How Should Clinicians Respond to Patient Interest in Dietary Supplements to Treat Serious Chronic Illness?

The Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey data reveal that consumption of over-the-counter vitamins, minerals, and herbals is widespread. Many clinicians, however, lack critical information about their patients' use of dietary supplements. Particularly clinically relevant are supplement ingredients' interactions with prescription medications, supplements' questionable effectiveness in treating serious conditions, and their potential for causing harm. This article considers how clinicians might address dietary supplements' safety, efficacy, and appropriate use with patients.

Examining participant perceptions of the UCSF school of pharmacy master preceptor program

INTRODUCTION

The University of California San Francisco School of Pharmacy faculty created the Master Preceptor Program (MPP) to instill best practices in clinical precepting, leadership and professional development, and interprofessional education (IPE). Graduates of the program are encouraged to mentor colleagues at affiliated sites. This study aimed to explore MPP participants' perceptions about the program and to collect general feedback.

METHODS

A descriptive qualitative study of MPP participants who completed the program between 2017 and 2019 was conducted. Semi-structured interviews and focus groups were used to collect general programmatic feedback and examples of skill implementation. All encounters were conducted and recorded online via Zoom. Three investigators independently analyzed transcripts for codes related to key programmatic areas using conventional content analysis.

RESULTS

Ten of 14 past MPP participants participated. Themes included confidence and skills gained in clinical teaching, self-reflection and network opportunities supporting professional and leadership development, and a need for structured expectations and deliverables. Participants noted several benefits of the MPP on clinical teaching, such as improving confidence and adopting teaching techniques, structural and organizational skills, and a learner-centered approach. Participants also mentioned programmatic offerings that improved leadership and professional development, such as networking opportunities in the MPP and at conferences. Participants did not mention IPE in their responses.

CONCLUSIONS

All participants recognized the MPP as an effective training program to enhance clinical precepting skills, leadership, and professional development. Program structure and intentional incorporation of IPE skills are areas of improvement for future cohorts.

The Evolution of Drug Information Services to Asynchronous Delivery of Pharmacist eConsults

Drug information (DI) services provided an avenue to expand the role of pharmacists as the medication experts. The focus of DI has shifted from general questions submitted to DI centers to patient-specific questions that optimize care. One method to increase access to pharmacist expertise is through pharmacy eConsults. Pharmacy eConsults provide specialist care for medically complex patients using a patient-centered, asynchronous approach. The purpose of this article is to describe the evolution of consults from formal drug information services and describe one academic medical center's implementation of a pharmacy eConsult service to provide patient-specific DI.

Development, Implementation, and Evaluation of Introductory Pharmacy Practice Experiences at an Academic Medical Center

Purpose

Introductory pharmacy practice experiences (IPPEs) for pharmacy students are required by the Accreditation Council for Pharmacy Education, but guidance for rotational structure is limited.

Objective

To describe the design, implementation, and evaluation of IPPE rotations at a large, multisite, academic medical center.

Conclusion

A large IPPE program was successfully implemented and sustained. Rapid cycle changes were made based on post rotational surveys completed by both preceptors and IPPE students to assess and modify the rotations until the average experience was rated at least a 4 on a 5 point scale, illustrating a mutually beneficial collaboration between the Medical Center and the School of Pharmacy. The IPPE program structure and capacity has continued to grow at the Medical Center in a collaborative manner.

Effect of influenza vaccination on international normalized ratio during chronic warfarin therapy

WHAT IS KNOWN AND OBJECTIVE

Warfarin is a widely used anticoagulant, well-known for its interactions with medications and foods. Vaccinations, particularly the influenza vaccine, have been thought to potentially interfere with anticoagulation response in those on chronic warfarin. Our objective was to systematically review the literature to assess the validity and clinical significance of this association.

METHODS

A primary literature search was performed using MEDLINE (1966 - June 2011) and EMBASE (1980 - June 2011). Additional studies were obtained by performing a manual bibliographical review of literature from the initial results and by searching The Cochrane Database of Systematic Reviews. All English-language, peer-reviewed publications identified were evaluated. Reviews, case studies and trials reporting anticoagulation response using an unconverted prothrombin time ratio were excluded.

RESULTS AND DISCUSSION

Thirty-one abstracts were initially reviewed, and seven studies were identified for inclusion in this review. Significant changes in mean INR post-vaccination between the study and comparator groups were documented in one trial. Through subgroup analysis, another study noted that elderly patients spent more time in the subtherapeutic range post-vaccination when compared with baseline INR levels. No other significant changes in mean INR levels were documented following influenza vaccination. Adverse bleeding events reported after immunization were limited and minor in nature.

WHAT IS NEW AND CONCLUSION

Overall, our review does not indicate a consistent, clinically relevant effect of influenza vaccines on INR of patients on chronic warfarin therapy. Isolated reports of variations in INR following influenza vaccination are likely due to other factors.