RSS 1.0Pharmacy Student Research Projects
ABOUT THE COLLECTION
All PharmD students at the University of Arizona College of Pharmacy must complete a research project as part of their graduation requirements. This repository collection contains the abstracts of these projects, and the full-text of projects that students have opted to make available.
QUESTIONS?
Contact Jennifer Martin, Librarian & Clinical Instructor, Pharmacy Practice and Science, for more information about the student research projects in this collection.
Recent Submissions
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Omnicell Medication Optimization in the Emergency department at Northwest Medical CenterSpecific Aims: To identify medications needing adjustment or removal from the Omnicell, and to assess if the adjustment made a difference in restocks. Methods: This project collected baseline usage data during a 60-day timeframe in Emergency Department (ED) Omnicell machines. Changes were made to the Periodic Automated Replacement (PAR) and Reorder (R/O) amount in the ED East and West Omnicell machines based on max used day, restocks, and number of stockouts. After implementation, a 45-day timeframe was used to assess the effects. Chi Square was used to compare the number of restocking events before and after interventions at ED West and East Omnicell machines with p<0.05 for significant results. Results: Of the 414 medications in the ED West Omnicell, 29 (7%) medications were adjusted. Of the 489 medications in the ED East Omnicell, 28 (5.3%) medications were adjusted. The average number of restocks per period changed from 10.86 times to 7.17 times in the ED West, and changed from 9.86 times to 5.57 times in ED East. The changes gave a significant reduction in the average number of restocks in the ED West with p=0.011, and ED East with p=0.0002. The number of stockouts did not change. Conclusions: Adjustments to PAR and R/O amounts in the Emergency Department Omnicell machines led to a significant reduction in the average number of restocks for pharmacy technicians. Since stock outs were not reduced, nursing time and patient safety were also not improved.
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Analysis of Adverse Events Occurring in Ordered KIDs List Medications Administered to Pediatric Patients at Diamond Children’s Hospital at Banner University Medical CenterSpecific Aims: This study aims to examine prescribing practices and potential side effects linked to KIDs list medications at Diamond Children’s Hospital, Banner University Medical Center Tucson in 2022. Methods: The study utilized a descriptive, retrospective analysis. A chart review was conducted to identify patients who received KIDs list medications. The chart review focused on identifying adverse effects, evaluating alerts generated during prescribing and dispensing, and monitoring for adverse reactions occurring within 48 hours of medication administration. KIDs list medications prescribed to patients in the cautionary age range were considered inappropriately prescribed. Results: The study found that 9.86% of KIDs list medications administered to children at Banner Diamond Children’s Medical Center were inappropriately prescribed. In the group inappropriately prescribed these medications, 1.01% experienced an adverse reaction, none of which was severe. Out of 198 patients who were inappropriately administered KIDs list medications, only 29 of these patients were administered a medication where avoidance was recommended. Additionally, a total of 95 alerts were generated during the verification process. The majority of these alerts were related to duplicate therapy (27) and were linked to weight-based dosing alerts (34). Conclusion: This study provides a foundational understanding of prescribing practices related to KIDs List medications. However, there remains a need for ongoing evaluation and improvement in pediatric medication safety protocols. In the future, it would be beneficial to duplicate this study across multiple in-patient sites over an extended period of time. Addressing these challenges may lead to safety optimizations that will improve outcomes in pediatric populations.
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Naloxone: A Pain to Co-Prescribe? Evaluating naloxone co-prescribing practices for patients at an increased risk of opioid overdose at a federally qualified health centerSpecific Aims: Describe the population at high risk for opioid overdose that are receiving naloxone orders with concurrent prescriptions with a morphine milliequivalent (MME) ≥ 50, concurrent prescriptions for benzodiazepines or opioid use disorder, and/or a history of opioid overdose. Methods: This is a descriptive, observational, retrospective, cross-sectional study from October 2022 using data extracted from El Rio charts. To be eligible for this study, patients must have been treated at El Rio Clinic during October 2022, and meet certain Centers for Disease Control and Prevention (CDC) criteria for being at high risk for opioid overdose. A sample size of 773 was provided for data analysis. A total of 77 patients were excluded due to a lack of combined MME available, leaving a total of 696 patients analyzed. Results: Of the sample size analyzed (n=696), there were 367 naloxone orders prescribed. For MME >50, 238 patients were analyzed and 159 were prescribed concurrent naloxone (66.8%). For patients with medications used for opioid use disorder (OUD) and/or substance use disorder (SUD), 186 patients were analyzed and 130 were prescribed concurrent naloxone (69.9%). For patients with an OUD/SUD diagnosis, 239 patients were analyzed and 148 had concurrent naloxone (61.9%). For patients with concurrent benzodiazepines and opioids, 143 patients were analyzed and 65 had concurrent naloxone (45.4%). For patients with orders for benzodiazepines, muscle relaxants, and opioids, 75 patients were analyzed and 38 had concurrent naloxone (50.6%). Conclusions: There were 881 total opportunities to provide naloxone that met CDC recommendations. On average, 2 out of every 5 patients could have received naloxone that did not. Patients with OUD/SUD history or relevant medications were most commonly co-prescribed naloxone. The most overlooked group were those on opioids and benzodiazepines concurrently.
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Evaluating the efficacy of an addiction consult serviceSpecific Aims: To explore whether an addiction consult service improves 30-day emergency department readmission rates. Methods: Chart review was performed on 278 patients to collect demographic data on age, substance used, recommended treatment, and discharge. Data was de-identified and stored electronically to perform analysis. Descriptive analysis was done using Excel. Results: The two most common substances used were opioids and alcohol at rates of 59% and 21% respectively. 91 patients were recommended to start buprenorphine, 81 were recommended methadone, and 86 were given resources. 66% of patients were discharged without difficulty and 13% of patients left against medical advice. In patients who met with the addiction consult service, 30-day emergency department readmissions decreased by 59%. Conclusions: This project demonstrated that an addiction consult service can have a positive impact on 30-day emergency department readmissions and is an important intervention that should be implemented in more healthcare systems.
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The Use of Fomepizole with N-Acetylcysteine for Acetaminophen Overdose: A Scoping ReviewSpecific Aims: N-acetylcysteine (NAC) has been the treatment of choice for acetaminophen toxicity but fomepizole’s mechanism of action can play a potential role. This systematic review aims to evaluate the use of fomepizole in acetaminophen overdose. Methods: This systematic review examined the use of fomepizole in acetaminophen overdose and included 13 publications. Medline, EMBASE, PubMed ePubs, and The Cochrane Library were used to locate articles and we used the PRISMA guidelines. For the articles that qualified, data was gathered using a review tool completed by all five independent reviewers. The criteria required that the studies mentioned acetaminophen toxicity; the control groups received NAC and fomepizole or another antidote; the study trial duration was greater than a day; and outcomes related to survival were reported. Results: This systematic review had a total of 42 patients with cases of acetaminophen overdose. Of the 42 patients, 36 of them survived their overdose when given fomepizole and NAC as treatment. The 7 patients who did not survive were not overdosing on solely acetaminophen. Kusnik et al. included a case of a 58-year-old female who presented with an APAP level of 126.3 μg/ml and was given fomepizole and NAC treatment. She survived and her kidney function greatly improved after 80 hours from admission. Conclusion: There are still no human studies available to indicate fomepizole’s safety and efficacy as adjunct therapy in acetaminophen overdose and further research is necessary. Current data has shown it may be an effective adjunct therapy to acetaminophen overdose.
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Cost Efficiency of Trilaciclib, A First-in-Class Kinase Inhibitor Providing Multilineage Myeloprotection, and Expanded Budget-Neutral Access to Multilineage Myeloprotection for Extensive-Stage Small Cell Lung Cancer PatientsSpecific Aims: To determine the cost-efficiency of multilineage treatment with trilaciclib versus monolineage cytopenia prophylaxis/management in a panel of 10,000 ES-SCLC patients, and how accrued savings can be re-allocated budget-neutrally to provide additional ES-SCLC patients with trilaciclib treatment while undergoing myelotoxic cancer treatment. Methods: Economic simulation model from a 10,000-payer perspective in Microsoft Excel with the following inputs: cost of trilaciclib; cost of triple monolineage prophylaxis/management with granulocyte colony-stimulating agents (GCSFs) (neutropenia), erythropoiesis-stimulating agents (ESAs) (anemia), platelet transfusion and romiplostim (thrombocytopenia). Calculations were based on an ideal patient with non-end-stage renal disease and ES-SCLC, weighting 65 kilograms, measuring 180 centimeters. Pricing data was sourced from the United States Centers of Medicare and Medicaid Services (Average Sale Price). Results: There was one simulation (darbepoetin-alfa, pegfilgrastim biosimilars, and romiplostim) that was shown to have a cost efficiency of 12.5% in the treatment of combination anemia, neutropenia, and thrombocytopenia. For this simulation trilaciclib had a savings of $549,816 per cycle per 10,000 patients. When extrapolated to six full cycles of chemotherapy treatment, a savings of $3,298,896 which can be reallocated into 469 individual cycles of trilaciclib or 78 full six cycle treatments. Conclusions: Trilaciclib has the potential to provide savings benefits when treating myelosuppressive events. However, due to factors in the current market it is not very compelling to use at this time. Once trilaciclib gains expanded indications for use, a generic equivalent becomes available, or market competition changes the current prices of myelosuppressive treatments, further studies can be performed to reassess potential economic benefit of its use.
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Effects of Propranolol Administration on Sedative and Analgesia Requirements in Traumatic Brain Injury PatientsSpecific Aims: To evaluate the use of propranolol in reducing sedative and analgesic requirements among adult critical care patients with confirmed traumatic brain injury (TBI). Methods: This retrospective, multicenter observational study conducted at Banner Health Hospitals included patients with moderate-to-severe TBI (Glasgow Coma Scale [GCS] 3-12) who received at least 48-hours of propranolol within the first 3 days of an intensive care unit (ICU) admission with concurrent sedative and/or analgesic therapy. Medical records were reviewed for patients admitted between November 1, 2017, and February 28, 2023. The primary outcome was the effect of propranolol initiation on 24-hour propofol and dexmedetomidine dosing requirements. Secondary outcomes included the effect of propranolol on 48-hour propofol and dexmedetomidine requirements and, 24- and 48-hour ketamine, benzodiazepine, and opioid requirements. Results: Ninety-six patients were included in the study. While there was no notable difference in 24-hour propofol (p = 0.329) requirements, there was a significant increase in 24-hour dexmedetomidine (p = 0.047) requirements. There was a significant increase in the 48-hour dexmedetomidine (p = 0.002) and ketamine (p = 0.05) requirements. A significant decrease in the 48-hour propofol (p = 0.003), ketamine (p = 0.05), and opioids (p = 0.025) requirements and respective 24- and 48-hour benzodiazepine (p = 0.015, P = 0.027) requirements was demonstrated. There were no differences in 24-hour ketamine and opioid requirements. Conclusions: Propranolol administration within 3-days after moderate-to-severe TBI insult may facilitate the transition from a deeper sedative agent to a less sedating agent in the ICU setting.
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Immune-Related and Cutaneous Adverse Events Associated with Relatlimab Mono/Combo Regimens Versus Other Immune Checkpoint Inhibitors in Advanced, Non-Resectable Cutaneous Melanoma: Systematic Review and Meta-AnalysisSpecific Aims: The RELATIVITY-047 trial showcased relatlimab's effectiveness alongside nivolumab for advanced non-resectable cutaneous melanoma. This systematic review and meta-analysis in progress aims to evaluate relatlimab's safety as monotherapy or combined with nivolumab, compared to other immune checkpoint inhibitors, regarding cutaneous and immune-related adverse events, including grade 3/4 dermatological adverse events. Methods: In pairs, four independent reviewers will search databases for reports on advanced non-resectable cutaneous melanoma treatments with immune checkpoint inhibitors (ICIs). Exclusions encompass uveal, mucosal, and bronchial melanoma, patients with resected melanoma, autoimmune diseases, or aged<18. Data extraction includes study details, adverse events, and interventions. Disagreements will be resolved through discussion or escalated to a fifth reviewer. Meta-analyses will estimate relatlimab's adverse event frequency and risk compared to other ICIs, utilizing random-effect models and the Freeman-Tukey double arcsine transformation. Heterogeneity will be assessed using the I2 statistic, with subgroup analyses planned for high heterogeneity cases where I2>75%. The Cochrane Collaboration Risk of Bias Assessment Tool for randomized trials and the Newcastle-Ottawa Scale for nonrandomized studies will evaluate risk of bias. Results: 1339 studies have been included for full-text screening, of which, 7.6% are randomized controlled trials, 0.2% case series, 21.0% retrospective studies, and 5.7% prospective studies. The remaining 65.5% of studies are expected to be excluded. Conclusions: Preliminary findings of this systematic review highlight the diverse literature on safety profiles of established ICIs for melanoma treatment. This underscores the need for comparative safety data on relatlimab.
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Naloxone dispensing models in the United States: A scoping review of the literature evaluating the outcomes and prevalence of implemented naloxone distribution methodsSpecific Aims: To identify and evaluate naloxone distribution methods in the United States (U.S.). Methods: PubMed, EMBASE, Cochrane Library, and Scopus databases were searched between January 2013 and June 2023 to identify U.S. based studies that evaluated programs, initiatives, and laws relating to naloxone dispensing or distribution. The four databases were searched using polyglot search queries that included terms such as naloxone, opioid overdose, dispensing, distribution, naloxone use education, and harm reduction. Articles obtained from the search queries were each screened by two independent reviewers for mentions of programs and initiatives in the U.S. that included opioid education and naloxone distribution (OEND) programs, pharmacies dispensing naloxone under standing orders, and take-home naloxone rescue kits. Articles were included if they had outcomes or data on the prevalence of opioid-related deaths post-intervention. Data on where naloxone was distributed, method of naloxone access, naloxone administration route, and cost-effectiveness were extracted by two independent reviewers. Results: Five articles were identified with evaluations of programs, initiatives, and laws that broadened access to naloxone. One study evaluated naloxone access laws across the U.S. Four studies looked at the effectiveness of OEND programs with or without additional training for persons who use opioids (PWUO) or healthcare professionals. One study evaluated the cost-effectiveness of intranasal naloxone distribution. Conclusions: Naloxone is commonly distributed through community OEND programs. However, in areas where an OEND program was not available, naloxone was often provided through take-home kits, standing orders, and individually dispensed in pharmacies.
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Assessing Antibiotic Use in Hemodialysis Facilities across ArizonaSpecific Aims: Identify challenges that prevent Arizona HD facilities from obtaining necessary labs for the treatment of infectious diseases and the impact this has on their ability to provide optimal outpatient antibiotic therapy. Methods: This cross-sectional observational study will be done in collaboration with the Arizona Department of Health Services. Prospective data will be obtained via an on-line Qualtrics survey consisting of 15 questions determining barriers that prevent appropriate antibiotic therapy. Such as if the facility has an antibiotic stewardship program, as well as what barriers the facility faces when supplying antibiotic therapy. Participants will be recruited from Medicare-certified outpatient hemodialysis centers located within the state of Arizona. To be eligible, the facility must administer antibiotics. Results: Of the 130 outpatient hemodialysis facilities in Arizona, 46 consented to participate. 23 out of the 46 participants answered yes to having a designated leader for antimicrobial stewardship. 21 participants answered yes to tracking adverse drug events related to antibiotics. Participants reported the handoff of antibiotic treatment plans from other facilities as the most common barrier to outpatient treatment. It was selected 15 times. Access to antibiotics was the second most common, with 11 participants reporting that as a barrier to treatment. Conclusions: There is an opportunity for improved antimicrobial stewardship in outpatient hemodialysis facilities. Lack of communication between outside providers and hemodialysis facilities is a barrier to care. Improved processes around insurance reimbursement of antimicrobial agents and labs needed for follow-up monitoring would improve patient care.
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Assessing the impact of e-learning modalities used during the COVID-19 pandemic on student confidence to conduct patient interviewsSpecific Aims: To examine the impact of pandemic e-learning on pharmacy students’ confidence in interviewing patients in-person vs online. Methods: A survey was distributed via email and quick response (QR) code to three Doctor of Pharmacy (PharmD) cohorts at the University of Arizona R. Ken Coit College of Pharmacy: Classes of 2024, 2025, and 2026. The survey included questions gauging students’ confidence regarding different steps of the patient interview, presented using a Likert scale format (1-4). Questions 1, 3, & 5 addressed the online modality. Questions 2, 4, & 6 addressed the in-person modality. For each question, the median Likert response was calculated. Additionally scores from questions 1, 3, 5 and 2, 4, 6 were summated and the median score was reported as the Total Online Confidence (OC) and In Person Confidence (IPC) Score medians respectively. Differences in all medians were analyzed between cohorts. Interquartile ranges (IQRs) were calculated per cohort in both the Total OC and IPC medians to assess variance. Results: 79 surveys were completed by PharmD students: Class of 2024 (n=34), Class of 2025 (n=22), and Class of 2026 (n=23). For all cohorts, the median scores for each question and Total IPC/OC medians were the same with no differences when stratified by gender. Class of 2024 had the highest IQRs for both IPC (IQR=3) and OC (IQR=4) suggesting higher variability in responses. Conclusions: Insufficient evidence to indicate significant impact of pandemic e-learning modalities on students’ confidence levels in conducting patient interviews, whether online or in-person.
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Comparing Pharmacist Attitudes on Pharmacy Technician Vaccination PracticeSpecific Aims: To characterize and compare pharmacists’ attitudes regarding pharmacy technician vaccine practice in rural and urban areas. Methods: Data was collected via an online survey questionnaire consisting of 18 questions. One question was used to verify demographic information of each pharmacist’s practice site to differentiate a rural and an urban setting. The questionnaire was distributed from November 2023 through February 2024 by email notification to eligible pharmacists in Arizona. Results: The questionnaire included only 18 valid responses. Of those responses, the majority practiced in urban pharmacies. 75% concurred that technician vaccination is safe. 69% of pharmacists believed in technician vaccination practice, 62.6% thought they should be able to administer all vaccines, and 87.5% agreed that technician vaccination aids in pharmacy workflow. However, 56% of the responses demonstrated a lack of confidence in technician vaccine training. Conclusions: Due to inaccuracies of completed surveys, no comparisons were possible between urban and rural respondents. Collecting quality survey data poses a challenge as response rates are low and there is potential for bias and sampling error. Responses gathered are not representative of all practicing pharmacists’ attitudes, as it was limited to community pharmacy sites. Overall, the trend was in favor of technician vaccination but that better training should be provided. These results align with previous literature available that technician vaccination is beneficial to pharmacy workflow. Further studies with a larger population size and variety of practice sites are warranted.
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Barriers and Facilitators to Providing Diabetes Self-Management Education and Support and/or Diabetes Prevention Programs in Community PharmaciesSpecific Aims: Identify facilitators and barriers for community pharmacists providing Diabetes Self-Management Education and Support (DSMES) and/or Diabetes Prevention Programs (DPP) services. Methods: A 68-item exploratory questionnaire was administered via Qualtrics to United States community pharmacists between February and March 2024 to collect perceived barriers and facilitators to DSMES and DPP services using a 5-point scale (strong barrier, minor barrier, indifferent, facilitator, strong facilitator). Barriers and facilitators included patient awareness, contracting with medical insurance plans, space/physical location for services, physical equipment, referral sources for patients, accreditation/recognition requirements, ability to submit medical claims, and reimbursement for services. Data were summarized using frequencies and percentages for strong/minor barriers, indifferent, and strong/minor facilitators. Results: The questionnaire was completed by 70 pharmacists, most of whom had earned a Doctor of Pharmacy degree (78%) and were currently practicing community pharmacy in Arizona (75%). Participants identified DSMES perceived barriers as insurance reimbursement processes (63.1%), staffing shortages (60.3%), and contracting with insurance (58.8%). DPP barriers include contracting with medical insurance plans (60.3%) and patient awareness/engagement (49.2%). Facilitators identified are staff expertise (DSMES=40%, DPP=42%), referral sources for patients (DSMES=38%, DPP=33%), available equipment (DSMES=28%, DPP=28%), and patient engagement (DSMES=28%, DPP=30%). Conclusions: Challenges exist in providing DSMES and DPP services, including patient engagement, insurance reimbursement and processing, and staffing shortages. Key facilitators include staff expertise, referrals, resources, and patient engagement. Support in addressing barriers is required to further improve diabetes services.
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Z Code Utilization in Critical Access Hospitals in ArizonaSpecific Aims: To evaluate the prevalence, frequency, and barriers to Z code utilization in critical access hospitals in Arizona. Methods: Critical access hospitals who are part of Arizona’s Medicare Rural Hospital Flexibility Program were initially contacted over email to find willingness to participate in a verbal, over-the-phone survey. This survey had questions to determine the utilization of Z codes in these facilities, as well as questions on the barriers for each facility. This survey was voluntary, and facilities could opt out at any time. Results: The frequency of utilization of Z codes varied widely among the facilities surveyed, (1-90 of 100 patients). There was no specific Z code used more frequently among the facilities than others; these included homelessness, history of nicotine dependence, long term use of anticoagulants and inhaled steroids, and ongoing long term drug therapy. There is often no designated role for who is to collect this information among hospitals who do utilize Z codes. Of the many barriers to utilizing Z codes, lack of knowledge and resources were of the top barriers among facilities surveyed, both those who use and those who do not use Z codes. Conclusions: Z codes are underutilized in critical access hospitals in Arizona. More data needs to be collected to further understand all barriers to the utilization of Z codes in order to address the vast and various social determinants of health in Arizona’s rural populations.
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Exploring How to Improve Professionalism and Engagement During Zoom LearningObjective: To investigate the impact of remote learning on student engagement and professionalism and explore strategies that courses and students used to improve their engagement and professionalism. Methods: Individual structured interviews were conducted with student pharmacists from the class of 2023, 2024, and 2025 using predetermined, open-ended questions. The primary dependent variable was student perceived engagement and professionalism. Students were recruited by e-mail invitations to participate in zoom interviews. Student responses were audio recorded, transcribed, and analyzed via thematic analysis using Delve. Results: Approximately 6% of the students in the eligible cohorts at the University of Arizona College of Pharmacy participated in this study, of which the majority were female (67%) and anticipated to graduate in 2023 (67%). Major themes describing engagement involved active participation, increased distractions with zoom learning, and attendance credit. Major themes describing professionalism involved course camera requirements, Zoom chat etiquette, and speaker muting issues. Common student strategies for engagement involved having a dedicated learning area, writing notes, and staying organized. Common course strategies to increase engagement include Kahoot, quizzes, polls, & breakout rooms. Common student strategies for professionalism included consideration for peers, self-awareness, and professional standing. Common course strategies for professionalism include need for the camera to be on, attendance credit, and in class participation. Conclusions: Most students interviewed stated that interactive learning increased their engagement in online courses. A predominant number of participants reported that remote learning did not impact professionalism of pharmacy students but that camera requirements and chat monitoring could enhance professionalism.
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A retrospective study evaluating the effect of hepatic steatosis on paclitaxel tolerability in patients with breast cancerSpecific Aims: To evaluate the effect of hepatic steatosis on paclitaxel tolerability in patients with breast cancer and determine if metabolic syndrome contributes to the development of hepatic steatosis. Methods: At the University of Arizona Cancer Center, the electronic medical record was used to identify patients who received paclitaxel for breast cancer between September 1st, 2017 to October 15th, 2022. Data was extracted from Cerner PowerChart and stored on RedCap. Information gathered included the presence of hepatic steatosis on abdominal imaging, patient demographics, past medical history, LFT abnormalities, cancer staging, and paclitaxel dosing. Results: 219 patients were identified who met inclusion criteria for the study. 29% of patients had hepatic steatosis on imaging. Of those, 52% were noted to have hepatic steatosis prior to paclitaxel treatment, and 6% during paclitaxel treatment. Dose reduction was not statistically significant in patients with hepatic steatosis versus those without (46% vs 42%, p-value = 0.68). Patients with hepatic steatosis were more likely to be obese and have at least one comorbidity, but did not meet criteria for metabolic syndrome (p-value = 0.09) Conclusion: Paclitaxel was tolerated similarly in those with or without hepatic steatosis. Patients with hepatic steatosis were likely to meet some but not all criteria for metabolic syndrome.
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Accuracy and Reproducibility of Injections from Prefilled “Code Cart” Syringes Compared to Standard Polypropylene SyringesSpecific Aims: To evaluate the accuracy and reproducibility of small-volume injections from prefilled syringes and different sizes of polypropylene syringes. Methods: Atropine and epinephrine prefilled syringes were used to measure volumes of 0.5 mL and 1 mL of drug solution. Different sized polypropylene syringes (1-mL, 3-mL, and 10-mL) were used to measure volumes of 0.4 mL and 1 mL drawn from prefilled syringes. The measured volumes were compared to expected delivery volume. For analysis, t-tests and folded F test were conducted for prefilled syringe data and the general linear model and Levene’s test were used for polypropylene syringe data. Results: Both prefilled syringes demonstrated high variability at the 0.5 mL volume. The coefficient of variance (CV) was 14.3% and 15.0% for atropine and epinephrine for the first delivery and 7.39% and 9.41% for the second delivery. The 10-mL polypropylene syringe overdelivered 0.4 mL doses by 17.1% and 10.6% for atropine and epinephrine, respectively. With the 1 mL volume, the accuracy was improved and the expected delivery range was 0.863 to 1.19 mL (19% error). Use of a 3-mL or 1-mL syringe expectantly resulted in improved accuracy and precision. Conclusions: Using a 10-mL syringe, either prefilled or polypropylene, to measure volumes of 1 mL or less did not result in reproducible delivery of doses at the ±10% error threshold. When preparing doses smaller than the 20% of the total volume of a pre-filled syringe, we recommend using the smallest available polypropylene syringe that will accommodate the volume needed.
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Modified Patient Intake Process and its Effectiveness in Timely Access to Patient Data in Endocrinology Telemedicine VisitsSpecific Aims: To determine the frequency of timely and accurate completion of a chart preparation checklist (CPCL), to assess the frequency of timely access to insulin pump and/or CGM data and lab results during the telemedicine visits, and to evaluate the relationship between timely and accurate completion of the CPCL and timely access to data and results. Methods: This was a descriptive, observational, and retrospective cohort study conducted via chart review of clinic visits at the Endocrinology and Diabetes Clinic at Banner - University Medical Center South. Telemedicine clinic visits from June 1, 2020 to December 31, 2020, in which patients ≥ 18 years old with diagnosis of diabetes were seen for diabetes management were included. A CPCL was used as a modified patient intake process for telemedicine visits. In this checklist, patients were asked if they used an insulin pump and or a continuous glucose monitor (CGM), what brand, and if they had recent labs drawn to be able to obtain and have those data available for the visits. CPCL completion and availability of data were deemed to be timely if done/accessible by the time of the visit. CPCL was considered accurate if patient has the noted devices or has had recent labs drawn. Descriptive statistics were used to assess the specific aims as noted above. Results: Out of 293 clinic visits, 80 were included in the analysis. Only 17 (21%) had a completed CPCL by the start of their visits and 31(39%) of the visits had an insulin pump and/or CGM. Of those 31, 19 (61%) had timely data availability with 15 (48%) of those being from visits without CPCL. Of the total 51 patients with laboratory results, 42 (82.3%) had those results uploaded in the chart in a timely manner. Conclusions: This study suggests that CPCL utilization does not have added benefit in timely access to insulin pump/CGM data. As per very low CPCL utilization and the study limitations, further investigations are needed to assess the effectiveness of CPCL and if the checklist and its use need to be revised.
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The Role of Vaccine Literacy on Vaccination Rates in Maricopa County Health PodsSpecific Aims: The primary objective explored whether vaccine literacy is related to regular adult vaccination adherence. The secondary objective explored whether demographic variables of study participants held relationships with their level of vaccine knowledge. The tertiary objective explored whether preconceived beliefs about vaccines were related to vaccine adherence. Methods: Adult participants were recruited at Maricopa County Vaccine Clinics offered through the University of Arizona College of Public Health. Participants completed an anonymous survey that included demographic information, adherence to regular vaccines, a ten-question section to measure vaccine literacy, as well as “opinion statements” about vaccines that the participant would agree/disagree to. Survey responses were analyzed to determine relationships between participants’ vaccine literacy and other data collected via survey. Results (Primary Objective): Vaccine literacy was determined as the most significant factor that affected vaccination adherence. Participants categorized in the high literacy group had a significantly greater number of vaccine-adherent participants (Chi-squared test, p < 0.001). Results (Secondary Objective): Health insurance status was the only patient demographic that was statistically significant with vaccine literacy, with insured participants obtaining a greater literacy score (Chi-squared test, p = 0.04). Age, gender, formal education, and employment status was not significant to vaccine literacy. Results (Tertiary Objective): The level of agreement/disagreement with vaccine opinion statements showed significance to vaccine adherence. The number of participants with favorable overall opinions in favor of vaccination had higher vaccine adherence. (Chi-squared test, p = 0.04). Conclusions: This descriptive study revealed the correlation between vaccine literacy and vaccination rates within a sample population, in addition to the impact of outside variables affecting both vaccination literacy and rates. Further research is required to better understand these correlations and how they impact patient health outcomes within the greater population.
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Assessing community pharmacists’ confidence with and knowledge of veterinary medicationsObjectives: With rising numbers of pet prescriptions, pharmacists play an important role in distinguishing appropriate therapies for animals. This study examined pharmacists’ confidence with and knowledge of veterinary medications. Methods: This descriptive study surveyed pharmacists between January 24, 2023 and March 19, 2023. A link was distributed through many social media platforms, email, and word-of-mouth. The survey contained seven knowledge questions pertaining to counseling points and drug toxicities. Three questions had pharmacists subjectively score their confidence in resolving a given scenario. The primary outcome was to assess pharmacists’ confidence with and knowledge of veterinary pharmacotherapy. The secondary outcome was to determine which demographic factors influenced pharmacists’ confidence and knowledge. All responses were analyzed using a chi-squared test. Results: A total of 622 responses were collected with three pharmacists denying consent and 96 incomplete surveys. A total of 523 responses were analyzed by SPSS software. 41 (7.79%) respondents had a passing score of 70% or higher on the knowledge assessment. 37 (7.03%) respondents scored themselves to having high confidence in situations involving veterinary prescriptions. Baseline characteristics (veterinary prescriptions filled per month, access to veterinary pharmacotherapy resources, and veterinary pharmacotherapy lecture in pharmacy school) were significantly associated with higher knowledge and confidence scores. Conclusions: The lack of reliable resources and education regarding veterinary medicine correlates to pharmacists' knowledge gap. Further studies will need to be conducted to determine if these associations are causal or if other factors affect confidence and knowledge.
