Purpose: Adequate bowel preparation is crucial for successful colonoscopy, preventing delays, missed findings, and higher costs. This study compared small-volume preparation (SVP) and large-volume preparation (LVP) in hospitalized patients. Methods: A single-center, retrospective cohort study included 107 patients (SVP: 56, LVP: 51). Primary outcome: time from bowel preparation to colonoscopy. Secondary outcomes: time from admission to colonoscopy, need for additional cleansing, rate of morning colonoscopies, and hospital length of stay (LOS). Results: Median time to colonoscopy was similar (SVP: 21.2 hours, LVP: 19.9 hours; p=0.99). Hospital LOS (SVP: 5.7 days, LVP: 7.1 days; p=0.74) and time from admission to colonoscopy (SVP: 3.6 days, LVP: 3.1 days; p=0.60) showed no significant difference. More LVP patients needed adjunctive laxatives (41% vs. 13%; p<0.001). No significant difference in morning colonoscopies (p=0.25) or additional preparation (p=0.29). Conclusion: SVP and LVP had similar times to colonoscopy and LOS, but LVP required more adjunctive laxatives, indicating lower cleansing efficacy. Further studies are needed.

Background: While previous studies have highlighted the critical need for safe opioid disposal systems, there is limited information regarding patient utilization of these systems. This study aimed to determine if pharmacist-led education improved patients’ use of medication disposal systems. Methods: An observational pilot study was conducted at a single location of a large community pharmacy chain, enrolling patients receiving acute opioid prescriptions for short-term pain management following an outpatient procedure or inpatient admission. The objective was to determine if in-depth, pharmacist-led disposal counseling had an impact on patient utilization of a safe disposal system. Eligible patients were assigned to either the control or study group and underwent the appropriate counseling. Both groups received standard-of-care pharmacist-led counseling at prescription pick-up, and the treatment group received additional information regarding the disposal system. After three weeks, participants were contacted via telephone to determine if the disposal system was used. Results: A total of 100 participants were enrolled, with 63 completing the follow-up questionnaire. Among those, 3 participants (4.8%) reported using the safe medication disposal system for the dispensed opioid or an unwanted medication in their household, though it was unclear if these medications were initially co-dispensed with the disposal system. Twenty-seven participants (42.9%) reported no remaining medication, while 6 participants (16.7%) with leftover medication expressed a desire to keep it in case of future pain. Conclusion: This study demonstrates that patients are unlikely to utilize safe disposal systems for unused opioids, even with pharmacist counseling. These findings highlight the need for further research into effective disposal strategies and the development of more robust interventions to enhance safe medication practices.

Background: This study examines the implications of formulary drug tier systems on the accessibility and affordability of medications for the elderly/geriatric population within the New York metropolitan area. By systematically reviewing the Medicare insurance formularies and evaluating the most prescribed medicines with reported beneficial outcomes for ailments frequently experienced by the geriatric population, this research identifies disparities in drug tier placements and the cost of dispensing that may affect patient outcomes. The focus is on five prevalent conditions: Alzheimer’s dementia, Chronic Obstructive Pulmonary Disease, Rheumatoid Arthritis, Ischemic Heart Disease, and Diabetes Mellitus Type 2 (T2DM). The findings aim to highlight the need for more equitable healthcare policies that consider the financial and medical needs of the elderly population. Methods: This study reviewed the formulary tier systems used by Medicare, the primary insurance provider for the elderly in New York City. The research focused on medications prescribed for Alzheimer's disease, COPD, rheumatoid arthritis, ischemic heart disease, and diabetes. Data on tier placements were extracted from Medicare Part D formularies, with a detailed examination of the criteria for tier assignment. The study identified the three most prescribed medications for each condition, using data from relevant health organizations and literature. An economic analysis was conducted to compare the costs associated with these medications, assessing the financial burden on patients. Results: The study revealed a prevalence of chronic conditions among New York City's elderly population. Medications commonly prescribed for these conditions were reviewed, with a focus on their placement within the Medicare Formulary Tier system and associated costs. The analysis highlighted substantial variations in cost and tier placement, affecting patient affordability and adherence. For example, Alzheimer’s medications like galantamine and rivastigmine were found in higher tiers, leading to increased out-of-pocket expenses, while COPD treatments such as Symbicort and Trelegy Ellipta, although in preferred tiers, still imposed significant financial burdens. Rheumatoid arthritis drugs showed a wide cost range, with Humira in Tier 5 presenting the highest financial challenge. Similarly, ischemic heart disease and type 2 diabetes medications varied in affordability, with drugs like Eliquis and Steglatro positioned in higher tiers, significantly impacting patient costs and potential treatment adherence. Conclusion: Elderly patients in the United States, especially those dealing with chronic conditions are facing a substantial financial strain due to the increasing prices of prescription medications. Even with recent initiatives like the Inflation Reduction Act aimed at lowering expenses, the financial burden persists, causing issues with treatment adherence and negative health results. The results highlight the pressing requirement for more effective policy actions that support price transparency, promote the utilization of cost-effective generics, and deter the unwarranted classification of generic drugs in higher formulary tiers. It is crucial to handle these problems to guarantee fair access to medications for all elderly individuals, specifically those who qualify for both Medicare and Medicaid.

Background: Guideline-directed medical therapy in patients with systolic heart failure (HF) has demonstrated improvement in morbidity and mortality rates. The FDA approved sacubitril/valsartan in 2015 to reduce the risk of cardiovascular death and hospitalization for HF.Objective: The purpose of this study was to evaluate the change in loop diuretic dose and the clinical outcomes of angiotensin receptor-neprilysin inhibitor (ARNI) therapy within a 90-day follow-up period.Methods: A retrospective chart review of 110 HF patients on concomitant ARNI and loop diuretic therapy at New York University Langone Health was conducted. The primary endpoint was a change in loop diuretic dose. Six secondary endpoints, including dose conversion from ACEi or ARB to ARNI therapy, were assessed.Results: Of the 110 HF patients, 72 did not receive diuretic dose adjustments, yet 40 (55.56%) experienced laboratory-dependent dehydration. Fifty-six percent of patients experienced an improvement in systolic blood pressure, and 52 percent experienced a decrease in diastolic blood pressure. Sixty percent of patients experienced an improvement in EF, with a median increase of 10.00% over a 90-day follow-up. A significant negative correlation between patients’ age and absolute change in EF was identified (r= -0.28; p < 0.05), indicating that the increase in EF was stronger for younger patients. Eighteen hospitalizations occurred within a 90-day follow-up, with only 4 patients being admitted for heart failure exacerbation.Conclusion and Relevance: This study examines the real-world effects of ARNI therapy in patients with systolic heart failure. Optimization of HF medications, including ARNI therapy, remains an important factor for achieving the maximum benefits in heart failure management. ARNI therapy requires careful monitoring to ensure effective diuresis in symptomatic heart failure patients while avoiding adverse events. Future studies should address diuretic dose adjustment in conjunction with the administration of ARNI and sodium-glucose cotransporter-2 inhibitors.

Purpose: In the treatment of type 2 diabetes mellitus (T2DM), select sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are recommended based on comorbidities such as chronic kidney disease (CKD), heart failure (HF), and atherosclerotic cardiovascular disease (ASCVD). Because guidelines typically recommend insulin for inpatient treatment of T2DM, there is potential that these therapies may be negatively impacted by hospitalization. This study aimed to assess the effect of hospitalization on outpatient T2DM therapy. Methods: In this retrospective study, patients were included if they had a diagnosis of T2DM plus a comorbidity (CKD, HF, ASCVD) for which they were prescribed an SGLT2 inhibitor or GLP-1 receptor agonist and had a recent hospitalization and follow-up appointment at an outpatient clinic. Electronic medical records were reviewed to determine if these therapies were continued during transitions of care. Data was analyzed with basic descriptive statistics. Results: Thirty-six patients on SGLT2 inhibitor therapy met inclusion criteria. Four (11%) patients were never restarted on therapy outpatient following hospitalization, three of which did not have an appropriate reason for discontinuation. Twenty-two patients on GLP-1 receptor agonist therapy met inclusion criteria. Four (18%) were never restarted on therapy outpatient following hospitalization, two of which did not have an appropriate reason for discontinuation. Conclusion: Five out of 58 patients (8.6%) included in the study experienced an inappropriate discontinuation of therapy throughout the transitions of care process. While most patients had their T2DM medication restarted, this study shows hospitalization can impact guideline-directed outpatient therapy.

Purpose: Benzodiazepines are the mainstay treatment in Alcohol Withdrawal Syndrome (AWS), though they have the potential for abuse and cognitive side effects. Non-benzodiazepines are of growing interest for treatment of AWS; however, the prevalence of non-benzodiazepine use remains unknown. The purpose of this study is to evaluate the prevalence and predictors of non-benzodiazepine use for AWS in the Emergency Department (ED). Methods: A cross-sectional, retrospective study utilizing data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) spanning the years 2014-2020 investigated patients presenting to the ED with AWS. The primary outcome of this study is the prevalence of patients with AWS who received non-benzodiazepine treatment during their ED visit. The secondary outcome was the identification of predictor variables for non-benzodiazepine use. A multivariate logistic regression with a backward elimination approach was employed to identify predictor variables. Results: A total of 2,300 unweighted ED visits included over the study years. When weighted, this represented over 15.2 million ED visits. Across the study period, 3.1% (95% CI, 1.6-6.1%) of patients received non-benzodiazepines. Positive predictors of non-benzodiazepine use included the year 2020 compared to 2014 (OR 6.32, 95% CI, 1.39-28.73) and comorbid depression (OR 4.13, 95% CI, 1.38-12.36). Negative predictors of non-benzodiazepine use included ages 18-40 compared to ages 41-64 (OR 0.34, 95% CI, 0.13-0.91), nursing home residence compared to private residence (OR 0.02, 95% CI, 0.001-0.80), and the South compared to the Midwest region of the United States (OR 0.19, 95% CI, 0.07- 0.51). Conclusion: This study found that non-benzodiazepine use, despite being less common, is becoming more prevalent. Further research is needed to determine the optimal dosing and duration of non-benzodiazepines for AWS. Understanding the factors influencing the prescription patterns of non-benzodiazepines can contribute to informed decision-making and improve the management of AWS.

Introduction: According to the Centers for Disease Control, 11.8% of adults diagnosed with diabetes have severe vision difficulty or blindness, a complication of uncontrolled diabetes. The study evaluated the accessibility features of the most commonly used injectable products for diabetes and blood glucose monitors and obtained recommendations from manufacturers regarding use of these products in patients with visual disabilities. Additionally, accessibility of the medication guides was assessed using a checklist and screen reader. Methods: Selection of the most commonly prescribed insulin products, GLP-1 receptor agonist drugs, and blood glucose monitors were identified from the ClinCalc DrugStats database and ADA list. The accessibility features of these products were determined from the medication guides and verification of the information with the manufacturers were done in August 2022. All medication guides were then assessed using a checklist and tested with a screen reader for accessibility. Descriptive statistics were used to report the data. Results: No injectable products or glucose monitoring systems were fully accessible and manufacturers advised to use the product with caution and/or required assistance from a caregiver or family member. In evaluating the 14 medication guides for accessibility using the checklist, the most common issues were lack of structured headings to help with navigation, no descriptions for images, and tables did not have appropriate headers. Conclusions: Due to the lack of accessible features on diabetes medical devices and glucose monitoring systems, healthcare professionals can seek alternatives to assist this patient population to effectively manage their therapy.

Background: Community pharmacists are often the most accessible member of the healthcare team to many patients and can play a key role in managing their chronic conditions, such as diabetes or heart disease, through enhanced pharmacy services. Despite their accessibility, pharmacy services are often underutilized due, in part, to a lack of adequate reimbursement models that comprehensively encapsulate all elements of those pharmacy services. While routine documentation of services does collect certain qualitative data, they do not always indicate the nuance of the full scope of services with resulting robust impact and value of those services for the patient and healthcare system. Objective: To develop and pilot an online reporting tool for pharmacist documentation of high impact patient intervention "stories" that includes the nuances of care provision processes in outpatient pharmacy settings that promote positive outcomes. Methods: An online Patient Stories Reporting Tool (PRST) was developed to allow outpatient pharmacists to document details on distinct direct patient care encounters, or "stories", that they felt showcased their value. Documentation through PSRT included limited quantitative data and qualitative data with a focus on a free response narrative for the "story". In a pilot, the PSRT was distributed to 18 pharmacists across 16 practice sites from one partnering pharmacy organization. Qualitative data, the focus of the included analysis, was collected, assessed by project team members, and organized by intervention types. Results: Forty-seven stories involving 17 pharmacists across 13 practice sites from August 2021 to March 2023 were reported. Three types of key intervention stories were identified including General Patient Education (7 stories), Medication Optimization (20 stories), and Cost Reduction (20 stories). Given the nature and scope of this initial pilot, one story for each of the three most prevalent intervention types was identified as exemplifying the types of stories the tool can collect and are subsequently discussed in detail. Conclusions: The three selected stories help to characterize the services pharmacists provide, the critical components of pharmacist-patient interactions, and the value of sharing these stories utilizing tools such as the PSRT. Through these stories, the PSRT also begins to record the nuances of pharmacist interventions and the impact they can make in a patient's healthcare journey. Potential applications of the tool are multivarious including supporting improvements in the perception of pharmacists' roles on the healthcare team and justifying expansion of reimbursement models.

Background: Extemporaneous compounding is the preparation of medicines for individual patients when no commercially available authorized form exists. Unlike registered medications, these products are not subjected to various tests for quality by Regulatory Authorities. Data on compounded medications in Ghana is currently inadequate or unavailable. There is the need to collate data that can be used to influence policy and to regulate preparation of extemporaneous products. Aim: To establish the prevalence, scope and quality of extemporaneously compounded medicines at selected hospitals in Accra, Ghana. Methodology: Prescriptions presented at the pharmacies in selected hospitals were reviewed to determine the requests that needed to be extemporaneously prepared as well as the prevalence and the scope of formulations. Three of the most frequently compounded medications were procured and subjected to microbial contamination tests using the pour plate method followed by differential tests if microbes were present. Content analysis of the active ingredients was determined using High Performance Liquid Chromatography (HPLC). Results: 641 requests comprising 49 different extemporaneous products were collated from the hospitals studied. Hydroxyurea, furosemide and spironolactone suspensions were the three most frequently prescribed. Patients aged from 0-2 years had majority of the prescriptions. Conclusion: A population of patients still exist who depend on compounding for their drug needs. 49 different formulations were prepared at one of the hospitals visited. Samples of products analyzed were of good quality.

This book review of The No Club, Putting a Stop to Women’s Dead-End Work, would serve anyone struggling with burnout or lack of promotion. Supervisors can gain a better understanding of how to distribute non-promotable tasks (NPTs) as well as how to properly and fairly ask their employees to complete NPTs. The hope is that by promoting better understanding of NPTs, both individuals and organizations would see a benefit by preventing burnout, achieving higher promotability, and equitable allocation of workload.