a national train-the-trainer workshop designed to equip faculty with the necessary knowledge and skills to implement a shared curriculum, Rx for Change: Clinician-Assisted Tobacco Cessation, at pharmacy schools across the United States. Objective To conduct a long-term, qualitative follow-up study of faculty participants to describe (a) perceptions of the train-the-trainer workshop, and (b) subsequent experiences with curricular implementation. Results of this investigation will inform a national survey of all train-the-trainer participants. Methods Participants were selected via random sampling from the group of 191 faculty members who participated in the workshop. Semi-structured telephone interviews with participants were audio-recorded and transcribed, and qualitative thematic analysis was conducted. Results Eighteen (62%) of 29 invited individuals participated in the interviews. All participants reported implementing components of Rx for Change at their institution. The analysis yielded eight major themes pertaining to faculty perceptions and experiences with implementation: (1) accessibility to tools for teaching, (2) increased confidence and skills, (3) flexibility delivering the curriculum, (4) factors facilitating implementation and challenges encountered by faculty, (5) enhancement in treating tobacco users in clinical practice, (6) students' confidence and cognizance of the pharmacists' role as a public health advocate, (7) networking and career development opportunities, and (8) useful background for research. Conclusion Participation in the train-the-trainer workshop increased self-reported confidence for teaching tobacco cessation, and faculty valued access to useful, updated tools for teaching. Furthermore, their newly acquired counseling skills were deemed helpful for treating patients' tobacco use and dependence in clinical practice. Participants also perceived improved pharmacy students' confidence and beneficial networking opportunities. Results can help future trainers understand faculty experiences with implementing a shared, national curriculum and inform faculty participants of some of the potential long-term outcomes as a result of participation.

OBJECTIVE: To evaluate the long-term impact of two promising intervention approaches to engage pharmacy personnel (pharmacists, technicians) in referring patients who want to quit smoking to the tobacco quitline. DESIGN: Randomized trial. SETTING: Community pharmacies in Connecticut (n=32) and Washington (n=32). INTERVENTION: Two intervention approaches were evaluated: academic detailing (AD), which involved on-site training for pharmacy staff about the quitline, versus mailed quitline materials (MM). OUTCOME MEASURES: Changes in the overall percentage of quitline registrants who reported hearing about the quitline from any pharmacy during the 6-month baseline monitoring period versus the 12-month intervention period, and between-group comparisons of (a) the number of quitline registrants who reported hearing about the quitline from one of the study pharmacies during the 12-month intervention period, and (b) the number of quitline cards and brochures distributed to patients during the first 6 months of the intervention period. RESULTS: The percentage of quitline callers who reported having heard about the quitline from a pharmacy increased significantly, from 2.2% during the baseline monitoring period to 3.8% during the 12-month intervention (p < 0.0001). Additionally, comparisons controlled for seasonal effects also revealed significant increases in referrals. Across all 64 pharmacies, 10,013 quitline cards and 4,755 brochures were distributed. The number of quitline cards distributed and the number registrants who reported hearing about the quitline from a pharmacy did not differ by intervention approach (AD versus MM), however AD pharmacies distributed more quitline brochures (p=0.022). CONCLUSION: Brief cessation interventions are feasible in community pharmacies, and the two approaches evaluated for engaging pharmacy personnel are similarly effective and collectively lead to meaningful increases in the number and proportion of all patients who call the quitline. Engaging community pharmacy personnel in tobacco cessation presents a significant opportunity to promote quitline services by connecting patients with an effective, publicly available resource.

Objective To estimate the proportion of countries/territories that allow sales of tobacco products and electronic nicotine delivery systems (ENDS) in community pharmacies. Methods International Pharmaceutical Federation (FIP) member organisations were contacted by email and asked to respond to a two-item survey assessing whether their country/territory allowed sales of (a) tobacco products and (b) ENDS in community pharmacies. Results Of 95 countries/territories contacted, responses were received from 60 (63.2%). Seven countries (11.7%) reported that tobacco products were sold in community pharmacies, and 11 countries (18.3%) reported that ENDS were sold in community pharmacies. Conclusions Among the FIP member organisations, there are few countries that allow the sale of tobacco products and ENDS in community pharmacies, with ENDS being more likely than tobacco products to be sold.

Objective. To characterize educational attainment and experiences of current US pharmacy school deans and chairs. Methods. A cross-sectional study using a publicly available listing of accredited schools and information. Results. Among 134 deans and 301 chairs, 79.9% and 65.5% held a professional degree (BSPharm and/or PharmD), 33.6% and 26.2% completed PGY-1 residencies, 12.7% and 15.6% completed post-PharmD fellowships, 23.1% and 33.9% completed post-doctoral fellowships, and 13.4% and 18.3% held BPS certification, respectively. Fewer than 1 in 5 were employed at an alma mater. Ninety (20.7%) deans and chairs completed AACP's Academic Leadership Fellows Program. Average current tenure was 5.7 and 5.1 years for deans and chairs, respectively. Conclusion. The majority of deans and chairs held a pharmacy professional degree and the prevalence of post-graduate educational and leadership training is increasing. Future research should apply mixed methods to investigate educational attainment and employment experience of deans and chairs, institutional hiring trends, and how these characteristics compare between newer and established programs.

Background Despite the fact that individuals who smoke are at an increased risk for disease and therefore require frequent visits to pharmacies for medications, most community pharmacies do not integrate tobacco cessation activities into routine practice. Objective The objective of this report is to describe the methods and baseline findings for a 2-state randomized trial evaluating 2 intervention approaches for increasing pharmacy-based referrals to their state's tobacco quitline. Methods Participating community pharmacies in Connecticut (n = 32) and Washington (n = 32) were randomized to receive either (1) on-site education with an academic detailer, describing methods for implementing brief interventions with patients and providing referrals to the tobacco quitline or (2) quitline materials delivered by mail. Both interventions advocated for pharmacy personnel to ask about tobacco use, advise patients who smoke to quit, and refer patients to the tobacco quitline for additional assistance with quitting. Study outcome measures include the number of quitline registrants who are referred by pharmacies (before and during the intervention period), the number of quitline materials distributed to patients, and self-reported behavior of cessation counseling and quitline referrals, assessed using written surveys completed by pharmacy personnel (pharmacists, technicians). Results Pharmacists (n = 124) and pharmacy technicians (n = 127), representing 64 participating pharmacies with equal numbers of retail chain and independently owned pharmacies, participated in the study. Most pharmacists (67%) and half of pharmacy technicians (50%) indicated that they were not at all familiar with the tobacco quitline. During the baseline (preintervention) monitoring period, the quitline registered 120 patients (18 in Connecticut and 102 in Washington) who reported that they heard about the quitline from a pharmacy. Conclusion Novel tobacco intervention approaches are needed to capitalize on the community pharmacy's frequent interface with tobacco users, and these approaches need to be evaluated to estimate their effectiveness. Widespread implementation of brief, yet feasible, pharmacy-based tobacco cessation efforts that generate referrals to a tobacco quitline could have a substantial impact on the prevalence of tobacco use.

Objective. To characterize the educational background and academic rank of faculty members in US schools of pharmacy, estimate the extent to which they are employed by institutions where they received previous training, and determine whether differences in degree origin and rank exist between faculty members in established (≤1995) vs newer programs. Methods. A cross-sectional study was conducted using the American Association of Colleges of Pharmacy (AACP) faculty database and demographic information from the public domain. Results. Among 5516 faculty members, 50.3% held two or more types of degrees. Established schools had a higher median number of faculty members and a higher mean faculty rank than did newer schools. Conclusion. The difference in mean faculty rank highlights the shortage of experienced faculty members in newer schools. Future research efforts should investigate educational attainment in correlation to other faculty and school characteristics and prospectively track and report trends related to pharmacy faculty members composition.

The community pharmacy has been proposed as an ideal location for providing smoking cessation therapy to large numbers of patients. Studies of public health initiatives providing free nicotine replacement products through telephone quitlines have found increased call volumes and cessation rates. The purpose of this study was to evaluate a program where nicotine replacement therapy starter packs were provided to patients through community pharmacies at no cost. An online survey was developed to assess community pharmacists' participation in the program, perceptions of the initiative as a whole, and perceptions of smoking cessation counseling activities. Eighty-three pharmacists working at participating pharmacies completed the survey (65% response rate). Ninety-nine percent of pharmacists provided smoking cessation counseling during the study period; the median (IQR) number of patients counseled over the initial 3.5-months of the NRT distribution program was 50 (24-100), and the median number of minutes per counseling session was five (3-7). Most (89%) agreed smoking cessation counseling was accommodated into the pharmacy work-flow. A majority (85%) agreed the community pharmacy is an ideal location for distributing free NRT products and that the program should be replicated in other pharmacies (78%). Participating pharmacists viewed the program positively and perceived it to be effective in helping patients quit smoking. In conclusion, the community pharmacy is a viable location for implementation of community-based public health initiatives related to smoking cessation.

Background. Few health degree programs incorporate sufficient tobacco cessation education in core curricula. Methods. A national survey of 132 PA programs assessed the extent to which tobacco is addressed, educational methods, perceived importance and adequacy of tobacco education, and perceived barriers to enhancing tobacco-related content. Results. Surveys (n=99; 75%) revealed a median of 150 minutes of tobacco education throughout the degree program. Key barriers to enhancing training are lack of curriculum time and lack of access to comprehensive, evidence-based resources. Two-thirds expressed interest in participating in a nationwide effort to enhance tobacco cessation training. Conclusions. Similar to other disciplines, enhanced tobacco education is needed in PA programs to adequately prepare graduates to address the primary known cause of preventable death in the United States.

Background In 2002, a report indicated that tobacco-related curricular content in educational programs for acute care nurse practitioners was insufficient. To provide healthcare professionals with the necessary knowledge and skills to intervene with patients who smoke tobacco, the Summer Institute for Tobacco Control Practices in Nursing Education was implemented at Georgetown University in Washington, DC.Objective To evaluate the impact of a train-the-trainer program in which the Rx for Change: Clinician-Assisted Tobacco Cessation curriculum was used among faculty members of acute care nurse practitioner programs.Methods Thirty faculty members participated in the 2-day train-the-trainer program. Surveys were administered at baseline and 12 months after training to examine perceived effectiveness for teaching tobacco content, the value of using an evidence-based national guideline, and the number of hours of tobacco content integrated in curricula.Results The percentage of faculty members who devoted at least 3 hours to tobacco education increased from 22.2% to 74.1% (PConclusions Use of the Rx for Change train-the-trainer program can enhance the level of tobacco education provided in acute care nurse practitioner programs. Widespread adoption of an evidence-based tobacco education in nursing curricula is recommended to help decrease tobacco-related morbidity and mortality.

© 2015, American Association of Colleges of Pharmacy. All right reserved. Objective. To improve the quality of admissions interviews for a doctor of pharmacy program, using a multiple mini-interview (MMI) in place of the standard interview. Methods. Stakeholders completed an anonymous web-based survey. This study characterized perceptions of the MMI format across 3 major stakeholders (candidates, interviewers, admissions committee members) and included comparative cost estimates. Costs were estimated using human and facility resources from the 2012 cycle (standard format) and the 2013 cycle (MMI format). Results. Most candidates (65%), interviewers (86%), and admissions committee members (79%) perceived the MMI format as effective for evaluating applicants, and most (59% of candidates, 84% of interviewers, 77% of committee members) agreed that the MMI format should be continued. Cost per candidate interviewed was $136.34 (standard interview) vs $75.30 (MMI). Conclusion. Perceptions of the MMI process were favorable across stakeholder groups, and this format was less costly per candidate interviewed.

This study is the first to characterize tobacco-related content in pharmacy school curricula in the United States. A national survey mailed to 83 U.S. schools of pharmacy assessed the extent to which tobacco is addressed in required coursework, educational methods of instruction, perceived importance of addressing tobacco in the doctor of pharmacy degree program, perceived adequacy of current levels of tobacco education in curricula, and perceived barriers to enhancing the tobacco-related content. A total of 82 surveys (98.8% response) revealed a median of 170 min of tobacco education throughout the doctor of pharmacy program. The most heavily emphasized topics are aids for cessation, assisting patients with quitting, nicotine pharmacology and principles of addiction, and drug interactions with smoking, yet more than 40% of respondents believed that each of these topics was covered inadequately. Key barriers to enhancing tobacco training are lack of curriculum time and lack of clinical clerkship sites focusing on tobacco interventions. Pharmacy faculty members perceive tobacco cessation training to be important, yet a mismatch exists between the perceived importance and the perceived adequacy of current levels of training in pharmacy school curricula. The results of this study will serve as a baseline measure against which future, parallel assessments will be compared as faculty at schools of pharmacy across the United States work together toward enhancing the tobacco cessation training of student pharmacists.

Objective: To estimate the impact of Rx for Change, an 8-h tobacco cessation training program on pharmacy students' perceived counseling skills, confidence for counseling, and future counseling of patients for tobacco cessation. Methods: Unlinked, pre- and post-training surveys were administered to 142 pharmacy students enrolled at Texas Southern University, a primarily minority and historically black educational institution. Results: Post-training counseling abilities were significantly improved over pretraining values for each of the five key components of tobacco cessation counseling (Ask, Advise, Assess, Assist, and Arrange), overall counseling abilities, and confidence for counseling (P < 0.001). Racial/ethnic differences in self-reported overall counseling was observed (P = 0.01). Ninety-one percent of participants believed that the training would increase the number of patients whom they counsel for cessation, and 95% believed that it would improve the quality of counseling that they provide. At least 95% of participants believed that the pharmacy profession should be more active in preventing patients from starting smoking and helping patients to stop smoking. Conclusion: The Rx for Change program had a positive impact on perceived abilities and confidence for providing tobacco cessation counseling to patients. While it is important that all current and future health care providers receive specialized tobacco cessation training, it is particularly important for clinicians of racial/ethnic minority backgrounds, who are more likely to practice in geographic areas with a high density of population subgroups at an elevated risk for tobacco-related mortality. In particular, pharmacists, who are uniquely positioned within the community to provide care to all patients, including the medically underserved, must be equipped with the necessary skills to assist patients with quitting.

Objectives: To characterize nonprescription nicotine replacement therapy (NRT) users with respect to sociodemographic characteristics, tobacco use history, and support for tobacco cessation received from health care professionals; assess the methods used for quitting (past and present) by NRT users; assess NRT users' perceptions of the need for and usefulness of pharmacist-facilitated cessation interventions; and determine the types of pharmacy-based interventions that would be most helpful before and during quit attempts. Design: One-time attitudinal assessment. Setting: Primarily Northern California. Participants: One hundred three individuals who had recently purchased nonprescription NRT products for use during their current or upcoming quit attempt. Intervention: In-depth telephone interviews. Main Outcome Measure: Perceptions of pharmacy-based tobacco cessation counseling services. Results: The concept of pharmacist-facilitated assistance was appealing to many NRT users. Sixty-three percent of participants believed that receiving advice or assistance from a pharmacist would either probably (46%) or definitely (17%) increase a smoker's likelihood of being able to quit. Twenty-one percent were unsure, and 16% thought pharmacist assistance would not increase the chance of success. Forty-six percent reported that they would be either very or extremely likely to meet with a pharmacist for one-on-one counseling if a nominal ($10) co-payment were required; this percentage increased to 68% if the service were provided free of charge. The preferred structure for counseling interventions varied widely among participants, suggesting that individually tailored counseling programs are necessary. Conclusion: A substantial proportion of nonprescription NRT users view pharmacist-assisted cessation as an appealing approach to smoking cessation.

Background. A comprehensive tobacco cessation training program, Rx for Change, was developed and implemented as required coursework at all California schools of pharmacy and at the University of California San Francisco Schools of Medicine and Dentistry. Results. Post-training evaluations administered to pharmacy students (n = 544; 89% participation) show a positive impact of the training on students' self-reported abilities for providing tobacco cessation counseling to patients. Conclusion. Designed as a vehicle for nationwide dissemination of the U.S. Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence, Rx for Change equips students with skills to intervene with all tobacco users, including patients who are not yet considering quitting. J Cancer Educ. 2003; 18:142-149.

Background In October, 2008, legislation was implemented in the city and county of San Francisco, California, prohibiting the sale of tobacco products in pharmacies. Objective To characterise public awareness and perceptions of the ban on tobacco sales in San Francisco community pharmacies. Methods A brief, anonymous survey was used to assess public awareness and perceptions of a ban on tobacco sales approximately 1 year after implementation. Individuals were approached by researchers outside of chain pharmacies in San Francisco. Smokers and nonsmokers were included, and participants did not have to be patrons of the pharmacy. Results Of 198 participants, 56% were in favor of the ban, 27% opposed it and 17% were undecided. A greater proportion of current tobacco users (81%) than former/ never users (48%) were aware of the ban (p

Introduction: Exposure to tobacco smoke impacts the onset or exacerbation of most respiratory disorders, and respiratory therapists are well positioned to identify tobacco use and provide cessation assistance. The purpose of this study was to characterize the level of tobacco cessation education provided to students in U.S. respiratory care training programs. Methods: A national survey of 387 respiratory care programs assessed the extent to which tobacco is addressed in required coursework, methods of instruction, perceived importance, and adequacy of current levels of tobacco education in curricula and perceived barriers to enhancing the tobacco-related education. Results: A total of 244 surveys (63.0% response) revealed a median of 165 min (IQR, 88-283) of tobacco education throughout the degree program. Pathophysiology of tobacco-related disease (median, 45 min) is the most extensively covered content area followed by aids for cessation (median, 20 min), assisting patients with quitting (median, 15 min), and nicotine pharmacology and principles of addiction (median, 15 min). More than 40% of respondents believed that latter 3 content areas are inadequately covered in the curriculum. Key barriers to enhancing tobacco training are lack of available curriculum time, lack of faculty expertise, and lack of access to comprehensive evidence-based resources. Nearly three-fourths of the respondents expressed interest in participating in a nationwide effort to enhance tobacco cessation training. Conclusions: Similar to other disciplines, enhanced tobacco cessation education is needed in respiratory care programs to equip graduates with the knowledge and the skills necessary to treat tobacco use and dependence.

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

Objective To characterize the extent to which state and national professional pharmacy associations have implemented formal policies addressing the sale of tobacco and alcohol products in community pharmacies. Methods To determine existence of tobacco and alcohol policies, national professional pharmacy associations (n = 10) and state-level pharmacy associations (n = 86) affiliated with the American Pharmacists Association (APhA) and/or the American Society of Health-System Pharmacists (ASHP) were contacted via telephone and/or e-mail, and a search of the association websites was conducted. Results Of 95 responding associations (99%), 14% have a formal policy opposing the sale of tobacco products in pharmacies and 5% have a formal policy opposing the sale of alcohol in pharmacies. Of the associations representing major tobacco-producing states, 40% have a formal policy against tobacco sales in pharmacies, significantly more than the 8% of non-tobacco state associations with such policies. Conclusion Among national professional pharmacy associations, only APhA and ASHP have formal policy statements opposing the sale of both tobacco and alcohol in pharmacies. Most state-level professional pharmacy associations affiliated with these two national organizations have no formal policy statement or position.

Background Community pharmacies have the potential to reduce the prevalence of tobacco use, yet most pharmacies do not integrate cessation activities into routine practice. Objectives The objective of this study was to describe the recruitment strategy and participant yield for a 2-state, randomized trial evaluating 2 intervention approaches for increasing pharmacy-based referrals to tobacco quitlines. Methods Detailed study recruitment tracking forms were used to document all contact attempts between the study investigators and each potential study site. These data were analyzed to characterize the overall recruitment and consent process for community pharmacies and pharmacy personnel (pharmacists, technicians). Results Achieving the target sample size of 64 study sites required contacting a total of 150 pharmacies (84 independent and 66 chain). Excluding 22 ineligible pharmacies, participation rates were 49% (32 of 65) for independent pharmacies and 51% (32 of 63) for chain pharmacies (50% overall). Across the 64 participating pharmacies, a total of 124 pharmacists (of 171; 73%) and 127 pharmacy technicians (of 215; 59%) were enrolled in the study. Pharmacies that chose not to participate most often cited time constraints as the primary reason. Overall, combining both the recruitment and consent process, a median of 5 contacts were made with each participating pharmacy (range, 2-19; interquartile range [IQR], 4-7), and the median overall duration of time elapsed from initial contact to consent was 25 days (range, 3-122 days; IQR, 12-47 days). Conclusions Results from this study suggest that community pharmacy personnel are receptive to participation in multisite, tobacco cessation clinical research trials. However, execution of a representative sampling and recruitment scheme for a multistate study in this practice setting is a time- and labor-intensive process.

The availability of tobacco and alcohol products in community pharmacies contradicts the pharmacists’ Code of Ethics and presents challenges for a profession that is overwhelmingly not in favor of the sale of these products in its practice settings. The primary aim of this study was to estimate the proportion of pharmacies that sell tobacco products and/or alcoholic beverages and to characterize promotion of these products. The proportion of pharmacies that sell non-prescription nicotine replacement therapy (NRT) products as aids to smoking cessation also was estimated. Among 250 randomly-selected community pharmacies in Los Angeles, 32.8% sold cigarettes, and 26.0% sold alcohol products. Cigarettes were more likely to be available in traditional chain pharmacies and grocery stores than in independently-owned pharmacies (100% versus 10.8%; P < 0.001), and traditional chain drug stores and grocery stores were more likely to sell alcoholic beverages than were independently-owned pharmacies (87.5% vs. 5.4%; P < 0.001). Thirty-four (41.5%) of the 82 pharmacies that sold cigarettes and 47 (72.3%) of the 65 pharmacies that sold alcohol also displayed promotional materials for these products. NRT products were merchandised by 58% of pharmacies. Results of this study suggest that when given a choice, pharmacists choose not to sell tobacco or alcohol products.

It is well established that smoking is the primary preventable cause of disease and death in the United States and that it is responsible for a wide range of negative health consequences, including but not limited to respiratory disease. According to the US Public Health Service, all patients attempting to quit smoking should be encouraged to use one or more effective pharmacotherapy agents for cessation except in the presence of special circumstances or in populations for which there is insufficient evidence of effectiveness (pregnant women, smokeless tobacco users, light smokers and adolescents). These medications are most effective when coupled with behavioral counseling interventions. This review article provides an overview of comprehensive (the 5 A’s framework: Ask, Advise, Assess, Assist, Arrange) and brief (Ask, Advise, Refer) interventions for assisting patients with quitting, and a more detailed review of the seven first-line pharmacological agents for smoking cessation (nicotine replacement therapy formulations, bupropion SR and varenicline) and combination therapy regimens. This information will facilitate respiratory therapists in addressing the most important risk factor for pulmonary disease in the patient population that they serve.

To assess the train-the-trainer component of an initiative (Partners in D) to train pharmacy students to facilitate patient enrollment in the best Medicare Part D prescription drug plan (Part D).Faculty members from 6 California colleges or schools of pharmacy were taught how to train pharmacy students about Medicare Part D and how to conduct outreach events targeting underserved patient populations. A preintervention and postintervention survey instrument was administered to determine participants' (1) knowledge of the Part D program; (2) skill using the Medicare Prescription Drug Plan Finder tool; and (3) confidence in their ability to train pharmacy students. Implementation of the Partners in D curriculum in faculty members' colleges or schools of pharmacy was also determined.Participants' knowledge of Part D, mastery of the Plan Finder, and confidence in teaching the material to pharmacy students all significantly improved. Within 8 weeks following the program, 5 of 6 colleges or schools of pharmacy adopted Partners in D coursework and initiated teaching the Partners-in-D curriculum. Four months afterwards, 21 outreach events reaching 186 Medicare beneficiaries had been completed.The train-the-trainer component of the Partners in D program is practical and effective, and merits serious consideration as a national model for educating patients about Medicare Part D.

Patients infected with the human immunodeficiency virus (HIV) receive numerous medications from multiple providers. As a result, it is important that medication usage is properly documented in each patient's medical record. Lack of adequate documentation may confound a provider's assessment of drug efficacy, potentially leading to an increased incidence of drug interactions and adverse effects. The objective of this study was to determine if discrepancies exist between patient-reported medication usage and that documented in the medical record by healthcare providers. Data were obtained using structured telephone surveys and medical chart review. Study participants were recruited from the University of California, San Francisco Medical Center AIDS Clinic. Results obtained for 41 patients demonstrated discrepancies between patient-reported medication usage and that documented in the medical record ranging from 9 to 92 percent, depending on the class of drug. The largest differences were observed with the “as-needed” class of drugs: benzodiazepines (92 percent), morphine (60 percent), and codeine (56 percent). Differences were also noted for scheduled medications: ketoconazole (54 percent), clotrimazole (45 percent), acyclovir (38 percent), zidovudine (15 percent), and pentamidine (9 percent).These observed discrepancies reaffirm the need for accurate exchange of information between provider and patient to promote the most effective, rational, and safe drug therapy. Careful reviews of medication usage at each visit and use of pharmacy-based medication profiles are potential mechanisms to improve documentation of medication usage in HIV-infected patients.

To assess pharmacy faculty members' perceptions of the Rx for Change tobacco cessation program materials and train-the-trainer program.Pharmacy faculty members attended a 14.5 hour train-the-trainer program conducted over 3 days. Posttraining survey instruments assessed participants' (n = 188) characteristics and factors hypothesized to be associated with program adoption.Prior to the training, 49.5% of the faculty members had received no formal training for treating tobacco use and dependence, and 46.3% had never taught students how to treat tobacco use and dependence. Participants' self-rated abilities to teach tobacco cessation increased posttraining (p0.001). The curriculum materials were viewed as either moderately (43.9%) or highly (54.0%) compatible for integration into existing curricula, and 68.3% reported they were "highly likely" to implement the program in the upcoming year.Participation in a national train-the-trainer program significantly increased faculty members' perceived ability to teach tobacco-related content to pharmacy students, and the majority of participants indicated a high likelihood of adopting the Rx for Change program at their school. The train-the-trainer model appears to be a viable and promising strategy for promoting adoption of curricular innovations on a national scale.

Background: Previous studies have found that teaspoons are commonly used to administer liquid medications to children. The capacity of household teaspoons ranges from 1.5 mL to 9 mL, potentially leading to errors in dosing. There are few studies evaluating alternative measuring devices. Objective: To assess adult consumers’ previous experience with measuring devices for oral liquids, compare the accuracy of an oral syringe with that of a dosing cup, and determine consumer perceptions of accuracy and ease of use of an oral syringe and a dosing cup. Methods: Individuals at least 18 years of age were shown a picture of 5 commonly used measurement devices and asked their perceptions of and experience with the devices. They were then asked to measure a 5 mL (1 teaspoon) dose of Tylenol (acetaminophen) suspension, using the EZY Dose oral syringe and the dosing cup provided by the manufacturer. An acceptable dose was defined as 5.0 ± 0.5 mL. Following the measurement, participants completed a 5 item survey that assessed their perceptions of the accuracy and ease of use of the syringe and dosing cup. Results: A total of 96 subjects completed the study. Participants more commonly reported use of droppers (68%), dosing cups (67%), and teaspoons (62%) versus cylindrical spoons (49%) or oral syringes (49%) for measuring oral liquids. Sixty-four (66.7%) subjects measured an acceptable dose using the syringe versus 14 subjects (14.6%) using the cup (p < 0.001). The mean volumes ± SD measured with the syringe and cup were 4.5 ± 0.7 mL and 6.3 ± 0.7 mL, respectively (p < 0.001). After using both devices, the majority of subjects believed that the syringe (80%) and cup (71%) would measure an accurate dose. Most (87%) participants perceived that the cup was easy to use; 63% believed that the syringe was easy to use. Conclusions: Droppers and dosing cups were the most commonly used devices in the home for measuring liquid medications. Subjects were more likely to measure an acceptable dose with an oral syringe when compared with a dosing cup. However, a large proportion of study participants were unable to measure an accurate dose with either device. Community pharmacists should educate caregivers on the selection and proper use of measuring devices to improve the accuracy of medication administration in the home.

In 2002, a report indicated that tobacco-related curricular content in educational programs for acute care nurse practitioners was insufficient. To provide healthcare professionals with the necessary knowledge and skills to intervene with patients who smoke tobacco, the Summer Institute for Tobacco Control Practices in Nursing Education was implemented at Georgetown University in Washington, DC.To evaluate the impact of a train-the-trainer program in which the Rx for Change: Clinician-Assisted Tobacco Cessation curriculum was used among faculty members of acute care nurse practitioner programs.Thirty faculty members participated in the 2-day train-the-trainer program. Surveys were administered at baseline and 12 months after training to examine perceived effectiveness for teaching tobacco content, the value of using an evidence-based national guideline, and the number of hours of tobacco content integrated in curricula.The percentage of faculty members who devoted at least 3 hours to tobacco education increased from 22.2% to 74.1% (P.001). Perceived effectiveness in teaching tobacco cessation also increased (P.001), as did mean scores for the perceived value of using an evidence-based national guideline (P.001).Use of the Rx for Change train-the-trainer program can enhance the level of tobacco education provided in acute care nurse practitioner programs. Widespread adoption of an evidence-based tobacco education in nursing curricula is recommended to help decrease tobacco-related morbidity and mortality.

According to the US Public Health Service, all patients attempting to quit smoking should be encouraged to use one or more effective pharmacotherapy agents for cessation except in the presence of special circumstances. This article provides an overview of the pharmacologic agents for acute and critical care nurses to consider when intervening with tobacco-dependent patients. Medications addressed in this article include (1) first-line agents (nicotine replacement therapy, sustained-release bupropion) that have proven efficacy and are approved by the Food and Drug Administration (FDA) for smoking cessation, (2) second-line agents (nortriptyline, clonidine) that have proven efficacy but no FDA indication for smoking cessation, (3) approaches that use of combination or high-dose therapy, (4) herbal therapies, and (5) emerging therapies that are currently under investigation.

Previous studies suggest that healthcare professionals are inadequately trained to treat tobacco use and dependence. Because even brief interventions from clinicians improve patient quit rates, widespread implementation of effective tobacco cessation training programs for health professional students is needed.Pharmacy students received 7-8 h of comprehensive tobacco cessation training. Participants completed pre- and post-program surveys assessing perceived overall abilities for cessation counseling, skills for key facets of cessation counseling (Ask, Advise, Assess, Assist, Arrange), and self-efficacy for counseling.A total of 493 students (82.3%) completed linkable pre- and post-training evaluations. Self-reported abilities, measured on a five-point scale, increased significantly from 1.89 +/- 0.89 to 3.53 +/- 0.72 (P0.001). Twenty-two percent of students rated their overall counseling abilities as good, very good, or excellent before the training versus 94% of students after the training. Eighty-seven percent of students indicated the training will increase the number of patients that they counsel; 97% believed it will increase the quality of their cessation counseling.Comprehensive training significantly improved pharmacy students' perceived confidence and ability to provide tobacco cessation counseling. The curriculum is applicable to other health professional training programs and currently is being used to train pharmacy, medical, nursing, and dental students.

Objective As a key interface between patients and the health-care community, pharmacists are uniquely positioned to promote tobacco cessation. The objectives of this study were to: (a) characterize pharmacists’ past training and current activities in provision of tobacco interventions, attitudes toward assisting patients with quitting, and interest in receiving specialized training for tobacco cessation counseling; and (b) identify predictors of pharmacists’ counseling for tobacco cessation. Methods A 10-page survey was mailed to all licensed pharmacists in four California counties. Results Returned surveys ( n = 1168; 54.2% response) indicated that fewer than 8% of pharmacists have received formal training for tobacco cessation counseling, and current levels of counseling are low. Key predictors of cessation counseling include practice setting, pharmacists’ race/ethnicity, perceived pros of counseling, and self-efficacy for counseling. Of 715 pharmacists who have direct patient contact, 93% indicated that receiving specialized tobacco cessation counseling training would increase their counseling quality, and 70% indicated that it would increase the number of patients counselled. Eighty-eight percent reported interest in receiving specialized training to obtain these skills. Conclusion Although few pharmacists have received formal training in tobacco cessation and counseling activities currently are low, there is substantial professional interest in further developing this role. Practice implications Provision of comprehensive training that focuses on promoting self-efficacy for counseling likely will increase pharmacists’ tobacco cessation counseling activities.

Despite decades of public health initiatives, tobacco use remains the leading known preventable cause of death in the United States. Clinicians have a proven, positive effect on patients' ability to quit, and pharmacists are strategically positioned to assist patients with quitting. The American Association of Colleges of Pharmacy recognizes health promotion and disease prevention as a key educational outcome; as such, tobacco cessation education should be a required component of pharmacy curricula to ensure that all pharmacy graduates possess the requisite evidence-based knowledge and skills to intervene with patients who use tobacco. Faculty members teaching tobacco cessation-related content must be knowledgeable and proficient in providing comprehensive cessation counseling, and all preceptors and practicing pharmacists providing direct patient care should screen for tobacco use and provide at least minimal counseling as a routine component of care. Pharmacy organizations should establish policies and resolutions addressing the profession's role in tobacco cessation and control, and the profession should work together to eliminate tobacco sales in all practice settings where pharmacy services are rendered.

Background Prophylactic antibiotics must be administered so as to achieve adequate tissue levels before the initial surgical incision. We characterized antimicrobial tissue concentrations following intravenous administration at various times prior to surgical incision. Patients and Methods Twelve patients scheduled for elective colorectal surgery were randomized to receive cefmetazole 2 g by intravenous push either immediately prior to incision or 15 to 60 minutes prior. Blood and woundmuscle samples were obtained at predetermined intervals and assayed by high-performance liquid chromatography. Results Tissue distribution of the study drug was extremely rapid. All patients had theoretically adequate tissue levels at the time of incision. Levels above MIC90 of the common pathogens were sustained throughout the surgical procedure regardless of the timing of administration. Conclusions Administration of cefmetazole immediately prior to surgical incision should be effective prophylaxis for surgical wound infections.

issuesassociatedwiththeprofessionalpracticeastheyrelate to pharmaceutical education, and to establishand improve working relationships with all other or-ganizations in the field of health affairs. The Commit-teeisalsoencouragedtoaddressrelatedagendaitemsrelevanttoitsBylaws chargeandtoidentifyissuesforconsideration by subsequent committees, task forces,commission, or other groups.

To characterize the dissemination of study findings and assess project preceptor attitudes towards a required senior research project in a doctor of pharmacy (PharmD) curriculum.A survey was conducted to determine preceptors' perceptions of the value of a required pharmacy student research project and dissemination of research results.One hundred fifteen project preceptors (92.0%) responded. Most preceptors agreed that the projects provided a valuable learning experience to the students (87.5%) and were of value to them professionally (82.1%) and to their institution (78.2%). Study findings were disseminated primarily through institutional forums (47.3%). A smaller percentage of projects were disseminated externally through presentations at professional meetings (23.7%, poster presentations; 4.0%, platform presentations), and peer-reviewed publications (5.3%).Despite a modest level of dissemination of project results through presentations at professional meetings and a low level of dissemination via published manuscripts, the majority of preceptors perceived a required student research project to be of value.

To determine the training needs and interests of volunteer pharmacy preceptors.Volunteer preceptors (n=576) were surveyed on various aspects of precepting and their needs related to additional training.Two hundred thirty-six preceptors (40.9%) responded. Preceptors were less confident about enforcing attendance policies, identifying and managing unmotivated or failing students, identifying dishonesty or plagiarism, and handling conflict. While only 29.5% of respondents agreed that having an APPE student decreased their overall workload, approximately half (48.1%) indicated that student pharmacists helped them complete their daily tasks and 67.8% agreed that APPE students extended patient care. Respondents who had received training were significantly more confident than preceptors who had not received training in their abilities to clarify expectations, evaluate a student's knowledge, and foster skills related to critical thinking and problem solving.Training programs for pharmacy preceptors are effective; however, important areas in which additional training is needed or desired were identified among both new and experienced preceptors.

OBJECTIVE: To evaluate reports of renal toxicity associated with intramuscular ketorolac tromethamine. Medical charts were reviewed for all cases of renal toxicity associated with ketorolac therapy. METHODS: Patients with possible ketorolac-associated nephrotoxicity were identified through our institution's adverse drug reaction reporting program. Patients were included in this report if: (1) renal insufficiency was temporally related to ketorolac administration; (2) resolution of renal insufficiency occurred after discontinuation of ketorolac; and (3) no other causes of renal insufficiency, including other medications, could be identified. RESULTS: Six patients had renal insufficiency secondary to ketorolac administration. The mean age of the patients was 58 years and cardiovascular disease was present in five. Serum creatinine values increased from a mean of 106 ± 26 μmol/L (1.2 ± 0.3 mg/dL) to a mean peak value of 256 ± 195 μmol/L (2.9 ± 2.2 mg/dL). Recovery of renal function was observed after a mean of 2.3 ± 0.5 days. CONCLUSIONS: Short-term administration of ketorolac can be associated with reversible oliguric renal insufficiency. Indiscriminate use of ketorolac for pain management in place of narcotic analgesics should be avoided, especially in patients at high risk for toxicity induced by nonsteroidal antiinflammatory drugs.

To determine pharmacy students' perceptions of a required research project in a doctor of pharmacy curriculum.A survey instrument was administered to senior pharmacy students to determine their perceptions of the project advisor and overall project experience and their postgraduation employment plans.Two-hundred twenty-nine (81.5%) students completed a survey instrument. The majority agreed or strongly agreed that the project provided a valuable learning experience (88.2%), provided a competitive advantage for postgraduate job opportunities (73.2%), and should be a continued graduation requirement (74.2%). Respondents with plans for a residency or fellowship were more likely than those entering a community or hospital/institutional pharmacy to agree that completion of the project made them more qualified or marketable and should be continued as a graduation requirement (p0.05).A required research project was perceived by pharmacy students to be a beneficial experience. Students pursuing residency or fellowship were more likely to feel the project was beneficial than students entering the workforce.

The objectives of this report were to estimate the extent to which pharmacy student perceptions are aligned with the 2003 resolution of the American Association of Colleges of Pharmacy (AACP) addressing the use of experiential sites that sell cigarettes and other tobacco products.Pharmacy students participating in a national tobacco cessation training program completed posttraining survey instruments and indicated their opinion about tobacco sales in pharmacies. Responses were examined with respect to students' sex and tobacco use status.Of 3,064 students, 3.5% were in favor of tobacco sales in pharmacies. Opinions varied by students' sex (p0.001) and tobacco use status (p0.001); in logistic regression analyses, males (OR = 2.62; 95% CI, 1.77, 3.89) and current tobacco users (OR = 2.31; 95% CI, 1.41, 3.76) were most likely to be in favor of tobacco sales.Few pharmacy students are in favor of tobacco sales in pharmacies. Given the overall lack of support, and acting in accordance with the 2003 AACP resolution, pharmacy schools are encouraged to use only experiential sites that do not sell tobacco products. Suggested strategies for moving toward this goal are presented.

A simple procedure for the preparation of 10–500 mg of the Escherichia coli elongation Tu-Ts complex is described. The protocol is based on the separate purification and quantitation of EF-Tu-GDP and EF-Ts, followed by mixing of equimolar amounts of each protein and removal of the displaced GDP by dialysis. Single crystals grown from the final product have been analyzed by X-ray diffraction techniques. The procedure is also applicable to the bulk preparation and crystallization of the trypsin-modified Tu-Ts complex. Quantitation of the elongation factors by three methods is presented.