Long-term adherence and outcomes of oral Tyrosine Kinase Inhibitors for the treatment of CML in the US VHA medical system

textChronic Myeloid Leukemia (CML) represents about 15-20% of all adult leukemias. The introduction of Tyrosine Kinase Inhibitors (TKIs) was a breakthrough in the treatment of CML that drastically improved outcomes. Poor adherence is recognized to be a major source of treatment failure and is especially concerning in situations where medications are self-administered, as is the case with TKI therapy. Several published studies on patient adherence with oral chemotherapy found rates for long-term treatment to be around 40-50%. The primary purpose of this study was to determine long-term adherence to TKI therapy, and to establish the effect of adherence on the clinical response. A secondary purpose was to compare adherence and treatment outcomes among TKIs. This was a retrospective cohort study of CML patients receiving TKI therapy at any Veteran Health Administration (VHA) facility. Patients 18-89 years of age, with CML diagnosis that filled at least one prescription for imatinib, nilotinib, or dasatinib from 10/1/2001 through 9/30/2010 were included in this study. Adherence was ascertained for 2,873 patients by calculating the Medication Possession Ratio (MPR) using administrative refill data. A manual chart review of 683 patients determined the clinical effectiveness of TKI therapy by identifying cases of major molecular response (MMR), as well as complete cytogenetic response (CCyR). Thirty-three percent of dasatinib-treated patients were adherent during first-year of treatment relative to 28% of nilotinib-treated patients, resulting in an adjusted OR 1.24 (95% CI: 0.78-1.95, p= 0.361). Fifty-one percent of the patients receiving dasatinib as second-line treatment achieved documented MMR by 18 months relative to 56% of nilotinib-treated patients, resulting in an adjusted OR of 0.66 (95% CI: 0.35 -1.23, p= 0.189). Documented MMR by 18 months was achieved by 53% of the patients adherent to TKI therapy relative to 45% of nonadherent patients. When adjusted for covariates, the difference was significant with an OR of 2.68 (95% CI: 1.58 - 4.57, p< 0.001). In conclusion, no significant difference in adherence rates or clinical effectiveness was observed between dasatinib or nilotinib when administered as second-line treatment. Adherence to TKI therapy was found to be significantly associated with improved clinical effectiveness.Pharmaceutical Science

Impact of a Prepharmacy Program on Students&rsquo; Self-Awareness of Pharmacist Professional Identity: Comparison between Virtual and In-Person Settings

Ensuring an adequate preparation for undergraduate students transitioning to pharmacy school is challenging. A significant barrier is changing from a subordinate to a critical thinking mindset while self-identifying as a professional. Here, we aimed to (1) determine whether our prepharmacy program called &ldquo;Professional Identity and Me&rdquo; (PRIME) could enhance learners&rsquo; self-awareness of their professional identity and (2) compare the effectiveness of the in-person and online versions of PRIME. PRIME introduced prepharmacy students to aspects of pharmacists&rsquo; professional identity including community, hospital, and interprofessional work, as well as mental health, wellness, and time and stress management skills, Top-200 drugs, prerequisite foundational sciences, and calculations. Concepts of professionalism, graduate writing, and ownership were also presented. Bridging exercises were introduced to exemplify application. We used a mixed-methods approach to assess the outcomes. The average performance in knowledge-based assessments increased before and after the PRIME program from 53.8 to 74.6% and from 47.7 to 75.9%, while the difference in the test scores was statistically significant, with a 21% increase (p &lt; 0.001, 95% CI 15&ndash;26%) and a 28% improvement (p &lt; 0.001, 95% CI 23&ndash;34%) for face-to-face versus virtual PRIME. The results of a student perception survey revealed PRIME was equally effective as a virtual program during the COVID-19 pandemic, suggesting transferability to other pharmacy programs

Impact of a Prepharmacy Program on Students’ Self-Awareness of Pharmacist Professional Identity: Comparison between Virtual and In-Person Settings

Ensuring an adequate preparation for undergraduate students transitioning to pharmacy school is challenging. A significant barrier is changing from a subordinate to a critical thinking mindset while self-identifying as a professional. Here, we aimed to (1) determine whether our prepharmacy program called “Professional Identity and Me” (PRIME) could enhance learners’ self-awareness of their professional identity and (2) compare the effectiveness of the in-person and online versions of PRIME. PRIME introduced prepharmacy students to aspects of pharmacists’ professional identity including community, hospital, and interprofessional work, as well as mental health, wellness, and time and stress management skills, Top-200 drugs, prerequisite foundational sciences, and calculations. Concepts of professionalism, graduate writing, and ownership were also presented. Bridging exercises were introduced to exemplify application. We used a mixed-methods approach to assess the outcomes. The average performance in knowledge-based assessments increased before and after the PRIME program from 53.8 to 74.6% and from 47.7 to 75.9%, while the difference in the test scores was statistically significant, with a 21% increase (p p < 0.001, 95% CI 23–34%) for face-to-face versus virtual PRIME. The results of a student perception survey revealed PRIME was equally effective as a virtual program during the COVID-19 pandemic, suggesting transferability to other pharmacy programs

Effectiveness of an Advanced Naloxone Training, Simulation, and Assessment of Second-Year Pharmacy Students

Background: Opioid overdoses continue to be one of the most urgent public health priorities. In 2020, reported overdose deaths in the United States reached a high of over 93,000 cases. As the COVID-19 pandemic and opioid crisis continues to be addressed, life-saving agents must be more widely accessible to those with a high overdose risk. An essential step to increasing access is to train student pharmacists to dispense naloxone. Once licensed, the number of personnel authorized to dispense naloxone can increase. Objectives: To design a training program to educate second-year pharmacy (P2) students on furnishing naloxone under a state protocol. Methods: A multi-phased curriculum-based naloxone training program was delivered to P2 students and included lecture-based education, team-based learning (TBL) applications, case-based scenarios, and summative assessments to improve student knowledge and confidence in furnishing naloxone. Students were surveyed on their knowledge and confidence with naloxone prior to training, after the in-class training and TBL applications and after three assessments. Assessments included simulated patient counseling, case-based scenarios, and proper dispensing of naloxone in a community pharmacy simulation lab. Results: A total of 185 student pharmacists completed the naloxone training program and 68 completed all three surveys. Average scores for naloxone assessments were 83% for the APPS lab patient case, 90.5% for the prescription label typed for the naloxone product, and 88.5% for patient counseling. Statistically significant increases in knowledge-based quiz-like scores (42.1% after training vs. 7.2% after assessment) and in the proportion of students affirmatively answering survey questions after training and assessment was observed. Conclusion: Multi-phase curriculum-based naloxone training program improved pharmacy student knowledge and confidence in furnishing naloxone under a state BOP protocol

Impact of Completion of a Pre-Pharmacy Biochemistry Course and Competency Levels in Pre-Pharmacy Courses on Pharmacy Student Performance

Poor performance in foundational science courses, which are usually taken during the first or second year of pharmacy school, can have several negative consequences including increases in student drop-out rates and increases in the number of dismissals and remediating students. The primary goal of the current study was to determine whether completion of a pre-pharmacy biochemistry course and/or performance on a biochemistry competency test (administered at the beginning of the pharmacy program) are associated with pharmacy student performance in foundational science courses and overall academic performance. A secondary goal was to determine whether performance in pre-pharmacy courses and/or student demographics are associated with pharmacy student performance. Prospective univariate analyses (n = 75) determined that completion of a pre-pharmacy biochemistry course is not associated with pharmacy student performance. However, performance on a biochemistry competency test was associated with performance in Biochemistry and Cell&amp;Molecular Biology (p = 0.002). Furthermore, post-hoc analyses determined that pre-pharmacy cumulative chemistry GPA correlates with performance in both the Biochemistry and Cell&amp;Molecular Biology and Medicinal Chemistry foundational science courses (p = 0.002 and p = 0.04, respectively) and can predict first year GPA (p = 0.002). The combined data indicate that further assessment of the impact of pre-pharmacy competency in biochemistry and chemistry on pharmacy student success is warranted

Methicillin‐resistant Staphylococcus aureus and Pseudomonas aeruginosa community acquired pneumonia: Prevalence and locally derived risk factors in a single hospital system

Abstract Objectives Current American Thoracic Society/Infectious Disease Society of America (ATS/IDSA) community‐acquired pneumonia (CAP) guidelines expand the CAP definition to include infections occurring in patients with recent health care exposure. The guidelines now recommend that hospital systems determine their own local prevalence and predictors of Pseudomonas aeruginosa and methicillin‐resistant Staphylococcus aureus (MRSA) among patients satisfying this new broader CAP definition. We sought to carry out these recommendations in our system, focusing on the emergency department, where CAP diagnosis and initial empiric antibiotic selection usually ooccur. Methods We performed a retrospective cohort study of patients admitted with CAP through any of 3 EDs in our hospital system in Northern California between November 2019 and October 2021. Inclusion criteria included an ED admission diagnosis of pneumonia or sepsis, fever or hypothermia, leukocytosis or leukopenia, and consistent chest imaging result. SARS‐CoV‐2‐positive cases were excluded. We abstracted variables historically associated with P. aeruginosa and MRSA. Outcome measures were prevalence of P. aeruginosa and MRSA in the overall clinically defined cohort and among microbiologically confirmed cases and predictors of P. aeruginosa or MRSA isolation, as determined by univariate logistic regression, bootstrapped least absolute shrinkage and selection operator, and random forest analyses. Additionally, we describe the iterative process used and challenges encountered in carrying out the new ATS/IDSA guideline recommendations. Results There were 1133 unique patients who satisfied our definition of clinically defined CAP, of whom 109 (9.6%) had a bacterial pathogen isolated. There were 24 P. aeruginosa isolates and 11 MRSA isolates in 33 patients. Thus, the prevalence P. aeruginosa and MRSA was 2.9% in the overall CAP cohort, but 30.3% in the microbiologically confirmed cohort. The most important predictors of either P. aeruginosa or MRSA isolation were tracheostomy (odds ratio [OR] 22.08; 95% confidence interval [CI] 10.39–46.96) and gastrostomy tube (OR 14.7; 95% CI 7.14–30.26). Challenges included determining the suspected infection type in patients admitted simply for “sepsis”; interpreting dictated radiology reports; determining functional status, presence of indwelling lines and tubes, and long‐term care facility residence from the electronic health record; and correctly attributing culture results to pneumonia. Conclusion Prevalence of MRSA and P. aeruginosa was low among patients admitted in our medical system with CAP – now broadly defined – but high among those with a microbiologically confirmed bacterial etiology. Our locally derived predictors of MRSA and P. aeruginosa can be used to aid our emergency physicians in empiric antibiotic selection for CAP. Findings from this project might inform efforts at other institutions