• Cost-Effectiveness Analysis of PCSK9 Inhibitors for the Treatment of Heterozygous Familial Hypercholesterolemia

      Malone, Daniel; Lasica, Rick; Loy, Ashley; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To determine the cost-effectiveness of proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors with high-intensity statins compared to high-intensity statins alone for the treatment of heterozygous familial hypercholesterolemia (HeFH). Methods: A Markov model was built through TreeAge Pro to model two groups: patients taking PCSK9 inhibitors with high-intensity statins or high-intensity statins alone. For each group, there were five health states that patients could be in: well, unstable angina, myocardial infarction, ischemic stroke, or death. The data used in the model were extracted from published clinical trials evaluating PCSK9 inhibitors and statins. Results: For the primary analysis, the overall cost and effectiveness was $31,390.93 and 23.01 for the statin alone group and $362,798.50 and 24.32 for the PCSK9 with statin group, respectively. The incremental cost, incremental QALY, and incremental cost-effectiveness ratio (ICER) was $331,407.60, 1.31 QALYs, and $252,833.60/QALY, respectively. Conclusions: Since the calculated ICER was higher than the pre-established threshold of $150,000, the results from our primary analysis suggest that treatment of patients with HeFH with a PCSK9 inhibitor and a high-intensity statin is not cost effective, compared to treatment with a high-intensity statin alone. However, when certain parameters (cost of PSCK9 and mortality rate) were adjusted in the secondary analyses, these agents appear to be cost-effective.
    • The Effect of an Immunization Training Program on the Willingness of Pharmacy Students to Receive, Administer, Recommend, and Counsel About Vaccinations: A retrospective, pre-post study

      Spencer, Jenene; Fazel, Maryam; Ivanov, Marina; Rodriguez, Jessica; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To determine whether pharmacy students were more willing to receive, administer, recommend and counsel patients about vaccinations after completing an immunization training program Methods: Anonymous and voluntary questionnaires administered on paper during a regularly scheduled class collected ratings of confidence on the willingness of first year pharmacy students to receive, administer, recommend and counsel about vaccinations prior to and after the completion of an immunization training program. Data on gender, age range, status of completion and source of the immunization training program completed was also collected. This study was approved by the University of Arizona Institutional Review Board (IRB). Results: Questionnaires were completed by 110 students at the Tucson and Phoenix campus. Students were equally willing (p=0.235) to receive all vaccinations, even if they were not required to by the UA COP, before and after the immunization training program.There was a statistically significant difference in the willingness to administer (p<0.001), to recommend (p=0.024) and to counsel (p<0.001) about vaccinations after completion of an immunization training program. Conclusions: Completing an immunization training program did not have influence on the willingness of pharmacy students to receive vaccinations. However, the results suggest pharmacy students are more willing to administer, recommend and counsel about vaccinations after the completion of an immunization training program.
    • Evaluation of Safety and Efficacy Outcomes from use of Extended Infusion of Beta-Lactam in the treatment of Acute Pulmonary Exacerbations in Cystic Fibrosis

      Matthias, Kathryn; Tien, Quang; Sivinski, Jared; Lew, Darren; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: The objective of this retrospective cohort chart review was to evaluate the safety and efficacy of extended infusion beta-lactam regimens as part of treatment of acute CF pulmonary exacerbations in adults and pediatric patients. Methods: Inclusion criteria: adult and pediatric patients (age 1 month or older) with CF diagnosis who were admitted to BUMC-T for acute pulmonary CF exacerbation, and who received meropenem, imipenem, aztreonam, piperacillin-tazobactam, and or cefepime during their hospitalization (between 1/1/2011 and 10/30/2015). Exclusion criteria: pregnant women and admissions less than 24 hours. The two groups evaluated were patients receiving treatment (group 1) prior to extend infusion practices (Jan 2011 – Dec 2012) and (group 2) after implementation of extend infusion practices (Jan 2013 – Oct 2015). Data was collected from medical records using both the Sunrise Clinical Manager and EPIC electronic medical record systems. The data was then analyzed for differences in efficacy outcomes (e.g., length of hospitalization, lung function, return to baseline lung function), changes in renal and hepatic function, incidence of documented adverse drug effects, and potential factors associated with increased risk for changes in renal or hepatic function with use of extended infusion beta‐lactam regimens. Results: Pending. Efficacy outcomes: - length of hospitalization - improvement in lung function - return to baseline lung function Safety outcomes: - changes in renal and hepatic function - incidence of documented adverse drug effects - potential factors associated with increased risk for changes in renal or hepatic function Conclusions: Pending. As this study is being conducted at one academic medical center, conclusions may not be generalizable to other institutions.
    • In vitro aerodynamic analysis of co-spray dried fluticasone propionate (FP) and salmeterol xinafoate (SX) dry powder inhalation aerosols with lactose-alternative excipient

      Mansour, Heidi M.; Malapit, Monica; Mallory, Evan; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: Milk protein allergy is estimated to affect 1.2% to as much as 17% of people of all ages. Advair® Diskus® (FP/SX) utilizes lactose as an excipient which limits the utility of this product for this population. Furthermore, Advair® Diskus® is formulated as an interactive physical mixture via a micronization process. Alternatively, spray dried engineering achieves narrow particle size distribution, allowing greater deposition in the targeted respiratory bronchioles. The purpose of this dry powder inhaler (DPI) study was to conduct an in vitro comparative analysis of the aerodynamic performance of a co-spray dried lactose-free formulation of FP/SX with a mannitol excipient as a molecular mixture versus the Advair® Diskus® 250/50 (FP/SX) interactive physical mixture product. Methods: Utilizing mannitol as an excipient, a co-spray dried FP/SX powder was prepared using the Buchi Mini-Spray Dryer B-290 under closed system configuration. The resulting feed solution was spray dried at pump rates of 25%, 50%, and 100% with all other parameters remaining constant (aspiration, atomization rate, nitrogen gas rate). The primary outcome measure, aerodynamic performance, was assessed using the Copley Next-Generation Impactor (NGI). NGI data for the DPIs was used to calculate mass median aerodynamic diameter (MMAD), geometric standard deviation (GSD), and fine particle fraction (FPF) of each powder, including the Advair® Diskus®. Residual water content was quantified by Karl Fischer titration. Particle characteristics were visualized by scanning electron microscopy. Results: FPF, MMAD, and GSD were calculated from NGI data; Wolfram Alpha software was used to calculate MMAD and GSD. T-test regression was used for comparative analysis of spray-dried and Advair® Diskus® powders. MMAD for each spray dried sample was analyzed using a t-test regression against the MMAD values from the Advair® Diskus®. Using aerodynamic analysis studies triplicated for each powder, there was no significant difference between the spray dried powder and Advair® Diskus® for MMAD and GSD (p-values >0.05). The 50% and 100% pump rate samples had similar FPF to the Advair® Diskus® (p-values >0.05). However, the 25% pump rate sample had a significantly improved FPF compared to the Advair® Diskus® (p <0.01). Conclusions: A co-spray-dried lactose-free formulation of FP/SX with a mannitol excipient demonstrated similar aerodynamic performance to the Advair® Diskus® which consists of a physical mixture of two drugs with lactose. Of significance, 25% pump rate spray-dry conditions demonstrated an improved FPF compared to the Advair® Diskus®.
    • Evaluation of a Specialty Pharmacy Counseling Program on Patient Outcomes for Oral Oncolytic Medications

      Mathews, Kelly; Voight, Michael; Ketterer, James; Kennedy, Kyle; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: Our working hypothesis is that patients who opt in to pharmacist counseling will have a higher medication possession ratio and longer length on therapy than patients who opt out of pharmacist counseling. Methods: Using data extracted from patient’s charts we retrospectively calculated medication possession ratio and length on therapy in relation to the patient receiving or not receiving counseling. Results: The patients analyzed were receiving 8 specific oral oncolytic medications provided by Avella Specialty Pharmacy in 2015. There were no significant differences found in MPR values for any of the 8 oral oncolytic medications included in the study. Iressa (p=0.826), Lonsurf (p=0.392), Stivarga (p=0.838), Zydelig (p=0.633), Zykadia (p=0.077), Tagrisso (p=0.060), Imbruvica (p=0.263) and Tarceva (p=0.326). No statistically significant differences were found in LOT values for any of the 8 oral oncolytic medications included in the study. Iressa (p=0.885), Lonsurf (p=0.868), Stivarga (p=0.326), Zydelig (p=0.502), Zykadia (p=0.212), Tagrisso (p=0.089), Imbruvica (p=0.540), Tarceva (p=0.129). Conclusions: Pharmacist counseling does not appear to affect MPR or LOT for patients taking oral oncolytic medications. Further research is warranted targeting other chronic disease states with complex oral regimens where medication adherence has not already been established from prior therapy options and adequate disease state knowledge.
    • Identifying types of Motivation in Type 1 Diabetes Self-Management and Exercise in Adolescents

      Bhattacharjee, Sandipan; Kwan, Jason; Nguy, Linda; Yang, Jingxin; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: The purpose of the study was to identify the types of motivation that promote sustained physical activity among adolescents between the ages of 11-17 who are diagnosed with type 1 diabetes (T1D) to prevent diabetes related complications. Methods: Questionnaires were distributed and collected among the Juvenile Diabetes Research Foundation’s (JDRF) listserv, Facebook page, and events in Phoenix and Tucson, Arizona on motivations for managing diabetes and exercise and confidence in diabetes management and performing physical activity. Demographic data was collected on age, gender, and race/ethnicity. Physical activity, levels of activity intensity, weight, height, health- related risk behaviors, chronic health conditions, and use of preventative services were also included in this study. Results: 11 adolescents completed questionnaires, categorized by participants who exercise less than 60 minutes daily (Group below recommended exercise level, GBRE) and participants who exercise more or equal to 60 minutes daily (Group meeting recommended exercise level, GMRE). GBRE’s average mean age was 15.75 and GMRE’s average mean age was 13.92. GMRE was associated with higher intensity physical activity (42.85% versus 0%). GBRE had a relative autonomy index (RAI) of 1.67 on the Treatment Self-regulation Questionnaire (TSRQ) compared to GMRE with a RAI of 3.81 (Mann-Whitney U 19, p-value 0.412). GBRE scored 73.75 on the Diabetes Self-efficacy Scale (DSES) and GMRE scored 78.71 (Mann-Whitney U 7, p-value 0.23). Conclusions: Adolescents who exercised ≥ 60 minutes daily were observed to be self-motivated in managing their diabetes, especially maintaining exercise recommendations to decrease diabetes related complications.
    • Implementation of an Electronic Prescription System and its Effect on Perceived Error Rates, Efficiency, and Difficulty of Use

      Warholak, Terri; Morales, Armando; Nguyen, Lily; Ruddy, Tyler; Velasquez, Ronald; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To evaluate the perceptions of the pharmacy staff on prescription errors, efficiency, and difficulty of use before and after implementation of a new pharmacy computer system. Subjects: Employees of El Rio Community Health Center outpatient pharmacies located at the Congress, Northwest, and El Pueblo Clinics. Methods: This study was of a retrospective pre-post design. A 5-question survey on error rates and workflow efficiency was distributed to pharmacists and technicians 6 months after a new computer system had been implemented. Participants of the study included employees of El Rio Community Health Center outpatient pharmacies who were employed with El Rio during the time of transition between the old and new computer systems. Results: Questionnaire responses were completed by 10 (41.7%) technicians and 6 (66.7%) pharmacists at three El Rio Clinics. There was an increase in perceived efficiency between the new (Liberty) (n=17, 94.4%) and old (QS1) (n=11, 61.1%) computer systems (p<0.05). There were no significant differences in perceived difficulty of use, most common types of errors, error rates, and time to fix detected errors. Conclusions: While there were no significant differences between Liberty and QS1 in perceived difficulty of use, most common types of errors, error rates, and time to correct detected errors, there was a significant difference in the perceived efficiency, which may have beneficial implications.
    • Cost Effectiveness Analysis of Empiric Skin and Soft Tissue Infections Requiring Hospitalization and Methicillin Resistant Staphylococcus Aureus Coverage

      Malone, Daniel; Kennedy, William; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To assess the cost-effectiveness of vancomycin, daptomycin, linezolid, oritavancin, and telavancin as empiric treatment for MRSA skin and soft tissue infections in an inpatient setting from a third party perspective. Methods: A decision analytic tree model was constructed using TreeAge Pro and utilizing efficacy data from published clinical trials and costs estimates using HCUPnet.gov and Micromedex’s RedBook. Sensitivity analyses were run on linezolid costs, as well as oritavancin’s costs and efficacy data. Results: Linezolid was the most cost effective medication, dominating all other therapies. In a sensitivity analysis, increasing linezolid’s cost to include 7 days of inpatient therapy did not result in other therapies no longer being dominated. In two other sensitivity analyses, oritavancin was no longer dominated at 91.8% efficacy, but was still dominated with only 3 days of inpatient therapy. Conclusions: Linezolid was the most cost effective therapy for empiric treatment of suspected MRSA skin and soft tissue infections requiring hospitalization from a third party perspective.
    • Assessing Mental Health Stigma Between Rural and Urban Pharmacists

      Hall-Lipsy, Elizabeth; Salgado, Crystal; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To explore whether rural pharmacists express more stigmatized attitudes towards patients with psychiatric disorders, compared to their urban counterparts. Methods: Data was collected from participants attending the AzPA Southwestern Clinical Pharmacy Seminar during a weekend in February, 2015, using a questionnaire adapted from the Mental Illness: Clinicians’ Attitudes (MICA) Scale v4. The questionnaire consisted of demographic and attitude assessment questions regarding patients suffering from psychiatric disorders across different domains (quality of life, fear of patients, admitting to having a psychiatric disorder, and more). Participants were also asked if they would be interested in taking a continuing education course on mental health. Results: The majority of participants that completed the study were women (75%) and identified racially as white (89%). Pharmacists practice settings were as follows: 79% of pharmacists worked in urban areas and 21% in rural areas. Rural pharmacists displayed significantly higher rates of stigmatized attitudes compared to their urban peers (mean scale score 37.65 vs. 40.15, p=0.049). Conclusions: Pharmacists that practice in rural settings expressed more stigmatized attitudes, compared to their urban counterparts, towards patients diagnosed with psychiatric disorders.
    • Curriculum Map of the University of Arizona College of Pharmacy

      Cooley, Janet; Tran, Thuyvi; Nguyen, Quang; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To describe the content of the currently enacted curriculum and confirm that the University of Arizona doctor of pharmacy degree program meets all required elements defined by the Accreditation Council for Pharmacy Education (ACPE) appendix 1. Methods: A curriculum map that lists courses taken by each class years and the 2016 ACPE appendix 1 elements was developed. Course syllabi were then evaluated for class sessions that fit within specific ACPE required elements. Each 50 minutes class session was classified as a lecture unit (lu) and the total number of lu were recorded on the map. Furthermore, the redundancy of categorized sciences (biochemical, pharmaceutical, social/administrative/behavioral sciences) were evaluated with the map. Lastly, diabetes contents taught within each course and corresponding assessment tools were collected to gauge opportunities for progression of knowledge. This was done by confirming that different factors of the disease were taught within different courses. Results: Each required ACPE element was covered by at least one lu within the curriculum. The 1st, 2nd, and 3rd year covered 67.5%, 54.1%, and 40.5% of ACPE required elements, respectively. The subject of diabetes was covered with 24 lu, 4 lu, and 14 lu within the 1st, 2nd, and 3rd years, respectively. Progression of knowledge in diabetes was seen in the course materials. Conclusions: The enacted curriculum covers all ACPE required contents. The 1st year of the program teaches the largest percentage of required elements. All categorized sciences were reemphasized and the opportunity for progression of knowledge was shown.
    • Prescription Stimulant Medication Attitudes and Beliefs of Undergraduate Students Involved in Social Sororities

      Goldstone, Lisa W.; Ong, Nicholas; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To first educate undergraduates involved in social sororities about prescription stimulant medications and to evaluate the effectiveness of an educational intervention in influencing the attitudes and beliefs regarding prescription stimulant medication use of undergraduates involved in a social sorority. Methods: The intervention, an educational session, was presented to undergraduates involved in social sororities. Questionnaire that included demographic data of gender, age, ethnicity, race, undergraduate year, grade point average, type of member, history of an attention-deficit/hyperactivity disorder (ADHD) diagnosis, and previous or current non-medical use of prescription stimulants were collected. The participants’ beliefs on nine statements regarding prescription stimulants were queried pre- and post-intervention using a four-point Likert scale ranging from strongly disagree to strongly agree. To analyze change in attitudes and beliefs, Mann-Whitney test was used. Results: One hundred sixty-three sorority members participated in the study. The average age of participants was 19 years with the majority of respondents identifying as an active sorority member (81%) and in their first year of undergraduate study (69%). There was a statistically significant change in beliefs regarding the safety (p < 0.01) and health risks (p = 0.02) associated with prescription stimulants. There was no significant difference in topics relating to addiction, legality, emotional and academic outcomes from the use of prescription stimulants. Conclusions: The education session was effective in changing participants’ beliefs on safety and health risks of nonmedical use of prescription stimulants.
    • Evaluating Perceived Barriers and Challenges to Interprofessional Education and Practices Amongst Rural Health Care Providers: a Focus Group Approach

      Hall-Lipsy, Elizabeth; Roth, Carrie; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To facilitate a discussion among various healthcare professionals about the facets of interprofessionalism that occur, or do not occur, in a rural acute healthcare setting, and how interprofessionalism could be integrated into the facility’s current healthcare professional student programs. Methods: A focus group was conducted with 8 participants lasting about 45 minutes. Participants were one of three different professions (nurse, medical doctor, or pharmacist) and included administrators as well as staff employees. Six questions were discussed among participants and the answers from each participant were scripted onto a word document. This document was thematically analyzed and compared and contrasted to a previous study, which asked the same six questions in a different rural acute healthcare site. Results: The main findings of this study were that workforce shortage, lack of computerized physician order entry (CPOE), and lack of a uniformity throughout the hospital affected interprofessional practice, learning, and education. Conclusions: Perceived barriers of interprofessional practice at Canyon Vista Medical Center included: poor communication, understaffing, lack of a unified, computerized EHR throughout the hospital, and unclear policies. Some proposed ways to overcome these barriers include having a full staff, creating a unified electronic health record (EHR) system, offering interprofessional learning opportunities, and providing employees the opportunity to gain experience in departments other than their own.
    • Benefits and Sources of Calcium & Vitamin D: A Cross-Sectional Questionnaire Assessing Patient Knowledge and Contributing Factors

      Spencer, Jenene; Cooley, Janet; Browne, Jessica; Lunt, Nathan; Zappia, Julie; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To assess the general public’s knowledge of the benefits and sources of calcium and vitamin D dietary and supplemental intake and to identify any pertinent demographic characteristics that influence such knowledge. Methods: Participants were convenience sampled from Walmart locations in Safford, Arizona and Tucson, Arizona. Each participant completed a brief survey assessing their knowledge about the benefits and sources of calcium and vitamin D and optional questions regarding demographics. Results: 51 participants in Safford and 51 participants in Tucson completed the questionnaire. Of the 51 responders in Safford, 18 were men and 24 were women with a mean age of 49.52 (SD = 14.53, 80.49% white). Of the 51 responders in Tucson, 22 were men and 17 were women with a mean age of 50.97 (SD = 17.32, 71.79% white). Baseline demographics were equivalent. Statistical significant was observed when the mean total scores from Tucson and Safford were compared. On average, the participants in Tucson scored higher when compared to participants in Safford with mean scores of 55.5% and 49.0% respectively (p= 0.0412). Conclusions: Tucson participants scored statistically significantly higher when compared to Safford participants. This may be due to the health disparity between urban and rural populations. Gender, ethnicity, supplement use, personal or family history of osteoporosis, and education level did not appear to affect response scores on the questionnaire.
    • Healthcare Professionals as Study Participants: A Scoping Review

      Slack, Marion; Arpaia, Alison; Andrus, Sara; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To conduct a scoping review of studies involving healthcare professionals as study subjects and to describe the methods used, identify the topics researched, and describe the rationale and limitations of using healthcare professionals as subjects. Methods: The study was a scoping review of research utilizing health professionals as study subjects. A comprehensive literature search was conducted in several databases. Two investigators independently screened studies, collected data, and met to resolve discrepancies. Results: Sixty-five studies met the eligibility criteria. Forty-six percent of the studies evaluated cardiovascular events, 25% evaluated cancer, 9% examined ophthalmic events, 5% examined cognitive issues, and 17% miscellaneous topics. Of the 65 studies, 88% were prospective cohort studies. Questionnaires were utilized as the data collection method in 59 studies (91%). Physicians were the primary study subject in 30 studies (46%) and nurses in 20 studies (31%). No study included in the sample identified pharmacists as study subjects. A total of 41 studies (63%) did not list rationales or limitations to utilizing health professionals as subjects. Of the 24 studies that did discuss rationales and limitations, the most frequently cited advantage was reliable self-reporting (38%). The most common limitation to generalizability was high socioeconomic status. Conclusions: Questionnaires were the most common method used to collect data. Physicians were the most often studied health professional. High reliability of data reporting was a common rationale in using health professionals as subjects. The lack of studies utilizing pharmacists as subjects demonstrates an opportunity that should be further evaluated.
    • The Efficacy of Self-Management Programs for Chronic Pain: A Preliminary Review

      Slack, Marion; Azaril, Kim; Billington, Taness; Garlick, Kelsey; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To identify studies that have been conducted on pain self-management interventions to describe the strategies used in the treatment of pain Methods: Eligible studies were determined using a study inclusion-screening tool. To be eligible, studies needed to be randomized controlled trials comparing some type of self-management intervention to an alternative or usual care. Once determined to be eligible, selected studies were analyzed by two investigators using a consensus procedure and full article data extraction form which collected data on the study characteristics, patient characteristics, self-management strategies and relevant study outcomes. Results: The chronic pain management strategies from the 14 randomized controlled trials used in this study included: acupuncture, mobile based intervention, yoga, meditation/relaxation techniques, cupping therapy, musical therapy, cognitive behavioral therapy, physical therapy and self-management therapies. All studies showed a statistically significant reduction in pain from baseline, however, the effect size ranged from very small (0.02) to quite large (2.2). Conclusions: Most studies showed a meaningful reduction in pain, hence, a wide variety of self-management strategies are available for managing pain.
    • Self-Management Strategies for Chronic Pain Reported in Population-Based Surveys: A Systematic Review

      Slack, Marion; Bemis, Lola; Harper, Bonita; Molla-Hosseini, Sima; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: The purpose of this systematic review was to identify the types of management strategies reported by individuals with chronic pain to manage chronic pain, the average number of strategies used, outcomes, and side effects. Methods: To be included in the systematic review, reports of population surveys of adult patients with chronic pain, as defined by the authors, had to be published in English, include chronic pain from any cause, and include information on the treatment strategies used by respondents. Search terms included “pain,” “self-care,” “self management,” “self treatment,” and “adult” and the search strategy included systematic searches of Pubmed, Embase, Cochrane Library, PsycINFO, CINAHL, Web of Science, International Pharmaceutical Abstracts, searches of reference lists, and citation searches as well as key websites such as the CDC and NIH. Results: A total of 13 study reports were identified. Sample size ranged from 103 to 4839; mean age ranged from 42 to 81 and 51 to 69% female. All reports included information on medications used to manage pain; 6 reported other medical strategies; 9 reported physical strategies; 6 reported psychological strategies; and 11 reported non- medical strategies. Only 4 studies reported some data on the number of strategies used; one study reported 23% used 6 or more medications, another reported 51% used 3 or more strategies. Six studies reported some type of outcome; including inadequate control of pain (40%) or good relief (87%), and 36% as effective in a third study. Few side effects were reported; two studies reported constipation, nausea and vomiting. Conclusions: Population-based surveys of chronic pain have identified a large number of strategies used to manage pain, however they provide little information on the average number of strategies used, the effectiveness of the strategies, or resulting side effects.
    • Brentuximab Vedotin for Treatment of Non-Hodgkin Lymphomas: A Systematic Review

      McBride, Ali; Anwer, Faiz; Berger, Garrett; Lawson, Stephanie; Royball, Kelsey; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: Brentuximab vedotin (BV) is an antibody-drug conjugate comprising a CD30-directed antibody conjugated to the microtubule-disrupting agent MMAE via a protease cleavable linker. BV is FDA approved for use in relapsed classical Hodgkin lymphoma and relapsed systemic Methods: primary study outcomes being objective response rate. PubMed (1946-2015), EMBASE (1947-2015), and Cochrane Central Register of Controlled Trials (1898-2015). Inclusion criteria included all studies and case reports of NHLs in which BV therapy was administered. Twenty-eight articles met these criteria. Results: Utilizing the twelve clinical subtypes, we found clinical evidence of BV and stratified the study populations into three groups: B-cell malignancies (group A), T-cell malignancies (group B), and non-B or non-T-cell hematological malignancies (group C). Across the group A malignancies, there were 87 patients. 48% experienced an objective response (OR). Across the group B malignancies, there were 274 patients. 74% experienced an OR. Across the group C malignancies, there were 9 patients. 44% experienced an OR. Conclusions: Our findings indicate that BV induces a variety of responses, largely positive and variable between NHL subtypes. With properly powered prospective studies, BV may prove to be a strong candidate in the treatment of CD30+ malignancies.
    • Awareness of Medication-Related Fall Risk Before and After Online Education

      Lee, Jeannie; Ancheschi, Evellyn; Henry, Nicole; Votruba, Cassandra; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: The aim of this project was to assess community-dwelling older adults’ knowledge of prescription and Over-the-Counter (OTC) medications associated with fall risk, then provide an online educational intervention tailored to older adults on the topics they answer incorrectly. The knowledge assessment of the missed questions will be repeated after the online education to detect the effectiveness of the online intervention in increasing the knowledge of community-dwelling older adults. Methods: This study used an interventional design with pre-test, post-test survey method to quantitatively analyze community-dwelling older adults’ knowledge on medication-related fall risk. The persons taking the survey were community dwelling older adults, 65 years of age and older, living in the greater Tucson and Phoenix areas. Data was obtained through an online Qualtrics questionnaire between February 1, 2016 and February 1, 2017. The survey respondents answered questions regarding prescription and OTC medications associated with fall risk. For the questions they answered incorrectly, an online educational intervention tailored to older adults was provided immediately. The knowledge assessment of the missed questions was repeated after the online education to detect the effectiveness of the intervention. Results: Questionnaires were completed by 302 community-dwelling older adults. The mean age of the participants was 79 (range 65 to > 96), and majority were women (61.2%). A majority of respondents (53.87%) reported falling once in the last 5 years. Of the total participants, 50% were taking between 5 and 9 prescribed medications and 56% taking 0 to 4 OTC medications. The primary outcome of this study is that online education was effective in educating community dwelling older adults on medication-related fall risk. Patients whose pharmacist had previously educated them did not directly correlate with better performance on the pretest than those who did not receive counseling. Participants that received online education during the survey improved their score from 69% before education to 84% post education. Conclusions: The online educational intervention on medication-related fall among older adults was effective and informative. Such educational strategy may be used by pharmacists to educate older patients using medications that may increase fall risks.
    • Perspectives of Rural and Non-Rural Community Pharmacists in Pediatric Dosing and Recommendations

      Phan, Hanna; Hall-Lipsy, Elizabeth; Hu, Jackie; Lin, Grace; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To assess the perceived confidence level of community pharmacists in utilizing weight-based dosing, dispensing prescriptions, counseling, and recommending over-the-counter medications for the pediatric population in rural and non-rural settings. Methods: A 33-item questionnaire generated through REDCap was distributed to 11,280 pharmacists registered with the Arizona State Board of Pharmacy via email from March 14 to April 4 of 2017. The survey collected information on the participants’ experiences in managing pediatric prescriptions and demographics. Results: Of the 11,280 surveys distributed, a total of 857 responses were submitted by the end of the survey period (7.6%) and 482 responses were included in the analysis; 49 (10.2%) were practicing in rural areas and 433 (89.8%) were practicing in non-rural areas (including urban and suburban) in Arizona. There was no significant difference in the rural group compared to the non-rural group regarding experiences with dispensing pediatric medications. In regards to the confidence level, there was a significant difference between the two groups in calculating and recommending weight-based dosing for prescription and OTC pediatric medications (p = 0.022 and 0.031, respectively) and identifying a dosing error in pediatric prescriptions (p = 0.016). Conclusions: Community pharmacists practicing in rural and non-rural settings in Arizona had similar experiences with dispensing pediatric medications and confidence levels in managing medications for pediatric patients.
    • Comparison of Hypersensitivity Reaction Incidence to Carboplatin in Patients with Ovarian, Fallopian Tube, or Primary Peritoneal Cancer with or without the BRCA1 or BRCA2 Mutations

      McBride, Ali; Garcia, Andrew; Corey Frahm; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: The specific aims of this project were to evaluate the incidence of carboplatin HSR in patients with the BRCA1 or BRCA2 mutations compared to those without these mutations. Secondary objectives were to identify carboplatin cycles where reactions occurred, grade of reaction, and treatment outcomes. Methods: This retrospective chart review included 167 ovarian, fallopian tube, and primary peritoneal cancer patients at the University of Arizona Cancer Center who underwent a regimen with carboplatin from 2013-2015. Results: 126 out of 167 patients were analyzed. HSR occurred in 4 patients with BRCA mutations, and in 9 patients without mutations, though incidence was not significant with respect to the groups (3.1% versus 17.4%, P=0.5291). Overall, there were 11 grade 1 reactions, 14 grade 2 reactions, and 16 grade 3 reactions to carboplatin. Conclusions: Presence of a BRCA1/2 mutation was not associated with a higher incidence of HSR in carboplatin. More studies are needed to clarify the impact of BRCA mutations on developing carboplatin HSR.