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Objectives: The primary objective was to evaluate the correlation between maintenance dose and response rates in neonates less than 28 weeks gestational age. Secondary objectives included clinical indicators of response (number of weight adjustments, dose increases, and mini-loads) and tachycardia associated with caffeine therapy., Methods: This study was a retrospective analysis of neonates admitted to the North Carolina Children's Hospital from August 2009 to August 2011. Patients included were less than 28 weeks postmenstrual age and were treated with caffeine for apnea of prematurity. Patients were excluded if they were older than 28 weeks postmenstrual age, receiving caffeine therapy for other indications, or experiencing apnea from other conditions, or if therapy was initiated more than 7 days after birth., Results: A total of 89 neonates with a mean birth weight of 0.844 kg (range: 0.391 to 1.306 kg) and median gestational age of 26 2/7 weeks (range: 23 to 27 6/7 weeks) were evaluated. The median initial maintenance dose of caffeine citrate was 7.9 mg/kg/day, and 94.1% of neonates receiving ≤7.9 mg/kg/day required a clinical intervention during therapy compared with 76.3% in those receiving >7.9 mg/kg/day. Absolute incidence of tachycardia was low, and caffeine levels collected ranged from 16.6 to 34.4 μg/mL., Conclusions: In neonates less than 28 weeks gestational age, doses of caffeine citrate greater than 7.9 mg/kg/day are safe and are associated with a decreased need for clinical interventions.

Objective: To determine the extent of pharmacist use in medication management, roles of school nurses, and use of other health care providers at elementary schools in North Carolina., Methods: Prospective survey of 153 (130 public and 23 private) elementary schools in four counties of North Carolina. A 21-question survey was e-mailed to the head administrator of each school (e.g., principal, headmaster) containing a Qualtrics survey link. Questions were designed to elicit information on school policies and procedures for medication management and use of health care providers, including pharmacists, in the schools. Responses were collected during a 2-month period., Results: Representatives from 29 schools participated in the survey (19% response rate). All 29 schools reported having a school policy regarding medication administration during school hours. Of those, 27 schools reported consulting with nurses on their policies. Only 1 of 27 respondents reported consulting with pharmacists on medication management policies. The majority of the respondents (93.1%) stated that administrative staff was responsible for medication administration at the schools., Conclusion: Use of pharmacists in creating and reviewing policies for schools and actual medication management at schools was extremely low. The findings in this study reinforce the findings in previous studies that pharmacists are not being used and are not a major presence in elementary school health.

Objective: To develop classroom games as alternatives to traditional pharmacokinetic instruction., Design: three classroom games were created for the following purposes: simple semester review, application of pharmacokinetics in a community-pharmacy setting, and development of critical thinking skills and concept application. All the games incorporated some degree of group activity., Assessment: A survey was conducted of students' attitudes towards the incorporation of games into the classroom. A comparison of final examination scores to scores from the previous year was used to determine whether incorporating games hindered learning., Conclusions: Overall, students found the games enjoyable, but some students questioned how much they learned. Although the games appeared to have a positive impact on grades and incorporated more than just factual, book knowledge (eg, critical thinking skills), determining how these games improved learning will require further assessment.