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Objective: To determine whether a pharmacist-led intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting. Design: Prospective quality improvement intervention in an academic family medicine clinic. Methods: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set. Results: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person. Conclusion: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.

There is a recent and increasing trend in the incidence of pancreatic neuroendocrine tumors (PNETs). Ki-67 proliferative index is required for routine pathologic evaluation of PNETs. This index has been found to be a consistent prognostic factor to assess clinical/prognostic outcome of PNETs. Unfortunately, we still lack a standardized method to reliably obtain the Ki-67 proliferative index. As part of a large study to standardize this index, here we present an accurate, easy-to- use, reproducible method to identify tumor nuclei and hotspots within PNETs. We modified the U-Net image segmentation architecture to identify tumor positive and negative nuclei. We also introduced the concept of local depth for identification of hotspots. On an independent test set of 8 whole slide images, the modified U-Net achieved a sensitivity of 96.2% and specificity of 93.3%. The hotspot detection framework resulted in a dice coefficient of 0.81. The method has the potential to not only facilitate the detection of tumor nuclei, but can be adapted to reproduce hotspots by pathologists.

The prevalence of diabetes continues to rise worldwide. Over the past five years, available treatment options have expanded to allow individualized management of patients with diabetes. The glucagon-like peptide-1 (GLP-1) receptor agonists have become an essential tool in the management of type 2 diabetes mellitus (T2DM). This class provides several advantages for glycemic control with minimal risk of hypoglycemia. Based on the most recent guidelines for T2DM, GLP-1 receptor agonists can be prescribed as monotherapy or in combination with oral antidiabetic agents or insulin for the management of T2DM. Dulaglutide has become the most recent and available GLP-1 receptor agonist on the market. Dulaglutide is a once-weekly GLP-1 receptor agonist that can be used as monotherapy or as a second-line agent for T2DM. This review article summarizes the efficacy, safety, and clinical attributes of dulaglutide among patients with T2DM.

Since 1990, the prevalence of obesity has been steadily increasing in the United States. Over the past four years, new medications have become approved and available, allowing for more options in the management of chronic weight loss among overweight or obese patients. This review article summarizes the efficacy, safety, and clinical attributes of liraglutide among overweight or obese patients with or without comorbidities. Areas covered: A MEDLINE search, from 1970 to June 2016, was conducted using key terms-glucagon-like peptide-1 receptor agonist, liraglutide, overweight, and obesity. Published clinical trials, in the English-language and with primary endpoints related to weight loss, were reviewed and critiqued in this article. Expert commentary: Available as a subcutaneous daily injection, liraglutide is the first glucagon-like peptide-1 (GLP-1) receptor agonist indicated for obesity management, as adjunct therapy with lifestyle and behavioral modifications. Liraglutide 3 mg daily has been associated with greater weight loss than placebo or orlistat in patients without type 2 diabetes. Additionally, liraglutide has resulted in reductions in waist circumference, systolic and diastolic blood pressure, and improvements in lipid panel among overweight and obese patients with and without type 2 diabetes.

Background Active learning is an essential component in pharmacy education and has become a focus of governing bodies and pharmacy education organizations. Many strategies exist by which faculty can accomplish active learning in the classroom. Methods This study was conducted to determine if clinical controversy debates achieve the course objective to critically evaluate clinical trials and guidelines in order to form and support an opinion regarding a current clinical controversy facing ambulatory care pharmacists today. Debates were based on cases written by instructors, and arguments were based on primary literature identified by students. Students enrolled in an Ambulatory Care Elective responded to a 9-question survey at the completion of the semester, assessing time spent on debate preparation, debate style preference, and assessment of the role of the debates in their learning and skill development. Results There was a 72% response rate (n = 13) from students who completed the course. Results from the survey showed that all students who completed the survey strongly agreed or agreed that the course outcome was met and clinical controversy debates aided in achieving the outcome. Additionally, all students strongly agreed or agreed that the debates improved their ability to apply a clinical trial to a patient and make an evidence-based medicine recommendation. Conclusion The authors conclude that this study illustrates a useful pedagogical strategy for implementing in-class debates into the pharmacy curricula while also enhancing evidence-based medicine and critical thinking skills.

Interindividual variability in response to 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, with regard to both efficacy and safety is an obvious target for pharmacogenetic research. Many genes have been identified as possible contributors to variability in statin response and safety. Genetic polymorphisms may alter the structure or expression of coded proteins, with potential impacts on lipid and statin absorption, distribution, metabolism, and elimination as well as response pathways related to the pharmacologic effect. Many studies have explored the variation in statins' pharmacokinetic and pharmacodynamic parameters; however, to our knowledge, few have established definitive relationships between the genetic polymorphisms and patient outcomes, such as cardiovascular events. In this review article, we provide a statin-based summary of available evidence describing pharmacogenetic associations that may be of clinical relevance in the future. Although currently available studies are often small or retrospective, and may have conflicting results, they may be useful in providing direction for future confirmatory studies and may point to associations that could be confirmed in the future when more patient outcomes-based studies are available. We also summarize the clinically relevant evidence currently available to assist clinicians with providing personalized pharmacotherapy for patients requiring statin therapy.

This article describes how to introduce pharmacy students to online pharmacogenomic resources and also to apply pharmacogenomics to clinical patient scenarios. This novel approach has been successful by integrating medical genomics into a core curriculum at a new school of pharmacy. To date, implementation of clinical exercises within a pharmacogenomics course has been well received by pharmacy students. The exercises have proven to be successful in enhancing students' understanding of the clinical applicability of pharmacogenomic concepts. As pharmacogenomics is a topic of increasing importance in the health care field, it is crucial to continue to identify successful ways in which this concept can be integrated into the pharmacy curriculum.

Clinical pharmacy has a rich history of advancing practice through innovation. These innovations helped to mold clinical pharmacy into a patient-centered discipline recognized for its contributions to improving medication therapy outcomes. However, innovations in clinical pharmacy practice have now waned. In our view, the growth of academic–practice partnerships could reverse this trend and stimulate innovation among the next generation of pioneering clinical pharmacists. Although collaboration facilitates innovation,academic institutions and health care systems/organizations are not taking full advantage of this opportunity. The academic–practice partnership can be optimized by making both partners accountable for the desired outcomes of their collaboration, fostering symbiotic relationships that promote value-added clinical pharmacy services and emphasizing continuous quality improvement in the delivery of these services. Optimizing academic–practice collaboration on a broader scale requires both partners to adopt a culture that provides for dedicated time to pursue innovation, establishes mechanisms to incubate ideas, recognizes where motivation and vision align, and supports the purpose of the partnership. With appropriate leadership and support, a shift in current professional education and training practices, and a commitment to cultivate future innovators, the academic–practice partnership can develop new and innovative practice advancements that will improve patient outcomes.