Notes

A new glass windows strategy for sustentaculum tali attach fixation while using the sinus tarsi means for calcaneal breaks: a cadaveric study.
he primary targets of states looking to decrease regulatory burdens and that regulatory boards have a significant opportunity to remove regulatory burdens even in the absence of legislative action.
A statewide opioid risk screening program was introduced to pharmacists to provide them with resources to screen patients who are prescribed an opioid medication. Using opioid risk screening equips pharmacists to deliver education and patient-centered interventions for opioid harm reduction. Nearly 50% of pharmacists that enrolled their pharmacy to participate in this program did not actively implement the program to patients. Little research is dedicated to examining factors which contribute to unsuccessful implementation of pharmacy-centered interventions. This research aims to describe barriers and beliefs which may hinder the ability of pharmacists to integrate innovative practices into existing workflow.

Using the theory of planned behavior, determine what attitudes and beliefs contribute to unsuccessful implementation of opioid risk screening.

A survey was developed within the context of a theoretical framework and distributed to pharmacists who did not successfully implement opioid risk screeningmost influential factor in unsuccessful implementation of opioid risk screening.
These results suggest that perceived behavioral control of pharmacists is the most influential factor in unsuccessful implementation of opioid risk screening.
Traditional advanced pharmacy practice experiences (APPEs) in academia provide students exposure to job responsibilities and expectations of pharmacy faculty members. The purpose of this manuscript is to describe the development and structure of a precepting-focused academic APPE, APPE student perceptions of the experience, and introductory pharmacy practice experience (IPPE) student perceptions of being precepted by APPE students.

An academic pharmacy APPE was developed to emphasize preceptor development in addition to traditional academic pharmacy topics and responsibilities. Pre- and post-experience surveys were completed by APPE students to collect perceptions of academic pharmacy and precepting. During the experience, APPE students, under the supervision of faculty, precepted IPPE students, who were given the opportunity to assess the APPE student's precepting ability by completing a survey following the experience. Descriptive statistics were used to analyze the results.

Nine students completed tharmacy preceptors."Prescription adaptation services" (PAS) refers to the ability of pharmacists "to adapt an existing prescription when, in their professional judgment, the action is intended to optimize the therapeutic outcome of treatment." If structured appropriately, PAS can provide a benefit in enhancing the timeliness of patient care, while reducing the administrative burden on both physicians and pharmacists. Moreover, it leverages the strengths of both health professions, specifically the medication expertise of pharmacists. Unfortunately, in most states it will require a change in regulations in order to enable PAS.
Burnout syndrome is well-documented among healthcare professionals across various practice settings. There has been recent expansion of Canadian pharmacists into team-based primary care and burnout in this setting has not been assessed. Our objective was to assess workplace burnout and to identify factors that play a role in perpetuating or diminishing it.

An online survey to assess burnout was developed using the Maslach Burnout Inventory (MBI) tool and questions regarding pharmacist background and practice. Invitations to complete the survey were sent to Canadian pharmacists working in team-based primary care settings on November 26, 2019 via a national primary healthcare listserv.

A total of 31/433 completed responses were collected. The main analysis focused on the personal accomplishment (PA) domain as it had an adequate response rate. The PA domain had a median score of 5.0 (95% CI 4.69-5.22). We compared medians of the PA domain across different groups of each categorical variable. We found that the number of years working in primary care settings was positively associated with a higher PA domain score (p= 0.029).

PA was higher in pharmacists who have been practicing in a primary care setting for longer; however, burnout rates could not be properly assessed due to the limited response rate.

This is the first study to assess burnout among Canadian team-based primary care pharmacists. Personal accomplishment was higher in those who have been practicing in a primary care setting for longer. Future studies should consider alternate methods to evaluate burnout in this population.
This is the first study to assess burnout among Canadian team-based primary care pharmacists. Personal accomplishment was higher in those who have been practicing in a primary care setting for longer. Future studies should consider alternate methods to evaluate burnout in this population.This latest version of the Minnesota guidelines is intended to reassert the application of the standards of normal science in formulary submissions for new and existing pharmaceutical products and devices. This represents a paradigm shift from the existing value assessment standards which are focused on imaginary or I-QALY modeling of lifetime claims. The proposed new paradigm rejects this as pseudoscience; a failure to recognize the standards of normal science, in particular a failure to recognize the constraints of fundamental measurement. As a result, current health technology assessment is dominated by value assessments that create claims that are neither credible, nor empirically evaluable or replicable. The fatal flaw is the failure to recognize that QALYS are an impossible mathematical construct (hence the term I-QALY). The proposed paradigm recognizes that if there are claims for product value then, regardless of whether the claim is for clinical impact, quality of life or resource utilization, all claims must be empirically evaluable. If not, then they should be rejected. The Minnesota guidelines propose a new evidence based approach to formulary assessment, together with ongoing disease area and therapeutic class reviews. The focus is on claims that are specific to target patient populations that are claims for specific attributes and are consistent with the axioms of fundamental measurement. Manufacturers are asked to support claims assessment through protocols detailing the evidence base for claims assessment, the timelines for those assessments and the process by which claims assessments are reported back to formulary committees. Value assessment leads naturally to value contracting, revisiting provisional prices as new information is discovered and delivered to the formulary committee.
Type 2 diabetes mellitus and gastroesophageal reflux disease are highly prevalent in the United States. First-line therapies for these disease states include metformin and proton pump inhibitors, respectively. Both of these medications have been associated with a decreased absorption of vitamin B12.

The objective of this study was to assess the prevalence of B12 monitoring and supplementation in patients receiving concomitant metformin and PPI therapy.

A retrospective data analysis was performed at a single federally qualified health center. buy Oltipraz Patients receiving concomitant metformin and PPI therapy (specifically omeprazole and pantoprazole) over the past year were included. Data collected included demographics, dosing, therapy duration, and vitamin B12 level. Data were analyzed using descriptive statistics.

A total of 104 patients met the inclusion criteria for this study. Metformin 1000 mg immediate release tablets was the most common dose and formulation prescribed. Omeprazole and pantoprazole were td B12 level. Of those patients, none were categorized as deficient. Though routine monitoring of B12 levels may be important for patients on long-term therapy with both agents or who present with symptoms of B12 deficiency, this study does not support routine monitoring of B12 levels for patients with duration of therapy of 4 years or less.Pakistan is one of the countries with the highest number of medications filled per prescription due to overly prescribed antibiotics and injectable drugs. This is due to a lack of ethical practices in prescribing because doctors aresignificantly influenced by lucrative financial incentives of pharmaceutical companies rather than clinical findings. This immoral activity has become significantly amplified over the past few years and continues to be a challenge in Pakistan. Currently, there is no code of ethics for marketing and promotional activities of pharmaceutical companies. This year, authorities have step up and are in the process of creating policies to regulate companies and practitioners. Implementation of these new policies needs vigilance from health officials, strong professional commitment and institutional collaboration. If executed correctly, these polices should create an environment of professionalism within the healthcare sector.
The purpose of this study was to evaluate the impact of sugammadex on operating room (OR) times versus neostigmine in patients recovering from rocuronium or vecuronium induced neuromuscular blockade.

This retrospective cohort study evaluated patients 18 years or older with an American Society of Anesthesiologists (ASA) physical status of I-III who received sugammadex or neostigmine (January- October 2017) for reversal of rocuronium or vecuronium at a 500 bed, community hospital. Patients who were pregnant or breastfeeding were excluded. The primary outcome measure was the time from sugammadex or neostigmine administration to OR exit. The primary outcome was evaluated using a linear regression model adjusting for inpatient procedures, age, sex, body mass index, and ASA score. Secondary outcomes included the incidence of bradycardia as well as nausea and vomiting.

The baseline characteristics of the patients in the cohort (sugammadex=134, neostigmine=143) were similar. The median time from drug administration to OR exit was similar for neostigmine and sugammadex (16 vs. 15.5 minutes, p=0.11). Sugammadex had a statistically significant reduction in time from drug administration to OR exit (coefficient -2.7 minutes, 95% confidence interval -5.2 to -0.2 minutes) in the multivariable linear regression model. Sugammadex had lower rates of bradycardia (5.6 vs. 2.2%) or nausea and vomiting (18 vs. 11%) that did not reach statistical significance.

Sugammadex had statistically shorter OR exit times after drug administration in the cohort. The mean 2.7 minute benefit is unlikely to be clinically meaningful and limits its application in practice unless larger cohorts detect a benefit due to a significant reduction.in.adverse.events.
Sugammadex had statistically shorter OR exit times after drug administration in the cohort. The mean 2.7 minute benefit is unlikely to be clinically meaningful and limits its application in practice unless larger cohorts detect a benefit due to a significant reduction.in.adverse.events.Recent attention has been afforded to the concept of burnout and other quality of worklife issues among pharmacy faculty, underscoring the importance of organizational culture, citizenship, collegiality, and support. Support comes from the larger academic institution, the college/school, and individual colleagues. Evidence points to reassurance of worth, guidance, and positive affirmation as being among the most salient factors in mitigating burnout of faculty, who are caught in the midst of increasing demands and higher administrative burdens. A supportive culture that reassures worth of individual faculty is not a unidimensional typology, but rather, is one that permeates through all components of a multifaceted and strong culture that encourages citizenship. There is a growing body of research and evidence on faculty burnout and related factors. This commentary calls for the use of such evidence in guiding policies, creating mentoring programs, and carrying out daily activities in much the same manner that scholars use the best available evidence in their own specific lines of inquiry in teaching and research.
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