• A 12-Month Comparison of Medication Adherence, Combination Therapies, Psychiatric Hospitalization Rates and Cost of Care in Patients with Schizophrenia on Clozapine versus Quetiapine in an Outpatient Mental Health Treatment Facility

      Fankhauser, Martha; Bahraini, Zhinus; Baqseh, Aftehar; Quah, Bee-Chin; College of Pharmacy, The University of Arizona (The University of Arizona., 2007)
      Objectives: This 12-month retrospective, naturalistic study determined medication adherence, psychiatric hospitalizations, cost of services, cost of prescriptions, and rates of polypharmacy (less than 4 versus greater than or equal to 4 concomitant psychotropic medications) for patients receiving clozapine versus quetiapine therapy for the treatment of schizophrenia in an outpatient mental health facility. Methods: The clozapine and quetiapine groups were compared for gender, age, medication adherence rates, hospitalizations, cost of care, polypharmacy, and types of concomitant psychotropic medications over 12-months. The polypharmacy groups for clozapine and quetiapine (e.g., greater than or equal to 4 psychotropic medications versus less than 4 psychotropic medications) were compared for medication adherence. Results: A total of 71 patients met the entry criteria (44 = clozapine and 27 = quetiapine). The two groups were similar for age, gender, court order, average daily dose, and hospitalization rates. The clozapine group had a higher medication adherence rate of 0.901 (e.g., 329 days supply) compared to the quetiapine group’s adherence rate of 0.723 (e.g., 264 days supply) (p=0.007). The clozapine group had higher costs for medication, labs, and other services compared to the quetiapine group, as well as total costs of services (p=0.004). The clozapine group was on fewer concomitant psychotropic medications compared to the quetiapine group based on the rates of polypharmacy. Conclusions: Patient on clozapine therapy had improved medication adherence and lower rates of polypharmacy, but higher costs of care compared to quetiapine. The frequent monitoring required with clozapine may result in medication adherence that results in improved efficacy, less polypharmacy, and lower hospitalization rates. Further studies in larger populations are needed to compare different frequency rates of monitoring patients on outcome measures over a longer period of treatment.
    • A 13-year Review of Initial Employment Trends for Pharmacy Graduates of the University of Arizona

      Boesen, Kevin; Tabis, Ryan; Short, Jeremy; College of Pharmacy, The University of Arizona (The University of Arizona., 2006)
      Objectives: To gain insight into current trends in pharmacy employment directly after graduation in the areas of community, hospital, pharmacy practice residencies and to relate those findings to environmental factors within the field. Methods: An exit survey was distributed to fourth-year students at The University of Arizona College of Pharmacy (UACOP) in the spring prior to graduation during the years 1993 to 2005. Among other items, the survey inquired about each student’s initial job selection. Group I consisted of data from the graduates of 1993-1995, Group II contained graduates from 1996-2000, and Group III included data from students during the years 2001-2005. The groups were compared using the chi-square method. Results: Data were collected from a total of 688 graduating students over the thirteen year period. Groups were assigned based upon the year of graduation. The largest reported difference between the groups was the percentage of students pursuing community practice, increasing from 25% to 51.8% between the groups, respectively (p <0.0001). Additionally, a significant reduction in percentage of students pursuing residency training was also noted, decreasing between Group I (36.2%) and Group III (23.7%), with p = 0.006. There were no significant changes in the percentage of students taking hospital positions throughout the study duration. Conclusions: Over the last 13 years, the percentage of students from The University of Arizona College of Pharmacy that choose community pharmacy as their initial employment is increasing. The percentage of students starting out in hospital pharmacy has remained relatively stable, while the fraction of students choosing to pursue residency training is declining. This trend may be influenced by a variety of factors, including increased salaries in community pharmacy, more openings in the retail practice area, and increased competition for residency positions.
    • A Descriptive Study Identifying Pharmacist Workforce Gaps in Arizona

      Cameron, Caitlin; Fazel, Maryam T.; Fossati, Eliane; Nguyen, Tiffany; Raslan, Gamal; Bermingham, Trevor; Cameron, Caitlin; Alamer, Ahmad; Fossati, Eliane; Raslan, Gamal; et al. (The University of Arizona., 2020)
      Purpose. To determine if there are specific in demand knowledge/skills in pharmacy profession that applicants do not meet. Methods. Arizona licensed Pharmacists as of 5/14/2019, were invited to participate in an optional/anonymous descriptive electronic questionnaire to be completed using QualtricsXM. The survey contained eight domains assessing various knowledge/skills expected from pharmacist applicants. Descriptive statistics were used for respondents' characteristics, Chi-square test for categorical data, multivariate logistic regression to identify respondents' characteristics influencing their responses, and qualitative thematic analysis technique to assess the free responses. Results. Out of 7570 invited pharmacists, 970 responded (response rate=12.8%). In analyses, 686 respondents (88% working, 48.1% with precepting experience, 55.7% involved with hiring) included. Majority worked in chain community pharmacies (32.6%) followed by inpatient setting (21.6%). About 50.1% found pharmacist applicants able to effectively dispense medications and 46.4% able to provide appropriate therapeutic recommendations. Conversely, 42% stated that applicants lacked conflict management skills. Multivariate logistic regression showed respondents involved in hiring were more likely to find applicants lacking management skills, conflict management and laws/regulation knowledge than those not involved in hiring (ORadj=0.51 [95% CI (0.31-0.83), p<0.01], ORadj=0.49 [95% CI (0.29-0.80), p<0.01], ORadj=0.48 [95% CI (0.22-0.99), p=0.05] respectively). Qualitative thematic analysis found 37% of respondents finding applicants deficient in professionalism/work ethic, 34% in patient communication, and 24.2% in management skills. Conclusion. Our findings suggest gaps in management and conflict management skills, professionalism/work ethic, and patient communication in pharmacy workforce in Arizona. Interventions to bridge these gaps should include curricular and real-life trainings in these areas.
    • A Retrospective analysis of costs and trends in the treatment of HCV in the setting of specialty pharmacy

      Mathews, Kelly; Sredzinski, Eric; Allen, Tyler; Liu, Xiyi; Al-Badri, Hala; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: The goal is to determine the incidence of therapy failures in Hepatitis C Virus (HCV) by viral genotype (GT), the costs of therapy, and to investigate trends or specific viral genotypes causing a higher incidence of failure in therapy. Subjects: Patients had to be over 18 and had to have started therapy for HCV at any point during 2018. Patients were excluded from analysis if they did not have a definitive follow-up SVR result reported back to the treating pharmacy. Methods: Data was collected through retrospective chart review and de-identified by pharmacy staff. Demographic data, clinical comorbidities and the length and choice of drug therapy was collected. Data was then analyzed through application of Chi-square and one-way ANOVA. Main Results: Subjects (n=604) on average were 59.2 (±11.6) years of age, with a majority (56%) being of the GT1a. Gender was significantly different between GTs (P<0.05), 1A being primarily male (60% vs 40%) and 3 being higher in female patients (56% vs 44%). GT3 had a significantly lower rate of therapy success (91%, P<0.05). The cost of HCV therapy was not significantly different between GT groups despite a significant difference in choice of therapy (P<0.001). Stratified by GT, the only significant patient factors include average age (P<0.001) and the presence of hypertension (P<0.05), GT1b being the highest in these categories. Conclusions: GT3 had the lowest incidence of therapy success. Analysis of patient factors does not clearly explain this phenomenon, and may be due solely to the viral genotype. The cost of therapy is found to be even amongst GT groups. Additional research may be done to investigate GT groups 4, 5 and 6, or focus on patients who have failed previous HCV therapy.
    • A Retrospective Analysis of Dental Prescribing Trends at a Federally Qualified Health Center

      Slack, Marion; Hicks, Shelby; Norwood, Charles; Phillips, Krystin; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims: Describe dental prophylactic antibiotic prescribing practices at a federally qualified health center (FQHC) and to determine whether antibiotics are being prescribed according to American Dental Association (ADA) recommendations. Methods: A retrospective chart review for patients from January 2018-2019, who were 18+ and had been prescribed a medication for a dental procedure. Exclusion from the provided data included a non-antibiotic prescribed. Results: 178/10,082 de-identified patients were prescribed an antibiotic by a dental provider for prophylaxis. 176/178 (98.9%) of prophylactic antibiotics were prescribed within ADA guidelines. The number of antimicrobial agents used prophylactically were 3 [amoxicillin (n=136, 76.4%), clindamycin (n=38, 21.3%), and penicillin (n=2, 1.1%)]. However, penicillin is not recommended in the ADA guidelines. Conclusion: Most dental providers at El Rio prescribe antibiotics for dental prophylaxis in accordance with the ADA guidelines. This study shows that El Rio dentists are prescribing appropriately for prophylaxis and are helping to reduce antibiotic resistance in the dental field.
    • A systematic Review of Stock Albuterol Laws in the United States

      Phan, Hanna; Hall-Lipsy, Elizabeth; O’Shaughnessy, Scott; Lowe, Ashley; Nash, Bradley; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      BACKGROUND Asthma affects 10% of children in the United States. It is the most common chronic disease affecting school aged children 5 and 50% of them will experience an asthma attack during a one-year period 2 . Asthma causes school absenteeism and increased number of emergency room and urgent care visits compared to their peers 1,3 . All 50 states and the District of Columbia have enacted laws to allow students to carry and self-administer asthma medication while at school and school sponsored events. Children spend most of their day in a school setting or participating in school sponsored activities. Access to their asthma medication is important to prevent or relieve asthma symptoms. Students may not always have access to asthma medication due to lack of a primary care physician or asthma specialist, inability to afford the medication, or no documentation asthma diagnosis4. States have begun enacting laws that allow schools to maintain a supply of "stock inhalers" (i.e., short acting bronchodilators) that may be used to treat students' acute asthma symptoms. Common "stock inhalers" are short acting beta agonists such as an albuterol or levalbuterol inhaler or nebulizer solution. However, consistency in laws responsible for guiding initiation and maintenance of stock inhaler programs, school's access to obtain inhalers, documentation, and school and personal liability, is currently lacking. This review will categorize stock inhaler law variation and the implications for school systems and students.
    • Academic and Training Requirements in Advertisements for Pharmacy Management and Clinical Director Positions: A Follow up

      Murphy, John E.; Ashby, Jade; College of Pharmacy, The University of Arizona (The University of Arizona., 2008)
      Objectives: A follow-up analysis of academic and training requirements found in advertisements for pharmacy management, assistant director, and clinical pharmacy director positions. Methods: Advertisements appearing in the American Journal of Hospital Pharmacy (AJHP) were analyzed for academic and training criteria that were either preferred or required for pharmacy management, assistant director, or clinical pharmacy director positions. Included advertisements were for pertinent positions found in AJHP between January 2002 and December 2007. Some of the requirements or preferences that appeared in the advertisements that were analyzed included the type of pharmacy or other degree, postgraduate training including residencies and/or fellowships, board certification, and experience qualifications. Results: There was a total of 426 advertisements that met inclusion criteria. Results were listed in percentages of advertisements either requiring or preferring a certain qualification. A significant portion of ads sought applicants who had completed a residency (24% - pharmacy manager/director, 50% - clinical director, 47% - assistant/associate manager). Preferences and requirements of the PharmD or MS degree qualification decreased in percent from a previous study. However there was an increase in the relative number of ads pertaining to the MBA preference (9%, n=27). Conclusions: Many of the results from this study were similar to previous studies which looked at job qualifications in pharmacy manager and clinical directors. It remains evident that education, training, and experience play a major role in meeting the qualifications associated with obtaining a job as a pharmacy manager, clinical director, or associate director.
    • Access to Primary Medical Care among Patients with and without Mental Illness in a Rural Setting

      Hall-Lipsy, Elizabeth; Leutz, Kenneth; Elmer, Cody; Elmer, Sarah; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)
      Objectives: To assess access to and quality of primary health care services by individuals receiving meals at a food bank in a rural location using the Primary Care Assessment Tool- Short Form (PCAT-S). Also, to investigate whether individuals with a mental health condition at a rural community food bank receive different care compared to those without a mental health condition. Methods: The PCAT-S, a survey developed by John Hopkins University, was administered to evaluate care at first contact, ongoing care, coordination of care, and comprehensiveness of care. Demographics data (age, gender, health conditions, insurance status, etc.) was also collected. Results: The majority of our participants surveyed lived within an urban zip code (84.8%), had government insurance (81.4%), were male (61.9%), or were Native American (45%). The groups with the highest mean PCAT-S scores were participants with diabetes (mean score= 96.8), participants with no insurance (94.63), and participants who were female (91). The patient populations with the lowest scores were those with less than a high school education (63.11) with serious mental illness (64), or who had bipolar disorder (69). Groups with higher mean PCAT-S scores indicated more involvement with a primary care provider or overall better care within that section of the PCAT-S. Conclusions: Participants with a mental health condition may be receiving less healthcare than those without a mental health condition, especially in the coordination of care between healthcare services, as indicated by lower mean PCAT-S scores. Those living in a rural community, among our population, do not appear to be receiving less healthcare than those in an urban setting.
    • Accuracy and Reproducibility of Injections from Prefilled “Code Cart” Syringes Compared to Standard Polypropylene Syringes

      Edwards, Christopher J.; Nix, David E.; Erstad, Brian L.; Kim, Yoona; College of Pharmacy, The University of Arizona (The University of Arizona., 2023)
      Specific 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.
    • Accuracy of House, MD Season Five Episodes 1-12

      Apgar, David; Armstrong, Edward; Nye, Adam; Post, Tracy; Vomocil, Elisa; Apgar, David; Armstrong, Edward; College of Pharmacy, The University of Arizona (The University of Arizona., 2012)
      Specific Aims: This study was performed to assess the accuracy of the presenting signs and symptoms, diagnostic procedures, and treatments depicted in episodes one through twelve of the fifth season of House, MD. Methods: This study was a descriptive, retrospective evaluation of the accuracy of the first twelve episodes of the fifth season of House, MD. Dependent variables in this study were presenting signs and symptoms, diagnostic procedures, and treatment of the final diagnosis for the primary patient case. A rating of one to four was assigned to each variable, with one being most accurate and four being inaccurate. Statistical analysis consisted of ANOVA and Tukey HSD post-hoc test Main Results: The signs and symptoms had a mean of 2.42 ± 0.669 (95% CI 1.99 to 2.84). The diagnostic tests had a mean of 2.42 ± 1.084 (95% CI 1.73 to 3.11). The treatment had a mean of 1.42 ± 0.9 (95% CI 0.84 to 1.99). ANOVA showed a statistically significant difference among the accuracy ratings of the groups (p = 0.013). Tukey HSD did not show a significant difference between the accuracy of the signs and symptoms and diagnostic tests (p = 1). The test did reveal a statistically significant difference between accuracy of treatment and both the signs and symptoms (p = 0.027) and diagnostic tests (p = 0.027). Conclusions: The treatments shown in House, MD, season five, episodes one through twelve are significantly more accurate than both the diagnostic tests and the presenting signs and symptoms.
    • Accuracy of Medical Information in the Seventh Season of the Medical Television show House, M.D

      Apgar, David; Armstrong, Edward; Warholak, Terri; Foote, Kristy; Marciano, Jackelyn; Pellerito, Joseph; Apgar, David; Armstrong, Edward; Warholak, Terri; College of Pharmacy, The University of Arizona (The University of Arizona., 2016)
      Objectives: To evaluate the level of accuracy of medical information presented in the seventh season of the medical drama, House M.D. To assess the accuracy of the presentation, diagnostic procedures and treatment presented in season seven. Methods: A descriptive, retrospective assessment of the accuracy of all the episodes of the seventh season of House M.D. Three reviewers independently rated the accuracy (on a scale of one to four) for the presenting signs and symptoms, diagnostic procedures, and treatment in each episode. A rating of one meant a correct and usual representation while a rating of two indicated a correct but somewhat unusual representation. A three was given for a correct but extremely unusual representation and a rating of four indicated an incorrect representation. Each researcher independently rated the episodes, and an average for each rating was used for analysis. Results: Results of the ANOVA test demonstrated no statistically significance differences between the three dependent variables (p=0.0782), therefore the Tukey HSD post-hoc test was unnecessary. The average rating for the treatment variable was 2.17 (±1.19), whereas the average ratings for the signs and symptoms and diagnosis variables were 2.74 (±0.92), and 2.87 (±1.14), respectively. The ratings for the treatment variable were more accurate compared to the other two variables. Conclusions: All three dependent variables observed in season seven of House, MD were similar in regards to accuracy falling between a rating of 2.0-3.0 representing a correct but somewhat unusual to a correct and extremely unusual representation.
    • Activation Rates of the ADD-Vantage Medication Delivery System in a Community Teaching Hospital

      Bergstrom, Eric; Wolk, Robert; McLain, Michelle; Palese, Ian; Bergstrom, Eric; Wolk, Robert; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: The objective of this study was to describe the failure rate of activation of medications that employ the ADD-Vantage medication delivery system in one community hospital, Tucson Medical Center (TMC). Methods: A daily, hospital-wide summary was generated identifying all patients currently receiving ADD-Vantage medications using the TMC electronic medical record system, Epic. Data collection occurred on arbitrary days and times from July 2012 to March 2013. Direct observation of a failure or a success in activation occurred by entering a patient’s room after the ADD-Vantage medication was administered by the nurse. Important data collected included: medication, frequency of administration, nursing unit, time of administration, administering nurse, the shift during which the nurse was working and whether or not the medication was or was not properly activated. Main Results: All medications utilizing the ADD-Vantage medication delivery system at TMC were analyzed. The rate of failure across 347 total samples collected on various days and times was 6.92%. Night shift had a higher rate of failure at 11.43% versus 6.41% for day shift (χ2 = 1.23). The General Surgery and Cardiac units of the hospital had the highest rates of failure with 18.18% and 15.38% respectively. Zosyn was improperly activated with greatest frequency with 12 total failures. Conclusion: No statistically significant difference was found between the rates of activation failure for those samples collected during nursing day shift versus night shift. The overall rates of activation failure suggest a significant opportunity for nursing education to improve outcomes.
    • Acute Adverse Effects of Cannabis: A Perspective from Arizona’s Poison Control Centers

      Dudley, Steven; Sinchuri, Chandra; Chau, Dieu; Hoffman, Mark; Heydorn, Christian; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: The overall purpose of this study was to examine and describe some of the acute adverse effects of cannabis that have been reported in the state of Arizona in order to provide insights into potentially pertinent toxicities. Another aim was to examine the data for any correlation between age and side effects experienced. Methods: De-identifed data tables detailing case information for cannabis-related calls made to either of the two poison control centers in the state of Arizona in the year 2017 were prepared and analyzed. Data examined included age, gender, number of substances involved, and general descriptors of the side effects reported for each patient case. A chi-square with Yates’s correction was utilized to look for any association between age group and the different types of adverse effects reported. Main Results: A total of 82 poison control center cases were examined. Side effects involving the central nervous system, cardiac systems, and mental health were among the most commonly reported. No association was found between age and the occurrence of any particular type of adverse effect (p = 0.866). Conclusions: Though seemingly not dependent on the age of the user, our data may suggest that the use of cannabis can potentially contribute to a wide variety of acute adverse effects – most notably involving the central nervous system, cardiac systems, and mental health. However, as this study is lacking in generalizability, further research will need to be done in order to elucidate a more accurate side effect profile.
    • Acute Adverse Effects of Cannabis: A Perspective from Arizona’s Poison Control Centers: Addendum

      Dudley, Steven; Heydorn, Christian; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Specific Aims This is an addendum to Acute Adverse Effects of Cannabis: A Perspective from Arizona's Poison Control Centers. * The original purpose was to examine and describe some of the acute adverse effects of cannabis that have been reported in the state of Arizona in order to provide insights into potentially pertinent toxicities. Another aim was to examine the data for any correlation between age and side effects experienced. The addendum to this study will provide more data to examine while using the same methods. Also, a secondary set of information will be analyzed. It will include if the type/route of cannabis used correlates with the number of side effects. Methods De-identified data tables detailing case information for cannabis-related calls made to either of the two poison control centers in the state of Arizona in the years 2017-2019 were prepared and analyzed. Data examined included age, gender, and general descriptors of the side effects reported for each patient case. A chi-square was utilized to look for any association between age group and the different types of adverse effects reported. For the secondary set of data, a chi-square was utilized to look for any association between types of cannabis use and the different types of adverse effects reported. Main Results A total of 555 poison control center cases were examined. Side effects involving the central nervous system, cardiac systems, and mental health were among the most commonly reported. There was a correlation found between age and the occurrence of any particular type of adverse effect (p < 0.005). Also, there was a correlation found between type of cannabis used and the occurrence of any of the same categorical type of adverse effect (p <0.005). Conclusions This addendum concluded differently from conclusion of AAEC, which concluded that there was no correlation between age groups and side effects. With the additional data included, this project found a correlation. Lack of data was a limitation in AAEC. This addendum was able to show that there was a correlation between age and side effects. The secondary analysis also showed that there was a correlation between type/route of cannabis used and the number of side effects.
    • Adherence in Exercise Meta-Analyses: Assessment and Effect on Study Outcomes

      Slack, Marion; Bae, Jeffrey; Kobleski, Robert; College of Pharmacy, The University of Arizona (The University of Arizona., 2005)
      Objective: The purpose of this study was to explore whether current meta-analyses on exercise interventions assess adherence and/or compliance of the studies included in the meta-analyses and to determine if subject adherence had any effect on outcomes of the analyses. Methods: Data was collected through a search of the MEDLINE database using the key words exercise, adherence, compliance, clinical trials, and meta-analysis. Data on study title, author, number of studies screened, number in meta-analysis, range of sample sizes, total number of subjects, primary intervention, primary outcome, how study quality was assessed, how adherence was assessed, whether adherence was used as a control variable, and did adherence affect the outcome was recorded on a paper and pencil data extraction form. Data was analyzed by constructing a table describing the meta-analyses and calculating the number and percent of analyses that included adherence. The table allowed for the evaluation of the strength and methodology of each piece of literature with respect to acknowledging adherence as a significant variable in the strength and legitimacy of each analysis. Results: Nineteen meta-analyses met our search criteria and were evaluated. Five of the nineteen meta-analyses (26 percent) described a method for assessing adherence. It was found that none of these used adherence as a control variable. Four of the nineteen meta-analyses did not assess the quality of the studies contained within the analysis. One of these meta-analyses suggested that adherence may have confounded outcomes, but did not provide any data to address their concerns. Conclusions: In meta-analyses, adherence is unlikely to be addressed. Current meta-analyses frequently lack methods for assessing adherence, and do not use adherence as a control variable. Whether adherence to exercise regimens affects outcomes cannot be determined from current meta-analyses.
    • Adherence to Mood Stabilizers Using a Pharmacy Prescription Database Analysis: Assessment of the Relationship of Non-Adherence to Hospitalization Rates, Cost of Care, and Gender for Patients with Bipolar Type I Disorder

      Fankhauser, Martha; Slack, Marion; Kale, Andrea; Kuchanskaya, Yuliya; College of Pharmacy, The University of Arizona (The University of Arizona., 2006)
      Objectives: This study utilized a prescription claims database to retrospectively assess the relationship between adherence rates with a mood stabilizer in bipolar type I patients for: gender, age, psychiatric hospitalization rates, cost of services, and concomitant psychotropic medications. Methods: Adult patients with bipolar type I disorder (N=149; F=92 and M=57) who received at least two prescriptions of a mood stabilizer (i.e., carbamazepine, lamotrigine, lithium, oxcarbazepine, and valproic acid) during a 3-month intake period were included. Adherence to the mood stabilizer was retrospectively analyzed using high: >75% (> 274 days) vs. low: < 75% (< 274 days) supply of a mood stabilizer during 12-months. Results: Only 35.6% of the patients (N=53) met the criteria for > 75% adherence and 11.4% (N=17) met the criteria for > 90% adherence. There was a trend toward women having more days supply of a mood stabilizer compared to men (p=0.08) and older patients having a higher adherence rate with a mood stabilizer (p=0.06). The high adherence group had greater prescription costs (p<0.001) and total cost per year (R2=0.34, p=0.064) and more concomitant medications (p=0.04) than the low adherence group. Overall, there were no significant differences between the high and low adherence groups for mean hospital days, inpatient costs, and total cost of care. Among those patients that were hospitalized there was a negative correlation between adherence and inpatient cost (R2=0.49, p=0.024). Conclusions: Our findings suggest that patients with bipolar type I disorder demonstrate poor medication adherence with a mood stabilizer and that adherence rates based on a prescription claims database using two adherence categories may not be a predictive factor for psychiatric hospitalizations or cost of care.
    • Advanced spray dried proliposomes of Fasudil monohydrochloride microparticles and nanoparticles as dry powder inhalers using surfactant mimic-phospholipids for treatment of pulmonary arterial hypertension (PAH)

      Mansour, Heidi; Encinas, David; Ruiz, Victor Hugo; College of Pharmacy, The University of Arizona (The University of Arizona., 2021)
      Fasudil monohydrochloride salt (FMCS) and inhalable lung surfactant-based carriers composed of synthetic phospholipids DPPC (1,2-palmitoyl-sn-glycero-3-phosphocholine) and DPPG (1,2-dipalmitoyl-sn-glycero-3-[phosphor-rac-1-glycerol]) were designed and optimized as Co-spray dried powders using advanced organic solutions. The materials can potentially be used for treatment of various complex pulmonary diseases with this current work focusing on pulmonary arterial hypertension (PAH). Physicochemical characterization was carried out to analyze the morphology, surface structure, size, phase behavior, chemical composition, residual water content, and in vitro aerosol dispersion of the particles. The particle chemical composition was confirmed using attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy. Scanning electron microscopy (SEM) was performed to visualize the surface structure, morphology, and particle size. The residual water content was quantified by Karl Fisher coulometric titration (KFT). Phase behavior was measured using differential scanning calorimetry (DSC). The in vitro aerosol dispersion performance was conducted using Next Generation Impactor (NGI) and FDA approved human dry powder inhaler (DPI) devices (Aerolyzer®, Neohaler®, Handihaler®). Well defined, small, smooth nanoparticles/microparticles were engineered at different molar ratios of FMCS:DPPC/DPPG (25:75, 50:50, 75:25) and had low residual water content. Characteristic absorption bands regions in ATR-FTIR as well as defined endotherm DSC peaks confirmed that the molecular integrity of Fasudil monohydrochloride salt was not affected by the lung surfactant. In vitro aerosol performance demonstrated that the FMCS:DPPC/DPPG formulations may be suitable for targeted pulmonary drug delivery as inhalable powders. These engineered nanoparticles/microparticles composed of FMCS:DPPC/DPPG can be a suitable inhalable pharmacotherapeutic option for the treatment of pulmonary arterial hypertension as well as other complex lung diseases.
    • Aerobic Exercise and its Effects on HbA1c and BMI in Patients With Type 2 Diabetes Mellitus: a Meta-Analysis

      Slack, Marion; Aguilar, Alejandra; Gruhl, Steven; Slack, Marion; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: To assess the effect of aerobic exercise dose has on diabetes control monitoring parameter of HbA1c and BMI. Methods: Studies were found from previous studies and through a search of PubMed. These studies were screened for eligibility and data was extracted using a data extraction tool. The outcomes of HbA1c and BMI were analyzed using Comprehensive Meta-Analysis software and standardized mean difference (SMD) was used to assess the impact of different doses of exercise on the outcome measures. Variability was measured using the I2 statistic and publication bias was assessed. Main Results: Nineteen studies met inclusion criteria and were analyzed. Moderate dose aerobic exercise was found to have moderate effect in reducing HbA1c and BMI (p = 0.00 & 0.03 respectively). Low dose and high dose aerobic exercise were not to reduce HbA1c (p = 0.07 & 0.13) or BMI (p = 0.61 & 0.25). There was excess variation found in both the HbA1c analysis and the BMI analysis (I2 = 72.28 & 84.04 respectively). There was no publication bias found (Kendall’s tau = 0.809). Conclusion: Moderate dose aerobic exercise was effective in reducing HbA1c and BMI, while low dose and high dose aerobic exercise were not found to have a statistically significant effect on either HbA1c or BMI.
    • An Interventional study to assess knowledge and perception of strategies to minimize burnout among PharmD students

      Lee, Jeannie; Chang, John; Robles, Gregorio; College of Pharmacy, The University of Arizona (The University of Arizona., 2020)
      Methods Presentation and Questionnaire administered during college hour collected burnout levels and knowledge base from 2nd year pharmacy students. Main Results A total of 42 second year pharmacy students completed the burnout questionnaire (20 men and 22 women). The data was stratified based on demographic characteristics. There was no statistically significant difference in the burnout scores by age, gender, marital status, having children or type of job they hold. Knowledge based questions showed that students are more aware of burnout and ways to alleviate burnout after attending the burnout management presentation (All P-value < 0.03). Using the modified Maslach Burnout Inventory for students, about 30% of students reported experiencing burnout once a month or less, while 52% of students reported a few times a month and 12% expressed experiencing burnout once a week. Therefore, at least 64% of students were feeling burnt-out a few times a month or more, in the second year of the PharmD program. Conclusion Burnout is evident in second-year pharmacy students at the University of Arizona College of Pharmacy with the majority of participants reporting multiple burnout incidences a month. A student-developed and delivered educational intervention on awareness of burnout management was found to improve participants' knowledge of burnout awareness and ways to alleviate burnout.