Search

Background: As direct oral anticoagulants (DOACs) have become widely recommended as first-line anticoagulation therapy, patients who remain on warfarin are likely those unable to afford, adhere to, or utilize DOAC therapy due to the presence of a contraindication. It is currently unknown how availability of DOACs have affected populations being managed at warfarin (VKA) anticoagulation clinics. Methods: This was a retrospective chart review assessing warfarin-treated patients at an outpatient anticoagulation clinic. The primary endpoint was the 6-month time in therapeutic range (TTR) before and after DOACs were recommended as first-line therapy by clinical guidelines. Study periods were January to June 2015, before DOACs were recommended over VKA, and January to June 2022, when DOACs were often recommended over VKA. TTR, demographic changes, and the presence of contraindications to DOAC therapy in the clinic population between the two time periods were assessed. Results: No difference in 6-month TTR was observed between study periods (59% in 2015 vs 63% in 2022; P = .45). Patient demographics did not significantly vary, which may be due to the clinic retaining 45% of patients between both time periods. Contraindications to DOAC therapy were identified in 39% of the 2015 group and 49% of the 2022 group ( P = .18). The most common contraindication was indication for anticoagulation. Conclusion: Availability of DOACs did not seem to significantly affect the population or management of warfarin-treated patients at an outpatient anticoagulation clinic, however, contraindications and potential challenges to use of DOAC therapy are present in many patients., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: This study aims to explore the results of a Cultural Competency Assessment of Pharmacy Students (CCAPS) survey to identify areas where cultural competence content in one college of pharmacy curriculum can be improved., Methods: The 39-item CCAPS survey was developed and administered to Doctor of Pharmacy (PharmD) students from July 2022 (after the end of the didactic curriculum and at the beginning of experiential rotations for fourth-year students) to October 2022 (at the beginning of the fall semester for first-year, second-year, and third-year students). Self-perception of cultural competency items were selected from the Cultural Competence Assessment Instrument and the Clinical Cultural Competency Questionnaire items. Responses were collected anonymously and analyzed in the aggregate by academic year using SPSS., Results: A total of 541 students participated, with ethnicities including White/European American (26.6%), East/South/Southeast Asian (17%, 18.5%, 5.4%), Arab/Middle Eastern (17.9%), African American/Black (6.7%), and Hispanic (6.1%). Two-thirds of respondents identified as "very or extremely" culturally competent, and 78% reported comfort interacting with culturally diverse patients. Students scored lower on questions that assessed their comfort interacting with patients who have limited English proficiency or who refuse medications due to cultural reasons. Students in the fourth year reported more difficulty practicing skills related to cultural competency in their daily lives compared with students in other years., Conclusion: Using the CCAPS survey annually could help evaluate the cultural competency of pharmacy students across different academic years and identify gaps in the curriculum related to cultural competency., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to describe and evaluate the transition from a specialty service-based prospective order approval system to a computerized clinical decision support (CCDS) tool for apixaban dosing at a community teaching hospital. The primary objective was to assess the impact of the transition on the appropriateness of apixaban prescribing., Methods: A CCDS tool for apixaban dosing was developed and implemented using interprofessional collaboration. A retrospective chart review was conducted for apixaban orders placed before (preimplementation) and after (postimplementation) the CCDS transition. The primary outcome was the percent change in inappropriate apixaban orders, with secondary outcomes exploring percent change of apixaban orders with inappropriate dosing in different patient groups and indications per package insert., Results: Fifty orders were assessed in both arms, with 8% of orders preimplementation and 10% postimplementation deemed inappropriate. After accounting for questionable orders, overall appropriateness of prescribing was 88% preimplementation and 84% postimplementation ( P = 0.7). Challenges with implementation of CCDS included working with available information technology resources and facilitating acceptance of a new ordering process., Conclusions: The implementation of a CCDS tool for apixaban dosing at a community teaching hospital demonstrated comparable rates of appropriateness to the previous specialty service-based approval process. While the transition streamlined resources and improved efficiency, ongoing efforts are needed to address specific dosing challenges. Future research should explore the sustainability and generalizability of CCDS tools in diverse healthcare settings., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Despite recent advances that have improved outcomes following intestinal transplantation (ITx), achieving long-term patient survival and rejection-free survival is still challenging. Understanding the relevance of pre-transplant human leukocyte antigen (HLA) donor-specific antibody (DSA) in ITx and the immunomodulatory potential of the liver within the allograft is crucial to providing an accurate assessment of pre-transplant immunological risk, which could influence and improve post-transplant outcomes further. This was the primary objective of this retrospective study of 95 adult ITx transplants which took place at Cambridge University Hospitals (United Kingdom) between 2007 and 2019. Two novel programs were developed and validated to identify DSA (tested by Luminex single antigen beads) in this dataset. Data analysis utilised Kaplan-Meier survival methods, and statistical analysis was performed using log-rank tests and adjusted Cox models. Fifty-four (57%) ITx cases contained a liver, and 36 (38%) were sensitised to HLA. Pre-transplant DSA > 500 mean fluorescent intensity appeared to negatively affect post-ITx patient survival and rejection outcomes. Additionally, liver-inclusive allografts seemed to show particular resistance to HLA class I DSA. Our data hints towards consistency with other ITx studies where deleterious effects of DSA have been demonstrated, and where liver inclusion is protective from HLA class I DSA. This is in line with current national guidelines for immunological risk. Our publicly available research programs could support future large or multicentre studies where statistically relevant data might be gained., (© 2024 John Wiley & Sons Ltd.)

Background: Pharmacists and pharmacy interns were instrumental in vaccination efforts during the COVID-19 pandemic. Objectives: To identify pharmacy intern involvement in COVID-19 immunization practices in New York State (NYS) and explore interns' perceptions of experiences. Methods: A 34-item survey was developed and administered at 5 pharmacy programs in NYS. Data collected included: perceptions of immunization readiness, participation in immunizations, description of experiences, and perceptions on the role of pharmacists. Respondents also reported on their preparedness to participate in the immunization process and the types of questions received from patients. Data were analyzed using descriptive statistics and thematic analysis. Questions regarding student experiences before and after participating in immunization efforts were analyzed using a two-sample t test. Results: A total of 460 interns participated in the survey with 398 (87%) reporting participation in COVID-19 immunizations. Of those, 231 (58%) participated at work, 146 (36.7) during experiential rotations, and 98 (24.6%) during volunteer experiences. Respondents participated in various components of vaccine delivery including administration ( n = 246, 61.8%). Respondents administered an estimated 57,100 COVID-19 vaccines from December 2020 to April 2021 resulting in significantly higher mean scores for comfort level (5-point Likert scale) administering vaccines after participation (mean score 4.08 ± 1.31) compared to before (mean score 3.61 ± 1.42) ( p < .0001). Themes which emerged regarding student perceptions of their experience are described. Conclusion: Pharmacy intern involvement in NYS COVID-19 immunization practices contributed to public health vaccination efforts. Additionally, interns improved comfort levels with immunization administration and recognized pharmacists' emerging roles within the U.S. healthcare system., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.