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Barnard M, Reid D, LaPorte K, Yang J, Johnson T. Pharmacy Student Education Related to Opioids: A Scoping Review of the Literature. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100688. [PMID: 38513804 DOI: 10.1016/j.ajpe.2024.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This scoping review explores and assesses the extent of the literature on the current state of opioid-related training and education of student pharmacists and identifies areas for further research to improve the preparedness of future pharmacists in managing care for patients using opioid medications. This review also examines and maps the literature as it relates to the 4 substance misuse educational content areas (legal/ethical issues; screening, treatment, and stigma; pharmacology and toxicology; and psychosocial aspects) recommended by the 2020 American Association of Colleges of Pharmacy Special Committee on Substance Use and Pharmacy Education. FINDINGS A systematic literature search was conducted to identify articles reporting opioid-related educational and training initiatives for student pharmacists in the United States through May 2023. A total of 52 articles were included in the review. Nearly 40% of the included studies reported content that addressed all 4 recommended content areas, with only 8 addressing only 1 or 2 content areas. The majority of studies included students in the third year of their pharmacy program, with many reporting interprofessional educational initiatives. Assessments of opioid-related knowledge and attitudes, satisfaction with the activity, and interprofessional attitudes and competencies were reported. SUMMARY Most of the reported activities addressed at least 3 of the recommended educational content areas. However, relatively few reported sufficient details to support the replication of the activities and there is a need to evaluate the effectiveness of these educational initiatives with more vigorous research methodology to determine their potential effectiveness.
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Affiliation(s)
- Marie Barnard
- School of Pharmacy, University of Mississippi, University, MS, USA.
| | - Dorothy Reid
- School of Pharmacy, University of Mississippi, University, MS, USA
| | - Kennedy LaPorte
- School of Pharmacy, University of Mississippi, University, MS, USA
| | - Jiaxin Yang
- School of Pharmacy, University of Mississippi, University, MS, USA
| | - Tess Johnson
- School of Pharmacy, University of Mississippi, University, MS, USA
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McDowell L, Hohmann L, Maxson R. Impact of a Didactic-Experiential Naloxone Learning Model to Improve Student Pharmacist Skills and Patient Care. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100576. [PMID: 37459914 DOI: 10.1016/j.ajpe.2023.100576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To assess the impact of an integrated didactic-experiential learning model on student pharmacists' knowledge, confidence, comfort, and intention regarding provision of naloxone for patients receiving opioid therapy. METHODS An integrated didactic-experiential learning model was developed to bridge learning in the classroom and laboratory with application in the experiential setting. Student knowledge, confidence, comfort, and intentions regarding provision of naloxone services were measured via online survey at predidactic, postdidactic, and postexperiential time points, and analyzed using Friedman's analysis of variance. RESULTS A total of 280 first-year student pharmacists completed the baseline survey. The learning model increased student knowledge, confidence, comfort, and intention regarding naloxone services implementation. Specifically, students reported an increase in mean (SD) knowledge score from 60.85% (17.40%) in the predidactic to 81.47% (13.57%) in the postdidactic period. Similarly, mean (SD) confidence (2.49 [0.75] to 3.56 [0.45]), comfort (2.06 [0.74] to 3.57 [0.45]), and intention (3.46 [0.70] to 3.66 [0.44]) increased from pre- to postdidactic period, and these changes were maintained from postdidactic to postexperiential period. CONCLUSION The didactic-experiential learning model increased student knowledge, confidence, comfort, and intentions regarding naloxone services implementation. We believe that the model fills gaps in student pharmacist education and is the first step in enhancing and sustaining community pharmacy-based naloxone services. Although this study was limited to a single college, it shows the effectiveness of linking didactic and experiential training in improving students' knowledge and skills.
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Affiliation(s)
- Lena McDowell
- Auburn University, Harrison College of Pharmacy, Auburn, AL, USA.
| | - Lindsey Hohmann
- Auburn University, Harrison College of Pharmacy, Auburn, AL, USA
| | - Rebecca Maxson
- Auburn University, Harrison College of Pharmacy, Auburn, AL, USA
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Rawal S, Osae SP, Cobran EK, Albert A, Young HN. Pharmacists' naloxone services beyond community pharmacy settings: A systematic review. Res Social Adm Pharm 2023; 19:243-265. [PMID: 36156267 DOI: 10.1016/j.sapharm.2022.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pharmacists' provision of naloxone services in community pharmacy settings is well-recognized. Recently, studies describing pharmacists' naloxone services in settings other than community pharmacies have emerged in the literature. There is a need to synthesize evidence from these studies to evaluate the scope and impact of pharmacists' naloxone services beyond community pharmacy settings. OBJECTIVES The objectives of this systematic review were to a) identify pharmacists' naloxone services and their outcomes, and b) examine knowledge, attitudes, and barriers (KAB) related to naloxone service provision in non-community pharmacy settings. METHODS Eligible studies were identified using PubMed, Web of Science, and CINAHL. Inclusion criteria were as follows: peer-reviewed empirical research conducted in the U.S. from January 2010 through February 2022; published in English; and addressed a) pharmacists' naloxone services and/or b) KAB related to the implementation of naloxone services. PRISMA guidelines were used to report this study. RESULTS Seventy-six studies were identified. The majority were non-randomized and observational; only two used a randomized controlled (RCT) design. Most studies were conducted in veterans affairs (30%) and academic medical centers (21%). Sample sizes ranged from n = 10 to 217,469, and the majority reported sample sizes <100. Pharmacists' naloxone services involved clinical staff education, utilization of screening tools to identify at-risk patients, naloxone prescribing and overdose education and naloxone dispensing (OEND). Outcomes of implementing naloxone services included improved naloxone knowledge, positive attitudes, increased OEND, and overdose reversals. Pharmacists cited inadequate training, time constraints, reimbursement issues, and stigma as barriers that hindered naloxone service implementation. CONCLUSION This systematic review found robust evidence regarding pharmacist-based naloxone services beyond community pharmacy settings. Future programs should use targeted approaches to help pharmacists overcome barriers and enhance naloxone services. Additional research is needed to evaluate pharmacist naloxone services by using rigorous methodologies (e.g., larger sample sizes, RCT designs).
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Affiliation(s)
- Smita Rawal
- Clinical and Administrative Pharmacy, University of Georgia, Athens, GA, USA.
| | - Sharmon P Osae
- Clinical and Administrative Pharmacy, University of Georgia, Albany, GA, USA
| | - Ewan K Cobran
- Department of Quantitative Health Science, Mayo Clinic College of Medicine and Sciences, Scottsdale, AZ, USA
| | - Alexis Albert
- College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Henry N Young
- Clinical and Administrative Pharmacy, University of Georgia, Athens, GA, USA
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Patterson JA, Miller E, Stevens B, Jay JS, Frankart LM. Patterns of school and college of pharmacy engagement in addressing the opioid crisis. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1215-1221. [PMID: 36117121 DOI: 10.1016/j.cptl.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 07/22/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The American Association of Colleges of Pharmacy (AACP) has emphasized the need to prepare pharmacy students for practicing amidst the opioid crisis. This research aimed to identify patterns and predictors of pharmacy program participation in skills-based education, research, and service activities designed to address this crisis. METHODS Opioid-related activities were identified from the AACP opioid-related activities database and classified by two independent reviewers. The final activities included: (1) direct participation in drug disposal and/or naloxone outreach, (2) opioid-focused research, and (3) skills-based training in the doctor of pharmacy curriculum. Latent class analysis was used to identify classes of program involvement in these activities. Differences in class membership based on program and geographic characteristics were examined using multivariable logistic regression. RESULTS Of the 106 schools included, a minority reported opioid-focused research (38.7%), drug disposal or naloxone outreach (30.2%), or hands-on learning (22.6%). A "highly engaged" class (34.9%) and a "limited engagement" class (65.1%) were identified. "Highly engaged" programs were more likely to report opioid-related research (65.9% vs. 24.6%, P < .001), drug disposal or naloxone outreach events (86.5% vs. 0%, P < .001), and skills-based education (40.5% vs. 13%, P = .001) than "limited engagement" programs. No school or geographic factors were significantly associated with class membership. CONCLUSIONS Nearly two-thirds of schools and colleges of pharmacy reported limited involvement in skills-based education, research, and outreach efforts. Future research should explore other predictors of school-level opioid-related activities, including faculty expertise and institutional priorities.
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Affiliation(s)
- Julie A Patterson
- Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, United States.
| | - Emily Miller
- Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, United States.
| | - Benjamin Stevens
- Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, United States.
| | - Jessica S Jay
- Indivior Inc, North Chesterfield, Virginia, United States.
| | - Laura M Frankart
- Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, United States.
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Wilson M, Bray BS, Remsberg CM, Kobayashi R, Richardson B. Interprofessional education on opioid use and pain identifies team-based learning needs. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:429-437. [PMID: 33715807 DOI: 10.1016/j.cptl.2020.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/14/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND An interprofessional education (IPE) activity was designed for health professional students in pharmacy, medicine, nursing, social work, and addiction studies. The goals were to practice team-based collaboration for patients who are prescribed opioids for chronic pain and to evaluate student responses to the activity. INTERPROFESSIONAL EDUCATION ACTIVITY Student teams were guided through an unfolding patient case that included evaluating the patient's history, screening tool results, morphine equivalent dose, prescription monitoring program report, and videos of a patient-provider interaction. The two-hour, in-person IPE activity culminated in creation of a patient-centered treatment plan. Surveys were administered to compare pre- and post-course opioid knowledge and post-course IPE attitudes among the healthcare professions. DISCUSSION Pharmacy students' baseline opioid knowledge scores were similar to nursing students, significantly lower than medical students, and significantly higher than social work students. Pharmacy students reported significantly higher gains in opioid knowledge than medical students. Nursing and social work students showed significantly higher levels of agreement that the course enhanced attitudes toward interprofessional collaboration compared to medicine and pharmacy students. Students most frequently noted working with other professions as the most valuable aspect of the IPE activity. IMPLICATIONS Training gaps can be met using novel IPE activities specific to chronic pain and opioid use. Depending on profession, students demonstrated varied baseline knowledge regarding opioid use for chronic pain. Comparing knowledge gains and attitudes on IPE collaboration among professions can detect areas for program refinement to address each professions' unique needs.
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Affiliation(s)
- Marian Wilson
- Associate Professor Nursing, Washington State University College of Nursing, 412 E. Spokane Falls Blvd., Spokane, WA 99202, United States.
| | - Brenda S Bray
- Clinical Professor Medicine, Washington State University Elson S. Floyd College of Medicine, 412 E. Spokane Falls Blvd., Spokane, WA 99202, United States.
| | - Connie M Remsberg
- Clinical Assistant Professor Pharmaceutical Sciences, Washington State University College of Pharmacy and Pharmaceutical Sciences, 412 E. Spokane Falls Blvd., Spokane, WA 99202, United States.
| | - Rie Kobayashi
- Professor Social Work, Eastern Washington University School of Social Work, 102 Senior Hall, Cheney, WA 99004, United States.
| | - Barbara Richardson
- Interprofessional Education & Research, Medicine, Washington State University Elson S. Floyd College of Medicine, 412 E. Spokane Falls Blvd., Spokane, WA 99202, United States.
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Pharmacy Students' Perceptions and Stigma Surrounding Naloxone Use in Patients with Opioid Use Disorder: A Mixed Methods Evaluation. PHARMACY 2020; 8:pharmacy8040205. [PMID: 33153144 PMCID: PMC7712231 DOI: 10.3390/pharmacy8040205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022] Open
Abstract
Pharmacists represent a key group of healthcare professionals that can increase awareness and destigmatize naloxone use. The objective of this study was to investigate pharmacy student perceptions of the use, dispensing, and stigma surrounding naloxone. An electronic survey was administered to pharmacy students that included questions about demographics, work history, naloxone use, and naloxone stigma. Separate qualitative interviews were performed to identify themes surrounding naloxone use. Two-hundred sixty-two participants completed the survey. The majority of participants were “highly willing” (74%) to fill a naloxone prescription for a patient and “somewhat comfortable” (38%) in counseling on naloxone; most were “somewhat comfortable” (38%) administering naloxone. Naloxone is “very rarely” (87%) recommended in community workplace settings, and the majority (64%) reported that patients never request information about naloxone availability. Seventy-six percent of respondents reported that naloxone-associated interactions have an influence on the way they communicate with patients in community pharmacy settings. Thematic analyses found that pharmacy students identify the importance of naloxone as a life-saving medication and the need for naloxone training, but patient-perceived stigma and limited access to naloxone remain prevalent. Pharmacy students are generally well-versed and inclined toward distributing, counseling on, and administering naloxone. Naloxone is rarely dispensed and patient conversations involving naloxone are infrequent in community settings. Future efforts focused on approaches toward difficult patient conversations and normalization of naloxone are needed to destigmatize and facilitate use.
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Kuryluk V, McAuley J, Maguire M. Naloxone counseling: Confidence and attitudes of student pharmacists after a volunteer syringe exchange experience. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:429-433. [PMID: 32334759 DOI: 10.1016/j.cptl.2019.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 09/24/2019] [Accepted: 12/07/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Our objective was to assess how a naloxone counseling experience impacted student pharmacists' confidence in counseling patients on naloxone use and their attitudes towards people who use drugs. METHODS Students who completed a naloxone counseling experience at a syringe exchange program were recruited to conduct individual interviews. Investigators asked student participants open-ended questions to identify their perceptions in the following domains: experiences with naloxone, reported impact of naloxone counseling experience on confidence, experiences with people who use drugs, value of the experience, and suggestions for improvement for the experience. RESULTS Fifteen student pharmacists participated in semi-structured interviews. Fourteen of these students reported the experience as extremely valuable in developing their confidence with naloxone. The average change in confidence was 5.2 points on a 1 through 10 scale, and seven of the student pharmacists independently suggested that a naloxone counseling experience be incorporated the required doctor of pharmacy curriculum. The qualitative themes that emerged from student feedback were breaking down the stigma of addiction and feeling useful during this experience. CONCLUSIONS Participation in a naloxone counseling experience at a syringe exchange program was perceived as helpful in improving student pharmacist confidence in counseling patients on naloxone use. Incorporation of required experiential learning about naloxone and people who use drugs may positively impact student pharmacists by giving them more confidence and experience with this underserved population.
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Affiliation(s)
- Victoria Kuryluk
- The Ohio State University College of Pharmacy, 500 West 12th Avenue, Columbus, OH 43210, United States.
| | - James McAuley
- The Ohio State University College of Pharmacy, 500 West 12th Avenue, Columbus, OH 43210, United States.
| | - Michelle Maguire
- Southeast, Inc. Healthcare Services, 16 West Long Street, Columbus, OH 43215, United States.
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Thakur T, Frey M, Chewning B. Pharmacy Student Opioid Consultations with Standardized Limited English Proficiency Patients. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:418-422. [PMID: 32334757 DOI: 10.1016/j.cptl.2019.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/27/2019] [Accepted: 12/07/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Limited healthcare studies have analyzed communication practices with limited English proficiency (LEP) patients. Empirical literature lacks evidence about LEP patient-pharmacist communication about opioid risks. This study aimed to (1) explore topics discussed in opioid medication consults, (2) assess if students inform patients about dependency and overdose risks associated with opioid use and the manner in which those risks were introduced and discussed, and (3) assess LEP specific communication practices. METHODS Third-year pharmacy students in a required communications course consulted LEP standardized patients (SPs) who spoke 30% English and 70% non-English language. The SP followed a script simulating an encounter between a pharmacist and patient picking up a new, month long prescription of oxycodone. All consultations were video recorded and quantitatively coded for verbal and non-verbal communication skills. RESULTS Twenty-three pharmacy students conducted consultations with LEP SPs. The majority of students discussed common side effects, but only a few discussed severe side effects. Four of 23 students named the medication as an "opioid" or "narcotic" and described dependency, overdose, or other opioid specific risks. Students used several filler words, long sentences, and a fast pace. A majority of students used teach back methods to identify patient understanding. Students expressed the need for more structured education and training in providing patient counseling for opioids and communicating with LEP patients. CONCLUSIONS Pharmacy students lack confidence and skills in communicating with LEP patients regarding opioid-specific risks, suggesting structured training is needed.
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Affiliation(s)
- Tanvee Thakur
- University of Wisconsin-Madison School of Pharmacy, United States.
| | - Meredith Frey
- University of Iowa Hospitals and Clinics, United States.
| | - Betty Chewning
- University of Wisconsin-Madison School of Pharmacy, United States.
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Thakur T, Frey M, Chewning B. Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review. J Am Pharm Assoc (2003) 2020; 60:178-194. [DOI: 10.1016/j.japh.2019.06.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/07/2019] [Accepted: 06/18/2019] [Indexed: 01/21/2023]
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Abstract
Across all care environments, pharmacists play an essential role in the care of people who use and misuse psychoactive substances, including those diagnosed with substance use disorders. To optimize, sustain, and expand these independent and collaborative roles, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) has developed core competencies for pharmacists to address substance use in the 21st century. Key concepts, skills, and attitudes are outlined, with links to entrustable professional activities to assist with integration into a variety of ideally interdisciplinary curricular activities.
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Affiliation(s)
- Jeffrey Bratberg
- Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA
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Skoy E, Werremeyer A. The opioid crisis-Educating the next generation of pharmacists. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:431-432. [PMID: 31171244 DOI: 10.1016/j.cptl.2019.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/31/2018] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Elizabeth Skoy
- North Dakota State University School of Pharmacy, PO Box 6050, Dept 2660, Fargo, ND 58018-6050, United States.
| | - Amy Werremeyer
- North Dakota State University School of Pharmacy, PO Box 6050, Dept 2660, Fargo, ND 58018-6050, United States.
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Skoy E, Eukel H, Frenzel J, Werremeyer A. Preparing student pharmacists to identify opioid misuse, prevent overdose and prescribe naloxone. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:522-527. [PMID: 31171255 DOI: 10.1016/j.cptl.2019.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/14/2018] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND PURPOSE All 50 states have implemented policies to improve access to naloxone through community pharmacies. Many states require naloxone-based training for pharmacists before participating in these activities. The purpose of this study was to determine the effects of an opioid misuse and overdose training program on students' knowledge, self-efficacy, and value of pharmacists' role in preventing overdose. EDUCATIONAL ACTIVITY AND SETTING The training program was implemented with third-year professional pharmacy students. Students participated in a 50-min lecture followed by a two-hour hands-on laboratory activity. Students took a pre-survey immediately before the lecture and a post-survey immediately following the laboratory activity. FINDINGS Seventy students completed the pre- and post-surveys. Students showed a significant (p < 0.05) gain in self-efficacy and value after completing the training program, and a significant gain in knowledge from six of the eight related survey items. There was a significant correlation between students' self-efficacy and perceived value of the pharmacists' role in preventing opioid overdose. SUMMARY A training program implemented for third-year pharmacy students increases students' knowledge, self-efficacy, and perceived value. Specifically, the strong correlation seen between self-efficacy and perceived value after completing the training program is important to note as we prepare future pharmacists for their role in fighting the opioid epidemic.
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Affiliation(s)
- Elizabeth Skoy
- North Dakota State University School of Pharmacy, PO Box 6050, Dept 2660, Fargo, ND 58018-6050, United States.
| | - Heidi Eukel
- North Dakota State University School of Pharmacy, PO Box 6050, Dept 2660, Fargo, ND 58018-6050, United States.
| | - Jeanne Frenzel
- North Dakota State University School of Pharmacy, PO Box 6050, Dept 2660, Fargo, ND 58018-6050, United States.
| | - Amy Werremeyer
- North Dakota State University School of Pharmacy, PO Box 6050, Dept 2660, Fargo, ND 58018-6050, United States.
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