Abstracts for Senior Projects: College of Pharmacy
The University of Arizona
Class of 2012
Marion Slack, PhD, Course Coordinator
1. Title: Clinical and economic characteristics associated with inpatient cases of non-Acquired Immune Deficiency Syndrome (AIDS)-defining
malignancies in the United States, 2005-2009
Project Advisor(s): Grant Skrepnek, PhD
Student(s): Neha Giridharan and Christine Aguilar
Specific Aims: To evaluate disease- and patient-related characteristics, mortality, and charges associated with non-AIDS defining malignancies
(NADM) among inpatient settings in the United States from 2005 to 2009.
Methods: This retrospective cohort investigation utilized nationally-representative hospital discharge records from the Agency for Healthcare
Research and Quality (AHRQ) Healthcare Cost and Utilization Project (H-CUP) Nationwide Inpatient Sample. Inclusion criteria included adult
inpatients ≥18 years with a diagnosis of HIV or AIDS and malignant neoplasms. Multivariate regression analyses were used to assess inpatient
mortality and charges.
Main Results: Overall, 104,488 were included. Average age associated with each case was 46.9 years (±10.66), with 21.9% cases being female
(n=22,868). The mean length of stay was 8.6 days (±10.5) and inpatient mortality occurred in 7.7% of cases (n=8,035). The mean number of
procedures performed was 2.3 (±2.5) and the mean number of diagnoses on record was 9.5 (±4.4). Charges for each episode of care averaged
$59,483 (±85,748), summing to a national bill of $6.14 billion (2011 dollars) over the five-year course. A higher number of cases were associated
with teaching hospitals (74.1%), the south (42%), large metropolitan areas (75.1%), median household income in the 0-25th percentile (41.2%), and
Medicaid payers (34.3%). Increased mortality was associated with increased age, increased number of diagnoses and procedures, and the
comorbidities of anemia, coagulopathy, lymphoma, and fluid and electrolyte disorders.
Conclusions: This investigation of NADMs suggest a considerable clinical and economic burden of illness, summing to a 7.7% inpatient death rate
and $1.3 billion in charges per year.
2. Title: Inaccuracies in the Second Half of Season Five of the Medical Drama, House, MD.
Project Advisor(s): David Apgar, PharmD
Student(s): Bernadette Aragon and Erica Luiten
Specific Aims: To assess the accuracy of the presenting signs and symptoms, diagnostic procedures, and treatments presented in the last twelve
episodes of season five of the popular medical drama, House, MD.
Methods: A descriptive retrospective evaluation of the accuracy and inaccuracies of episodes 13 to 24 in season five of the television series House,
MD. The accuracy of the presenting signs and symptoms, diagnostic procedures, and treatment in each episode was rated on a scale of one to
four. A rating of one described a correct and usual representation. A rating of two described a correct but somewhat unusual representation. A
rating of three described a correct but extremely unusual representation. A rating of four described an incorrect representation. Each researcher
independently rated the episodes, and then a collaborative rating was agreed upon by both researchers.
Main Results: Results of the ANOVA test demonstrated a statistically significant difference between the three dependent variables (p=0.002). The
Tukey HSD post-hoc test confirmed a significant difference between the accuracy of treatment when compared with signs and symptoms
(p=0.012), and with diagnostic procedures (p=0.002). The average rating for the treatment variable was 1.58 (0.9), whereas the average ratings
for the signs and symptoms and diagnosis variables were 2.75 ( 0.754), and 3 (1.128), respectively.
Conclusions: The treatments presented in the last twelve episode of season five of House, MD were more accurate than both the presenting signs
and symptoms and the diagnosis.
3. Title: Evaluating Student Pharmacists’ Comfort Level and Effectiveness in Referring Tobacco Users to a Quit Line During Health Screening
Events: A Pilot Study at One University
Project Advisor(s): Jenene Spencer, PharmD
Student(s): Mary Babico and Emily Lundeen
Specific Aims: To assess the number of patients referred to ASHLine during the health screenings performed by University of Arizona College of
Pharmacy students; and to identify the comfort level of students who asked patients about their smoking status.
Methods: An anonymous questionnaire was sent via electronic mail to evaluate students’ comfort levels in implementing a smoking cessation
referral program and subject demographics. Chart reviews quantified the number of patients referred to a smoking cessation program.
Main Results: A total of 1,147 patients were screened for smoking cessation, 85 of which said they still smoked. Of the 85 who smoked, only 2
(0.17%) were referred to ASHLine. There was no significant increase in the comfort level of students (based on three domains) who participated in
a smoking cessation training program or students in different years of their professional education. It was found that more students were
comfortable with completing the required smoking cessation paperwork if they attended three or more health fairs (P=0.014).
Conclusions: The comfort level of students with smoking cessation education is independent of the number of patients referred to a local smoking
cessation program.
1
4. Title: In Vitro Effect of Nonconventional Accessory Devices on Throat Deposition and Respirable Mass
Project Advisor(s): Paul B. Myrdal, PhD and Poonam Sheth, PhD
Student(s): Carrie L. Hammer and Matthew D. Bertsch
Specific Aims: To evaluate the in vitro throat deposition and respirable mass of the QVAR® pressurized metered-dose inhaler (pMDI) alone or
coupled to an accessory device, such as the AeroChamber Valved Holding ChamberTM or various nonconventional accessory devices.
Methods: The performance of the AeroChamber and nonconventional accessory devices, including a toilet paper roll, paper towel roll, rolled
paper, plastic bottle spacer, plastic bottle reverse-flow holding chamber, and nebulizer reservoir tubing, were compared to no accessory device.
Throat deposition and respirable mass were evaluated using a United States Pharmacopeia (USP) inlet ("throat") coupled to instrumentation for
particle size analysis. Each configuration was tested with three actuations and repeated in quadruplicate. The amount of drug deposition was
quantified using high-performance liquid chromatography. The data were analyzed using multiple independent t-tests assuming unequal variances.
An a priori α-threshold of 0.05 was used with a Bonferroni corrected α of 0.007.
Main Results: Compared to the pMDI alone, all of the accessory devices had significantly lower throat deposition (p < 0.001) and significantly
higher respirable fraction (p < 0.001). Differences in respirable mass were not significant for any accessory device (p ≥ 0.049), except the paper
towel roll and the nebulizer reservoir tubing (p < 0.001).
Conclusions: Under these testing circumstances, nonconventional accessory devices, such as the toilet paper roll, rolled paper, plastic bottle
spacer, and plastic bottle reverse-flow holding chamber, effectively reduce throat deposition and maintain respirable mass compared to a QVAR
pMDI alone. Therefore, they may be suitable alternatives to commercial spacers.
5. Title: Evaluation of Prescribed Empiric Cellulitis Therapy at an Academic Medical Center Emergency Department
Project Advisor(s): Kathryn R. Matthias, PharmD and Asad Patanwala, PharmD
Student(s): Joe Bissing, Satoru Ito and Erwin Lam
Specific Aims: Cellulitis accounts for the majority of skin and skin structure infections in patients who present to the emergency departments in
the United States. The primary objective of this study was to evaluate the appropriateness of empiric cellulitis therapy prescribed in an emergency
department of an academic medical center. The secondary objective of the study was to compare the cost-effectiveness of the empirical cellulitis
therapy prescribed at the institution.
Methods: This retrospective chart review study has been approved by the Institutional Review Board. Adult patients evaluated at an emergency
department of a tertiary care, academic medical center, diagnosed with cellulitis and prescribed empiric antibiotic therapy between October and
November 2010 were evaluated. Subjects were excluded if they required hospitalization or surgical intervention in an operating room or if they
were diagnosed with necrotizing fasciitis, orbital cellulitis, or a diabetic foot infection. Data collected for each subject included type of cellulitis,
therapy prescribed, and outcomes. Appropriateness of empiric cellulitis therapy was determined by expert opinion and guideline statements. A chisquare test was used to evaluate the statistical significance of treatment failure between the prescribed antibiotic groups. An independent t-test
was used to analyze the cost between the prescribed antibiotic groups. An incremental cost-effectiveness ratio was used to determine the costeffectiveness of the prescribed antibiotic groups.
Main Results: The majority of patients were given a prescription for either clindamycin montherapy (37%) or trimethoprim-sulfamethoxazole plus
cephalexin (40%) as empiric therapy when discharged from the emergency department. While follow-up (either repeat emergency department visit
or clinic visit within the academic medical healthcare network) was only available in 78% of subjects, there was no statistical difference (p=0.51) in
therapy outcomes between these two empiric therapy groups.
Conclusions: Types of antimicrobials, doses, and duration of therapy prescribed for outpatient empiric cellulitis therapy at a single medical center
were not consistent.
6. Title: The Usage of Smartphone and PDA Based Electronic Drug Databases Among Pharmacists
Project Advisor(s): Michael Katz, PharmD
Student(s): Steven Bluder
Specific Aims: To assess the use of PDA/smartphone based electronic drug databases among pharmacists as it has changed over time. The
working hypothesis is that the use of PDA/Smartphone based electronic drug databases has increased over time.
Methods: A systematic review of the literature regarding the usage of PDA/smartphone based electronic drug databases among pharmacists using
data that was obtained through literature searches.
Main Results: Since 2006, the percentage of pharmacists that are using PDA/smartphone based electronic drug databases has increased.
Conclusions: The usage of smartphones and PDA based electronic drug databases has increased among pharmacists since 2006 (p<0.05). Easier
and cheaper access to the technology has likely led to the products being available to more pharmacists.
2
7. Title: Identifying Areas of Commonality for an Interprofessional Curriculum on the University of Arizona Health Sciences Campus
Project Advisor(s): John Murphy, PharmD
Student(s): John Boyer, Libby Giesler and Kerry Redman
Specific Aims: To identify areas of commonality between the health profession curriculums on the University of Arizona campus, encompassing
nursing, pharmacy, medicine, and public health.
Methods: This descriptive, cross sectional study used a set of predetermined interprofessional education (IPE) topics including communication,
professional ethics, quality assurance and patient safety, evidence based medicine, and public health to compare the core curricula of the colleges.
Syllabi for each class were analyzed to determine which, if any, of the topics mentioned previously were covered, and if needed professors were
contacted for clarification purposes on their lectures.
Main Results: Each of the health professional colleges covers all 5 of the interprofessional topics studied. Evidence based medicine was the most
covered IPE topic with 233.5 hours followed by communication (153.5 hours), public health (133.75 hours), quality assurance and patient safety
(106.5 hours), and professional ethics (59 hours).
Conclusions: The University of Arizona Health Sciences Campus is capable of developing an interprofessional curriculum based on the shared aims
amongst the colleges. Although we were unable to identify a specific time slot that could be used to teach IPE curricula, we are able to recommend
that an IPE course be implemented in the first professional year for all the colleges as this was the time in which all the colleges spent the most
time teaching IPE topics.
8. Title: Evaluation of combination therapy for Clostridium difficile infections at an academic hospital
Project Advisor(s): Kathryn Matthias, PharmD; David Nix, PharmD and Donna Wolk, PharmD
Student(s): Theresa Stehmer and Jackie Campbell
Specific Aims: The incidence of non-response, recurrence, relapse, and rate of complications of Clostridium difficile infections treated with
combination of metronidazole and vancomycin versus vancomycin or metronidazole alone over a one-year period by treatment and strain type (i.e.
NAP1/BI/027) were evaluated. The incidence of mortality in patients with moderate to severe Clostridium difficile associated diarrhea prescribed
metronidazole, vancomycin, or combination metronidazole plus vancomycin as initial therapy was also determined. Additionally, significant factors
associated with the use of combination vancomycin-metronidazole as initial therapy for moderate to severe CDAD were characterized.
Methods: T This retrospective medical record review has been approved by the Institutional Review Board. Adult patients with stool specimens
tested for detection of Clostridium difficile toxin B by PCR between April 2010 and March 2011 at a tertiary care, academic medical center were
evaluated. Patients were included in the study if diagnosed with moderate to severe disease and received either monotherapy with metronidazole,
monotherapy with oral vancomycin, or combination therapy with metronidazole and oral vancomycin for at least 80% of the first 10 days of
treatment. Patients who are discharged alive within 72 hours of admission or who received therapy for less than 48 hours were excluded.
Main Results: All patients (N=411) with laboratory evidence of Clostridium difficile during the study time period were evaluated. A total of 26
subjects who received oral vancomycin monotherapy and 56 subjects who received oral vancomycin along with metronidazole for at least 80% of
the first 10 days of treatment were identified. Of the subjects who received oral vancomycin monotherapy during the first ten days of therapy, 5
(19%) were classified has a treatment failure or died within the first 21 days of therapy and 5 (19%) had either a recurrence or reappearance of
Clostridium difficile associated diarrhea between 22 and 65 days post start of therapy. Of the subjects who received a combination of oral
vancomycin and metronidazole during the first 10 days of therapy, 14 (25%) were classified has a treatment failure or died within the first 21 days
of therapy and 22 (39%) had either a recurrence or reappearance of Clostridium difficile associated diarrhea between 22 and 65 days post start of
therapy. In the combination therapy group, 5 (9%) were reported to have an ileus, toxic megacolon, or necrotic bowel during the first 10 days of
therapy.
Conclusions: In this study, the subjects who received a combination of oral vancomycin and metronidazole had higher rates of clinical failure,
death, and recurrence than subjects who received monotherapy. Current guideline statements recommend combination therapy only in patients
with an ileus with Clostridium difficile-associated diarrhea.
9. Title: Medication Reconciliation at an Academic Medical Center: Perceptions from Medical Professionals
Project Advisor(s): Terri Warholak, PhD
Student(s): Karol Candlish and Genevieve Young
Specific Aims: The goal of this project was to assess perceptions of medication reconciliation from medical professionals who perform them.
Specific areas of interest included the perceived: amount of time spent on medication reconciliation; process complexity; and effectiveness of the
current process. Opinions concerning the use of alternative processes were also solicited.
Methods: This prospective qualitative study involved four focus group sessions at one tertiary referral teaching hospital in Tucson, Arizona. Nurses
involved in admissions medication reconciliation in the emergency department were invited to participate, and their perceptions were categorized
and summarized.
Main Results: Participants reported a range of times to complete the medication reconciliation from zero to greater than 20 minutes. According
to the participants, the time spent on each patient depended on patients’ medication knowledge and the complexity of their regimens.
Participants wanted the medication list entry screen to be easier to use, and they also suggested patients’ medication lists from previous visits and
from outpatient clinics associated with the medical center be easily accessible. Participants felt that emergency triage may not be the most ideal
time in which to perform medication reconciliation, and they expressed concerns about accuracy of these medication lists. While some were
interested in the possibility of using a patient medication database and expected that it would improve accuracy and save time, others were less
open to a perceived additional step.
Concusions: Participants provided suggestions for changes in the current medication reconciliation process that they feel could improve patient
satisfaction and increase efficiency.
3
10. Title: Frequency of exhibited symptoms in the exposure to synthetic cathinones
Project Advisor(s): Keith Boesen, PharmD
Student(s): Connie Chau and Robyn Choi
Specific Aims: The purpose of this study is to identify the incidence of symptoms associated after exposure to “bath salts,” a term for synthetic
cathinones in Arizona.
Methods: This is a retrospective chart review of reported exposures to synthetic cathinones to the Arizona Poison and Drug Information Center and
the Banner Good Samaritan Poison and Drug Information Center.
Main Results: There were 306 cases of synthetic cathinone exposures reviewed and 76.5% were males (n=234) and 23.5% were females (n=72).
They were ingested, inhaled, snorted, or injected. The mean age of exposure to synthetic cathinones was 29 years old. The most common
symptoms included agitation (48.7%), hallucinations (27.1%), confusion (17.6%), hypertension (21.9%), tachycardia (50.6%), CK elevation (17.3%)
and chest pain (9.5%). Less frequent symptoms exhibited in synthetic cathinone abuse included other CNS effects, gastrointestinal symptoms,
muscular dysfunction, visual disturbances, and respiratory issues.
Conclusions: The symptoms exhibited after exposure to synthetic cathinones were mainly neurologic and cardiovascular. In most cases, symptoms
were effectively resolved within 24 to 48 hours after treatment with intravenous fluids and benzodiazepines. In some reports, patients were also
given oxygen, anti-emetics, sedatives and anti-psychotic medications. Medical outcomes included major (1.6%), moderate (42.2%) and minor
effects (26.1%) while 92 patients were lost to follow-up.
11. Title: Evaluation of Aminoglycoside Serum Concentration Monitoring
Project Advisor(s): Kathyrn Matthias, PharmD
Student(s): Gloria Sun and Juliane Christina
Objectives: The primary objective of this study was to evaluate the appropriateness of when aminoglycoside serum concentrations are obtained
and assess whether the timing and techniques used in obtaining aminoglycoside serum concentrations are appropriate. Additionally, pharmacists’
interpretation of aminoglycoside serum concentrations and the appropriateness of intervention in response to these results were assessed.
Methods: This descriptive retrospective study to evaluate the appropriateness of aminoglycoside monitoring at an academic medical center has
been approved by the Institutional Review Board. Patients over the age of 46 weeks gestational age admitted to an academic medical center
between February 1, 2010 to February 1, 2011 who were prescribed intravenous aminoglycoside therapy were included in this study. Patients
with therapy duration of less than 72 hours without at least one aminoglycoside level were excluded. The time of aminoglycoside concentrations
in relation to time of aminoglycoside administration along with calculated pharmacokinetic parameters and therapy recommendations
documented in clinical notes were also recorded. Appropriateness of aminoglycoside monitoring and documentation were determined by use of
expert opinion and pharmacokinetic guidelines.
Results: Timing of aminoglycoside serum concentrations and subsequent clinical assessments were evaluated in 103 subjects. The median (range)
age was 28 (0.2 – 88) years. The initial aminoglycoside prescribed in 12%, 40%, and 48% of subjects was amikacin, gentamicin, and tobramycin,
respectively. A total of 314 aminoglycoside concentrations were obtained: 41 amikacin, 129 gentamicin, and 144 tobramycin. At least one clinical
pharmacokinetic assessment of aminoglycoside concentration(s) was written for 91 subjects (88%). The aminoglycoside indication, actual time of
aminoglycoside dose administration, estimated renal function, and both goal peak/trough aminoglycoside concentrations were documented in at
least one aminoglycoside clinical note for each of these 91 subjects at a rate of 95%, 80%, 89%, and 51%, respectively. Calculated peak, trough,
estimated volume of distribution, and estimated half-life or ke were documented in 53 subjects.
Conclusions: Aminoglycoside serum concentration monitoring can be used to maximize therapeutic outcomes while minimizing toxicity. However,
errors in obtaining and evaluating serum drug levels can arise that may affect patient outcomes. For monitoring to be effective, the timing of
serum concentration orders, the process of obtaining serum concentration samples, and the interpretation of data including pharmacokinetic
calculations should be accurate.
12. Title: An evaluation of Warfarin and Statin Drug-Drug Interactions
Project Advisor(s): Daniel Malone, PhD
Student(s): Justin Clark
Objectives: To evaluate the literature with respect to drug-drug interactions of the hydroxymethylglutaryl CoA reductase inhibitors atorvastatin,
fluvastatin, lovastatin, pitavastitin, pravastatin, simvastatin, and rosuvastatin with warfarin.
Methods: This descriptive retrospective study identified articles reporting on each drug-drug interaction from the online databases PubMed (1970
– February 2012) and the drug compendia Micromedex and Facts & Comparisons. The studies included in this investigation were primary literature
reports, written in English with human subjects. All studies included were evaluated using the van Roon 5-point quality of evidence scale
developed in the Netherlands to assess drug-drug interactions. This scale rates the study type from lowest to highest quality, from zero to four.
Case-reports were evaluated using the Drug Interaction Probability Scale (DIPS). The DIPS tool uses 10 questions to evaluate the probability that
an adverse event is caused by a drug-drug interaction.
Results: Twenty studies met the inclusion criteria. One study involved atorvastatin, four for fluvastatin, three for lovastatin, 2 for pitavastatin, 1
for pravastatin, 5 for rosuvastatin, and 6 for simvastatin. The mean van Roon quality of evidence score was 2.1+/- 0.74, the mean score for
atorvastatin, pitavastatin, and pravastatin was 3, with the mean score of fluvastatin, lovastatin, rosuvastatin, and simvastatin was 2. 70% of the
literature reviewed were case-reports or letters.
Conclusions: The studies and reports supporting HMG-CoA reductase inhibitors and warfarin drug-drug interactions are most commonly casereports and are of low quality and quantity.
4
13. Title: Evaluation of Timing of Vancomycin Surgical Site Infection Prophylaxis with Scheduled Antibiotic
Project Advisor(s): Kathryn Matthias, PharmD and Brian Erstad, PharmD
Student(s): Edric Wong and Jason Clonts
Specific Aims: The primary purpose of this study was to evaluate the time of vancomycin pre-operative surgical site infection prophylaxis
administration relative to other scheduled antibiotic therapy at a tertiary care, academic medical center. The secondary purpose was to
characterize the incidence of adverse events post-surgery that were associated with vancomycin therapy in patients who received both preoperative scheduled vancomycin therapy and vancomycin for surgical site infection prophylaxis
Methods: This descriptive study was a retrospective medical chart review of all patients over the age of 28 days who received vancomycin for
surgical site infection prophylaxis between February 2011 and May 2011 at a tertiary care, academic medical center. This study was approved be
the Institutional Review Board. The subject population included patients admitted to the hospital for at least 72 hours who received at least 48
hours of scheduled vancomycin (IV), daptomycin or linezolid therapy before index surgery and subsequently received surgical site infection
prophylaxis with vancomycin.
Main Results: Of the 20 subjects who meet the study inclusion criteria, 18 (90%) subjects received scheduled vancomycin doses within 48 hours
prior to surgery, 5 (25%) subjects within 4 hours, and 4 (20%) subjects within 2 hours. No surgical site infections were reported.
Conclusions: This was a pilot study to evaluate the timing of vancomycin surgical site infection prophylaxis doses with scheduled vancomycin,
linezolid, and daptomycin. No adverse effects associated with surgical site infection prophylaxis were reported but the sample size is small and
likely inadequate to detect this potential issue.
14. Title: An interactive approach to educate older adults on fall safety & prevention
Project Advisor(s): Jeannie Lee, PharmD
Student(s): Andrew Cook and Rachael Cook
Specific Aims: The purpose of this study was to test an interactive educational program for older adults on preventing accidental falls.
Methods: This was a prospective, descriptive study evaluating the helpfulness of an interactive educational program. English speaking residents
were recruited from five independent senior living communities in Arizona. The intervention consisted of a 30-minute interactive PowerPoint
presentation followed by a 10-minute question and answer session. Information provided during the presentation focused on information from
the CDC and the Fall Prevention Center of Excellence. Participants completed an anonymous questionnaire to rate the helpfulness of the program.
The primary dependent variable was overall helpfulness of the educational session. Other variables included: intention of changing future behavior
related to preventing falls, whether participants would recommend the program to others, participant perception of gained knowledge, change in
fear of falling, and interest in meeting with pharmacist to discuss medications. Categorical data was analyzed by calculating frequencies and
percentages and continuous data by calculating means and SDs. A t-test for independent groups was used to compare men and women.
Main Results: A total of 93 individuals attended the presentations. Out of 81 completed surveys, 5 did not indicate gender, 7 additional did not
indicate age, and 6 were over 89 years of age. Demographic data for the men and women was similar. 90% of participants indicated that the
program was either "very helpful" or "moderately helpful". 92% of participants responded “absolutely yes” or “likely” that they would recommend
the program. No participants strongly disagreed that they had a better understanding of fall risks or medications that increase fall risk. 87% of
participants responded “absolutely yes” or “likely” that they plan to increase daily exercise . 42% of participants said it was “not likely” that they
plan to make changes in their living environment.
Conclusions: An interactive educational program on fall safety and prevention is helpful for older adults. As one of the most widely accessible
health care providers, pharmacists and pharmacy students are well suited to provide patient education and improve outcomes. The results of this
study provide preliminary data supporting the usefulness of a patient education program on fall safety prevention administered by pharmacy
students.
15. Title: Use of CONSORT Criteria for Reporting Randomized Controlled Trials in Pharmacy Journals
Project Advisor(s): Marion Slack , PhD
Student(s): Emalee Craft and Rachel Ogumbo
Specific Aims: To explore whether publishing requirements for human-centered randomized control trials, particularly the CONSORT criteria, have
any relationship to impact as measured by the Journal Citation Reports ™ Impact Factor.
Methods: A worksheet was used to evaluate a methodically selected list of journals, including types of articles published, requirements of authors
for human-focused randomized control trials, JCR Impact Factor and other JCR metrics for each specific journal title. A worksheet was filled out for
each journal by each member of the research team and answers combined for consensus. Group means and SDs were calculated and the Student’s
t-Test applied to values for selected journals.
Main Results: 50 candidate pharmacy journals were identified and 41 met the criteria for publishing human-centered randomized control trials.
Journals were grouped according to whether they required CONSORT or had other reporting requirements for human RCTs, or had no
requirements for such studies. Few (6; 15%) pharmacy journals required authors to use CONSORT; and additional 15 (37%) journals provided as
least some author guidelines similar to CONSORT. Pharmacy journals using CONSORT or other guidelines had a higher average impact factor (3.5;
SD = 1.5) than did journals without guidelines (2.4; SD = 0.9; p = 0.007).
Conclusions: There appears to be a statistical difference in average JCR metrics between journals which require specific RCT guidelines and those
which do not. The use of reporting guidelines, such as CONSORT, by pharmacy journals is associated with increased impact as represented by JCR
influence measures.
5
16. Title: Clinical Outcomes and Economic Characteristics Regarding Inpatient Treatment of Brain Tumors with Implantable Wafers in the United
States
Project Advisor(s): Grant Skrepnek, PhD
Student(s): Mark Culver and Justin VandenBerg
Specific Aims: This study was aimed to evaluate inpatient clinical treatment characteristics associated with the use of intracranial implantation of
chemotherapeutic wafers for malignant brain neoplasms within United States, and assess inpatient mortality and total charges regarding treatment
with wafer versus without.
Methods: A retrospective cohort investigation was conducted utilizing inpatient discharge records from the Agency for Healthcare Research and
Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample from 2005 to 2009. From this nationallyrepresentative sample, 9,455 adults aged 18 years or older were identified with malignant neoplasms of the brain treated with implantable
chemotherapeutic wafers. Outcomes of inpatient mortality and charges were assessed via multivariate regression analysis, controlling for patient
characteristics, hospital structure, comorbidities, and clinical complications.
Main Results: The average age of patients with brain neoplasms was 56.6 (±16.5) years, and of those patients, 42.9% were female. The odds ratio
for inpatient mortality of patients treated with implantable chemotherapeutic wafers was OR=0.380 (P<0.001), and patients that received wafer
treatment had increased charges exp(b)=2.147 (P<0.001).
Conclusions: Multiple factors were associated with inpatient mortality and charges among the 247,829 patients that were diagnosed with
malignant brain neoplasms from 2005-2009. With regards to these patients, implantable chemotherapeutic wafers were associated with increased
inpatient survival and increased charges.
17. Title: Venom Variability and Health Severity Outcomes of the Mohave rattlesnake (Crotalus scutulatus scutulatus) from Southern Arizona
Project Advisor(s): Keith Boesen, PharmD
Student(s): Ryan Curtis and Kelvin Richards
Specific Aims: Determine the difference in venom potency among Mohave Rattlesnakes in Cochise in Pima Counties and determine if those
differences correlate to changes in clinical outcomes.
Methods: Twenty-one Mohave rattlesnakes, C. s. scutulatus were collected from Arizona and New Mexico. Venom proteomes were analyzed using
RP-HPLC and SDS-PAGE. The toxicity of venoms was analyzed using LD50. Health severity outcomes between two Arizona counties, Pima and
Cochise, were determined by retrospective chart review of the Arizona Poison and Drug Information Center database between 2002-2009.
Main Results: Six phenotypes were identified based on three venom proteins; Mojave toxin, SVMP PI and PIII, and myotoxin. Venom changed
geographically from SVMP-rich to Mojave toxin-rich phenotypes from south central to southeastern Arizona. Phenotypes containing myotoxins
were only found in the transitional zone between the SVMP and Mojave toxin phenotypes. Venom samples containing the largest amounts of
SVMP or Mojave toxin had highest and lowest LD50s, respectively.
Conclusions: There was a significant difference when comparing the presence of CNS affects between Pima and Cochise counties (p = 0.001). No
significant difference was found when comparing severity number of antivenom vials administered, days spent in a health care facility or
envenomation per 100,000 population. Although not part of the original data to be collected, death and intubations, were also noted. There is a
10x and 50x increased risk of death or intubations if envenomated in Cochise County.
18: Title: Identification and evaluation of courses within pharmacy school curricula focusing on health care disparities
Project Advisor(s): Amy Kennedy, PharmD
Student(s): Derek Dindal and Sabrina Sykes
Specific Aims: To identify and assess cultural competency courses for healthcare professionals that are available to pharmacy students.
Methods: A literature review was performed to identify research articles discussing pharmacy courses in health care disparities. Additionally, a
systematic review of all curricula for ACPE accredited schools of pharmacy was conducted and these syllabi were subsequently evaluated.
Main Results: The search identified XXX articles focusing on specific health disparities curricula in schools of pharmacy and XXX syllabi about
specific courses. Out of those articles and syllabi XXX were included in the analysis. Results are pending.
Conclusions: Anticipated results will be utilized to design effective health disparities curricula at the University of Arizona College of Pharmacy.
19. Title: Evaluation of cytomegalovirus treatment in transplant patients before and during the foscarnet nationwide shortage
Project Advisor(s): Kathryn Matthias, PharmD and Sarah Yost, PharmD
Student(s): Deborah Doehnert, Allison Hattrup and Maggie Leadbetter
Specific Aims: To compare and evaluate the therapies prescribed, the incidence of adverse drug events, and the time to clinical cure in transplant
patients with a cytomegalovirus (CMV) infection at an academic medical center before and during the foscarnet nationwide shortage.
Methods: This study was a retrospective chart review to compare CMV treatment prescribed and clinical outcomes in pediatric and adult
transplant patients at an academic medical center. Transplant patients were evaluated over a 16 month time period between December 2009 and
March 2011. The average dose (mg/kg) and prevalence ganciclovir, foscarnet, and cidofovir prescribed in transplant patients with CMV infection
were evaluated. Additionally, the incidence of adverse drug events including acute renal dysfunction and myelosuppression were characterized.
Main Results: There were 30 subjects diagnosed with CMV disease during the evalutaion period. Of all of the patients treated for CMV before the
shortage, 79% received ganciclovir, 43% received foscarnet, and 21% received cidofovir. Following the shortage in September 2010, the usage of
the antiviral agents changed to 100%, 25%, and 13% respectively. Overall the usage of ganciclovir increased while the usage of foscarnet decreased
when there was a shortage of medication.
Conclusions: The antiviral prescribing patterns changed significantly during the foscarnet shortage. The average dose and incidence of ganciclovir
increased which likely contributed to serious adverse events. Due to the limited amount of patients treated for CMV and the short time frame,
clinical cure could not be determined at this time. Drug shortages are a serious problem and significantly influence patient outcomes.
6
20. Title: Evaluation of post-operative venous thromboembolism prophylaxis in lung transplant patients
Project Advisor(s): Michael Katz, PharmD and Richard Cosgrove, PharmD
Student(s): Randi M. Douglas and Lauren N. Parker
Specific Aims: The purpose of this study was to evaluate the effectiveness of various post-operative prophylaxis methods in lung transplant
patients by comparing the incidence of venous thromboembolism (VTE) before and after the implementation of a standardized hospital order set
at the University of Arizona Medical Center (UAMC) in April 2007.
Methods: Paper and electronic medical charts were retrospectively reviewed if patients had a lung transplant date between October 31, 2003 –
October 31, 2010. A computerized database was used to collect demographic data, length of stay (LOS), comorbid conditions, prophylaxis type
(including dose/frequency), and date/type of thromboembolic events in the post-operative period prior to discharge and up to 1-year postdischarge.
Main Results: Ninety-two patient charts were included in the study with 35 charts in the pre-order set (“Before”) group and 57 charts in the postorder set (“After”) group. All baseline characteristics were similar between groups except age (mean age difference 8.1 yrs, p=0.003), use of
mycophenolate (Before n=24, After n=54; p=0.002), and use of medications that increase risk of VTE (Before n=6, After n=2; p=0.05). The April 2007
protocol significantly increased the number of patients receiving any method of prophylaxis (p<0.0001). However, receiving prophlyaxis did not
significantly reduce event rates or readmissions due to VTE.
Conclusions: Although implementation of the April 2007 protocol did not significantly reduce VTE event rates and readmissions, VTE prophylaxis
should continue to remain a priority. Adherence to the implemented protocol may reduce the number of patients left without effective methods of
prophylaxis.
21. Title: Comparison of poractant versus beractant in the treatment of respiratory distress syndrome in premature neonates in a tertiary
academic medical center
Project Advisor(s): Hanna Phan, PharmD
Student(s): Kimia Nasrollah
Specific Aims: The purpose of this study is to evaluate and compare clinical outcomes and cost involved with use of poractant versus beractant for
the treatment of respiratory distress syndrome (RDS) in a level III, neonatal intensive care unit (NICU) within an academic medical center.
Methods: This retrospective cohort study included patients if they were admitted to the NICU for RDS between April 1, 2010 to November 30,
2010 and December 1, 2010 to June 30, 2011 treated with beractant and poractant respectively. Patients were excluded from the study if they
were greater than 35 weeks gestational age and survived less than 48 hours. This is a review and the information needed from the patients was
submitted in a data extraction form. Data collected included demographic variables (age, birthweight, birth length, gender, and race/ ethnicity),
FiO2 measurement, mechanical ventilation time, length of hospitalization in the NICU, the incidence complications in the first 28 days, number of
doses given, use of the nasal CPAP, concurrent complications or comorbidites such as pulmonary hemorrhage, bronchopulmonary dysplasia, patent
ductus arteriosis, intraventricular hemorrhage, and retinopathy of maturity.
Main Results: Data from 27 neonates in beractant and 13 in poractant groups were collected. The FiO2 measurements in both groups were
generally similar. However, FiO2 was consistently lower in the poractant group. (p = 0.044 from a runs statistical test)
Conclusions: The FiO2 measurement is poractant group was lower compared with beractant group, however the difference was noted to be not
statistically significant.
22. Title: Long-acting neuromuscular blocker use during pre-hospital transport of critically ill trauma patients
Project Advisor(s): Asad Patanwala, PharmD
Student(s): Kathryn Elofson and Sarah Girardot
Specific Aims: During pre-hospital transport, trauma patients may be given a long-acting neuromuscular blocker (NMB) to facilitate endotracheal
intubation or to prevent movement. The purpose of this study was to determine the rate of long-acting NMB use and evaluate the concurrent use
of sedatives.
Methods: This was a retrospective cohort study conducted in a tertiary care, academic emergency department of trauma patients aged 18-89
years who were intubated in the pre-hospital setting. The primary outcome was to determine the rate of long-acting NMB use. The use of postintubation sedatives was compared between the groups using Wilcoxon rank-sum test or Fisher’s exact test, using an a priori alpha level of 0.05 for
all analyses.
Main Result: A total of 51 patients were included in final analyses. All patients received etomidate or midazolam for intubation. 86% (n=44)
received succinylcholine, 10% (n=5) were given rocuronium and 4% (n=2) did not receive a NMB. After intubation, 75% (n=38) received an
additional long-acting NMB to prevent movement (vecuronium (n=22) or rocuronium (n=16)) . Overall, 82% (n=42) of patients received a longacting NMB during transport. There was no difference in the rate of post-intubation sedative use between groups (79% versus 67%, respectively,
p=0.42). The long-acting NMB group received midazolam less promptly after intubation (16 versus 7 minutes, respectively, p=0.04).
Conclusions: The use of long-acting NMB is common during the pre-hospital transport of trauma patients. Some of these patients may not be
given sedatives or have delays in receiving sedatives following intubation and be at risk of being paralyzed without sedation.
7
23. Title: Educating health profession students about health disparities: a systematic review of educational programs
Project Advisor(s): Elizabeth A. Hall-Lipsy, JD MPH and Amy K. Kennedy, PharmD
Student(s): Sujung Feilen and Karolina Seminova
Specific Aims: Health disparities are contributing to differences in access to healthcare and health outcomes among diverse groups in the United
States. Causes of health disparities are multifactorial. One approach to minimize health inequalities is through educating future health care
professionals. The purpose of this review is to identify and describe approaches for developing health disparities curriculum for health professions
programs in the United States.
Methods: A systematic review was conducted in April of 2012 to identify articles describing medical and nursing school curricula, educational
courses, and activities focusing on health disparities in the United States. The search was conducted by utilizing Medline PubMed database.
Articles describing a specific educational course/curriculum in health disparities in medical and nursing undergraduate or graduate programs were
included in the review. The review did not take into account continuing education programs. All articles describing educational programs focus on
healthcare disparities in the United States.
Main Results: The search identified 153 articles focusing on specific health disparities curricula or education programs. Out of those articles 30
were included in the analysis. Results are pending.
Conclusions: Anticipated results will aid in identifying successful and effective health disparities curricula for health professions programs in the
United States.
24. Title: Influence of genetic variation of the alpha-subunit of the epithelial sodium channel (ENaC) on baseline pulmonary function and
exhaled sodium ions (Na+) and chloride ions (Cl-) in healthy subjects and patients with cystic fibrosis
Project Advisor(s): Eric M. Snyder, PhD
Student(s): William T. Foxx-Lupo
Specific Aims: The epithelial sodium channels (ENaC) found on the apical membranes of epithelial cells including those lining the respiratory tract
are the rate limiting step of the absorption of excess fluid from the airspace of the alveoli. ENaC function is modulated by the effects of various
physiologic signals such as the adrenergic and purinergic pathways, in addition to other local channels which control the flow of negatively charged
ions such as the cystic fibrosis transmembrane conductance regulator (CFTR). We sought to determine the influence of genetic variation on the
alpha subunit of ENaC at amino acid position 663 on baseline exhaled ions and pulmonary function in patients with CF.
Methods: We assessed pulmonary function ( forced vital capacity[FVC], forced expiratory volume in one second [FEV1], forced expiratory flow
maximum[FEFmax]) using a Medical Graphics cardiopulmonary testing device (Minneapolis, MN). Measures of exhaled sodium (Na+) and chloride
(Cl-) were obtained using exhaled breathe condensate collected on a Jaeger Ecoscreen condenser unit (Cardinal Health, Yorba Linda, CA) with Na+
quantification using an atomic absorption spectrophotometer (Analyst 100; Perkin Elmer, Norwalk, CT) and Cl- anion quantification using a Dionex
AS11 HC column. Healthy n=31 (n=18[58%], 9[29%], and 4[13%] subjects; Body mass index (BMI)=23±1, 25±2, and 25±2kg/ m2 for AA, AT and TT
groups respectively). CF n= 42 (n=33[79%], 7[16%], and 2[5%] subjects; BMI equals 23±7, 19±0.4, and 20±2.2kg/m2 for AA, AT and TT groups
respectively).
Main Results: We found that the distribution of genotypes in CF differed from healthy subjects, with the AA genotype in 80% of CF and 59% in
healthy. No significant difference were demonstrated in healthy subjects between genotype groups for pulmonary function and exhaled chloride
while the genotypes did differ in exhaled Na (Na=2.9±0.4, 1.7±0.3, and 3.7±1.1mmol/L for AA, AT, and TT respectively, ANOVA p=0.07). CF subjects
with the AA genotype had a higher baseline exhaled Cl-, FEV1, and FEFmax than those in the AA group (Cl=0.125±0.038,0.0 27±0.007, and
0.033±0.02 mmol/L ; FEV1=71±5, 68±11, and 40±22L; FEFmax=86±4, 72±7, and 44±24L/sec; for AA, AT, and TT respectively, ANOVA p<0.05, Tukey
[AA vs. TT] p<0.05) while exhaled Na+ and FVC were similar between genotypes.
Conclusions: Our results suggest that CF subjects with the AA genotype of the alpha subunit of the ENaC have a higher baseline exhaled Cl- and a
resulting increase in pulmonary function when compared to the overactive TT groupCF patients with the TT αENaC genotype are likely candidates
for early identification and treatment with inhaled ENaC inhibitors or other modulators of this pathway in order to improve survival.
8
25. Title: Descriptive Study of Student Pharmacist Perceptions of Patient Health Literacy and Self Assessment of Student Pharmacist
Communication Techniques
Project Advisor(s): Marti Lindsey, PhD
Student(s): Miguel Garcia
Specific Aims: The objective of this study is to first assess whether student pharmacist interns feel they can gauge patient health literacy levels
with confidence, second to assess which methods are used most commonly in practice by student pharmacists to assess patient health literacy, and
third to determine what techniques student pharmacist interns most often employ to communicate more effectively to patients with low health
literacy.
Methods: The questionnaire consisted of questions about demographics, and knowledge/experiential based questions. Key questions were: How
well do you feel you are able to assess patient health literacy? How often do you use the following techniques to assess patient health literacy?
(Observe contextual clues, Observe patient word pronunciation, Observe patient willingness to talk, Assess by demographics) When counseling low
health literacy patients, how often do you use the following communication techniques? (Speak slowly, Give extra written material, Repeat
information, Ask patient to repeat information, Ask if patient understands English, Avoid complicated medical terms). The answers to these
questions are measured on a likert scale. Data from the questionnaire was analyzed using one sample t tests and paired t tests.
Main Results: Regarding the first primary objective, on a scale of 1 to 5, with confidence measured 3 or greater and no confidence measured 2 or
less, student intern pharmacists are statistically significantly confident in their ability to gauge patient health literacy (p< 0.001). There is no
statistically significant difference in confidence in ability to gauge patient health literacy between males and females.
The method student pharmacist interns used for assessing patient health literacy with the highest average use was observing patient willingness to
talk (3.65 +/- 1.01) followed by observing patient word pronunciation (3.57 +/- 0.97), assessing patient demographics (race, age, ability to pay,
culture, gender) (3.23 +/- 1.16) and observing contextual clues (patients identify pills by color, asks to be read to, etc) (3.04 +/- 1.04). There was no
statistically significant difference between observing patient willingness to talk versus observing patient word pronunciation (p=0.55). There is a
statistically significant difference between observing patient willingness to talk versus assessing patient demographics (p=0.011).
The technique for improving communication with patients with low health literacy with the highest average use was avoiding complicated medical
terms (3.97 +/- 0.95) followed by speaking slowly (3.91 +/- 0.89), repeating information (3.85 +/- 0.73), giving extra written material (3.02 +/- 1.36),
asking patients if they understand English (2.85 +/- 1.21) and asking patients to repeat information. (2.39 +/- 1.02). There is a statistically significant
difference between avoiding complicated medical terms and giving out extra written material (p<0.001) and speaking slowly and giving out extra
written material (p<0.001).
Conclusions: We conclude that students pharmacists working as interns are quite confident in their ability to assess patient health literacy, that
observing patient willingness to talk is be the most commonly used method to assess patient health literacy, and that avoiding complicated medical
terms is be the most commonly used technique student pharmacist interns use to communicate more effectively with patients who have low
health literacy.
26. Title: Chemomobilization with cyclophosphamide and filgrastim in multiple myeloma patients following lenalidomide treatment
Project Advisor(s): Myke Green, PharmD
Student(s):
Ashlee Gerfen
Specific Aims: Autologous stem cell transplant (ASCT) is the current gold standard following induction therapy to improve survival of multiple
myeloma (MM). Lenalidomide (LEN) is used for treatment of MM before ASCT, but exposure may impair autologous peripheral blood stem cell
(PBSC) mobilization. Chemomobilization with cyclophosphamide (CTX) has not been evaluated in this setting. CTX + filgrastim was investigated to
determine if LEN-associated mobilization impairment can be abrogated.
Methods: 36 pts (group A=12 pts who received ≥2 cycles of LEN and group B=24 pts without LEN) were analyzed retrospectively. Baseline
characteristics were matched (p>0.05 for all variables). All pts received CTX (median group B, 1.5g/m2; median group A, 3gm/m2(p=0.18)) and
filgrastim 10µg/kg/day. Primary outcomes include number of CD34+ cells collected and number of leukapheresis sessions. Secondary outcomes
include failure to collect CD34+ cells and total CD34+ cells collected after second leukapheresis.
Main Results: Total median number of CD34+ cells collected in group B=9.15x106/kg CD34+ cells and group A=7.43x106/kg CD34+ cells (p=0.159).
Median number of apheresis sessions in group B=2 and group A=3 (p=0.42). Two of 12 pts with antecedent LEN usage failed to collect while no
patient without previous LEN exposure failed to collect (p=0.105). Total number of CD34+ cells collected after 2 apheresis sessions for group
B=8.13x106/kg CD34+ cells and group A=3.34x106/kg CD34+ cells (p=0.06).
Conclusions: Chemomobilization with CTX + filgrastim yields robust PBSC collections irrespective of antecedent lenalidomide. There was a trend
towards lesser PBSC collection in LEN-treated pts.
9
27. Title: An Evaluation of HMG-CoA Reductase Inhibitor Drug-Drug Interactions for Quality in the Literaure
Project Advisor(s): Daniel Malone, PhD
Student(s): Nathaniel Green
Specific Aims: To evaluate the quality of evidence in the literature substantiating major drug-drug interactions of the HMG-CoA reductase
inhibitors (statins) atorvastatin, lovastatin, and simvastatin with the azole anti-fungals fluconazole, itraconazole, and ketoconazole.
Methods: In this descriptive retrospective analysis, a list of articles reporting on each drug-drug interaction was compiled from the online
databases Medline and International Pharmaceutical Abstracts, and the drug compendia Micromedex and Facts & Comparisons. The studies
included in this analysis were primary literature reports, written in English, and consisted of human subjects. All studies included were evaluated
using a 5-point quality of evidence scale developed to assess drug-drug interactions (van Roon scale). This scale rates the study type from lowest to
highest quality, from zero to four. Case reports were additionally analyzed using the Drug Interaction Probability Scale (DIPS). The DIPS tool uses 10
questions to evaluate the probability that an adverse event is caused by a drug-drug interaction.
Main Results: Twenty-one studies met the selection criteria. There were three studies involving atorvastatin, four studies involving lovastatin, and
fourteen studies involving simvastatin. The mean quality of evidence score on the van Roon scale was 2.0 + 0.77, where atorvastatin studies had a
score of 2.3 + 1.15, lovastatin had a score of 2.25 + 0.95 and simvastatin had a score of 1.86 + 0.66. Seventy-one percent of the studies reviewed
were case reports.
Conclusions: The reports substantiating some drug-drug interactions may be of little and low quality evidence.
28. Title: Genetic Variation of the BETA-2 Adrenergic Receptor and the Bronchodilatory Response to Albuterol in Patients with Cystic Fibrosis
Project Advisor(s): Eric Snyder, PhD
Student(s): Kara Herko and Benjamin Guthrie
Specific Aims: We sought to determine the influence of genetic variation of ADRB2 on the airway response to albuterol in patients with CF when
compared to matched healthy controls at baseline and at 60 minutes following the administration of albuterol (2.5mg diluted in 3ml normal saline).
Methods: Baseline pulmonary function (forced vital capacity, FVC, forced expiratory flow in 1-second, FEV1, mid-maximal expiratory flow, MMF,
and forced expiratory flow at 50% of the FVC) was assessed in 17 patients with CF and 31 healthy subjects.
Main Results: As expected, the healthy group had higher baseline pulmonary function when compared to the CF group (FVC=97±3 vs. 83±5;
FEV1=95±3 vs. 72±6; MMF=90±4 vs. 54±8, % predicted for healthy and CF, respectively, mean±SE, p<0.05 for all. We compared Arg16Arg to
Arg16Gly/Gly16Gly subjects. There was no effect of genotype on the response to albuterol in healthy subjects. However, in the CF group, we found
that the Arg16Arg group (n=6) had an attenuated response to β-agonist when compared to the Gly-containing group (n=11) (FVC=0±0.9 vs. 6±3:
FEV1=3±1 vs. 7±4: MMF=12±3 vs. 12±5 % change, for Arg16Arg and Gly-containing groups, respectively, p<0.05 for FVC, p=0.06 for FEV1).
Conclusions: These results demonstrate a differential response to β-agonists according to genetic variation of the ADRB2 at amino acid 16. Due to
the differences in FVC and FEV1 but not in MMF, these data suggest that the genetic difference in airway function is primarily in bronchodilation of
the larger airways.
29. Title: Extending the stability of intravenous ampicillin
Project Advisor(s): David Nix, PharmD
Student(s): Nathan Hanan
Specific Aims: To assess the chemical stability of ampicillin for injection in normal saline at pH values ranging from 5 to 6.
Methods: A stability-indicating high performance liquid chromatography (HPLC) method was developed and used to determine the stability of
ampicillin for injection in normal saline following buffering with sodium acetate and acid adjustment with HCl at pH values of 5, 5.5, and 6. To
confirm that the assay was stability-indicating, ampicillin trihydrate reference standard (1 mg/mL) was exposed to alkali, acid, and oxidative stress
conditions and analyzed by HPLC for the presence of degradation products. Analysis was performed on a reverse-phase (C-18) column with a
mobile phase consisting of water, acetonitrile, 1 M monobasic potassium phosphate, and 1 N acetic acid (909:80:10:1). Other HPLC parameters
were: flow rate 1 mL/min; detection wavelength 254 nm; injection volume 20 µL; column temperature 30˚C. The method was evaluated for
linearity, precision, and accuracy. The chemical stability of ampicillin for injection (18 mg/mL) in normal saline and sodium acetate (pH adjusted at
values of 5, 5.5, and 6) was assessed at baseline (t=0), 7, 11, 17, 31, and 44 hours and compared to a control solution (no pH adjustment).
Measurements at each time interval were performed in triplicate.
Main Results: Ampicillin trihydrate reference standard (1 mg/mL) was adequately separated from degradation products following exposure to
alkali, acid, and oxidative stress conditions. After 16 hours, a precipitate was observed in the solution at pH 6, and therefore stability is not
reported. All other solutions (pH 5, pH 5.5, and control) were stable for at least 24 hours at room temperature and yielded t90 values of 110, 64.2,
and 27.5 hours, respectively.
Conclusions: Adjustment of intravenous ampicillin solutions to pH values of 5 or 5.5 significantly increased stability. Ampicillin appears to be most
stable at a pH near its isoelectric point (pH 5).
10
30. Title: Statistical Information Included in Labeling for Disease-Modifying Anti-Rheumatic Drugs for Rheumatoid Arthritis
Project Advisor(s): Daniel C. Malone, PhD
Student(s): Lashley Hatch
Specific Aims: To evaluate the presence of statistical information from clinical studies in official product labeling specific for disease-modifying
anti-rheumatic drugs (DMARDs) used in the treatment of rheumatoid arthritis.
Methods: Data were abstracted from official product labeling DMARDs with FDA approval for treatment of rheumatoid arthritis. Each document
was examined for the presence of statement regarding a priori type 1 error rate, p-values, and measures of variance. Medications were classified
as either biologic or non-biologic.
Main Results: A total of 14 DMARDs, 7 biologics (50%) and 7 non-biologics (50%), were found to be FDA approved for the treatment of rheumatoid
arthritis. Primary outcomes consisted of American College of Rheumatology (ACR) response rates, radiographic changes, and health assessment
questionnaire score (HAQ). Any measure of variance and the presence of a p-value were both found in six (43%) of the drug labels. Inclusion of pvalues was found to be significantly greater in biologics compared to non-biologics for both ACR and radiographic results. Inclusion of variance was
found to be significantly greater in biologics compared to non-biologics for radiographic changes only. No package inserts contained statements
regarding the a priori type I error rate.
Conclusions: Measures of variance are not frequently included in product labeling for either biologic or non-biologic DMARDs. However, inclusion
of variance and p-values for ACR response rates and radiographic changes were more likely to be reported for biologics therapies as compared to
non-biologics. A statement regarding Type 1 error rates were absent from labels regardless of outcome assessed.
31. Title: Assessing the Factors Involved in Provider Preference and Willingness to Pay for Informational and Screening Services
Project Advisor(s): Elizabeth Hall-Lipsy, JD MPH
Student(s): Jennifer Rust and Kalie Heideman
Specific Aims: The purpose of this study is to assess rural community members in Cochise County, Arizona, to determine if healthcare screenings
and informational sessions are desired by the community members for chronic disease states, and from which healthcare providers the community
members prefer to obtain these services. Identify which health professional rural members are most likely to seek for healthcare screening. Identify
which health professional rural members are most likely to seek for healthcare informational sessions. Determine if rural community members are
willing to pay for healthcare screening and informational sessions.
Methods: This descriptive study obtained data through 350 questionnaires distributed during selected Cochise County community events in late
2011.
Main Results: 341 surveys were completed. The majority of results favored physicians with 47.7% of the people stating they would very likely
attend a health care screening conducted by a physician. 34.5% responded they would very likely attend an informational session conducted by a
physician. Of the respondents willing to pay for health screenings, 63.9% would pay $30 or less. 70.9% stated they would not be willing to pay for
an informational session. However, the majority of participants, 61.3%, indicated they would utilize pharmacists for OTC questions. Regarding
questions about prescription medications, 43.4% would go to pharmacists, and similarly, 44% indicated they use physicians.
Conclusions: As seen from the results, pharmacists are underutilized by rural community members; except for OTC questions. Respondents with
higher levels of education were also more likely to prefer and attend events held by pharmacists.
32. Title: Job Satisfaction Among Tucson Area Chain Community Pharmacists: Results from a Pilot Study
Project Advisor(s): Terri Warholak, PhD
Student(s): Megan Martineau, Stephanie Yandow and Stephanie Hines
Specific Aims: The purpose of this study was to assess the overall satisfaction of Tucson area pharmacists in the community retail setting and to
identify the facets of community practice that have the greatest contribution to job satisfaction and dissatisfaction.
Methods: Surveys were sent by facsimile to all community retail pharmacies in the Tucson area. All pharmacists working in these stores were
encouraged to respond to the survey by faxing back the paper copy or by responding to the online version of the survey at surveymonkey.com.
Respondents were asked to rate their job satisfaction and demographic data were also collected.
Main Results: Questionnaires were completed and returned by 32 pharmacists, an estimated response rate of 10%. After reviewing the returned
surveys, four questions were chosen from the satisfaction portion to determine their relationship to the job satisfaction ratings. Those four
variables were “recognition one receives for good work”, “opportunity to use abilities”, “hours of work”, and “patient contact”. Those four
satisfaction variables were then analyzed using the demographic grouping variables “other experience”, “store type” and “degree earned”.
Following analysis, only hours of work was found to play a significant role with pharmacy job satisfaction when grouped by other experience.
Conclusions: The area of community pharmacy practice that affects job satisfaction the most is hours of work, which is especially true when
pharmacists have work experience outside of community practice.
11
33. Title: Appropriateness of Antimicrobial Therapy for Bloodstream Infection based on Reporting Conditions with a Rapid Species Identification
Assay
Project Advisor(s): Kathryn Matthias, PharmD and David Nix, PharmD
Student(s): Youchin Huh and Tina Wang
Specific Aims: The primary aim of this study was to determine the time to appropriate therapy for all patients with candidemia and/or bacteriemia
(due to either Enterococcus or Streptococcus species) during a one year period in relation to time of blood culture, time of Gram-stain result, time
of PNA FISH species result, and time of final species determination result. The secondary and third aims were to compare the time to appropriate
therapy based on clinician group that was notified of Gram-stain result and PNA FISH result and compare the time to appropriate therapy based on
PNA FISH assay results reported during the day and night microbiology laboratory shifts.
Methods: This Institutional Review Board approved project is a retrospective, chart review evaluation of the 24 hour/ 7 days a week use of PNA
FISH assays with therapeutic interventions by infectious diseases pharmacists and physicians on patient outcome measures and time to
appropriate therapy. All patients admitted to an academic medical center during a one year period (April 2010-March 2011) with either
Enterococcus, Streptococcus, or Candida species isolated from blood were included.
Main Results: A total of 168 subjects were identified with Candida species isolated from 31 subjects and Enterococcus/Streptococcus species
isolated from blood in 137 subjects.
Conclusions: While reporting conditions can affect interpretation and intervention rates, rapid species identification assays such as PNA FISH can
be used by pharmacists to provide antimicrobial therapy recommendations based on the species identification and to decrease the time to
appropriate antimicrobial therapy.
34. Title: Comparison of poractant versus beractant in the treatment of respiratory distress syndrome in premature neonates in a tertiary
academic medical center
Project Advisor(s): Hanna Phan, PharmD
Student(s): Ashley Jorgensen
Specific Aims: The objective of this study is to evaluate and compare clinical outcomes and economic impact involved with the use of beractant (B)
compared to poractant (P) for the treatment of respiratory distress syndrome (RDS) in premature neonates admitted to a neonatal intensive care
unit.
Methods: Patients were included if they were less than 35 weeks gestational age at birth, survived at least 48 hours, and admitted to the neonatal
intensive care unit and treated with P or B for RDS. The primary outcome of this study is the change in the fraction of inspired oxygen (FiO2) over
the first 48 hours after surfactant administration. Secondary outcomes were the change in oxygen saturation, time spent on mechanical ventilation
and continuous positive airway pressure (CPAP), complication occurrence and mortality of the neonates.
Main Results: There were a total of 40 neonates whose charts were reviewed (n= 13 and n=27 in the P and B groups respectively). The mean
gestational age of the neonates were 29.2+/-2.9 and 28.8+/-2.9 weeks in the P and B groups respectively. The FiO2 was found to not be lower
between the P and B groups (35.5+/-22.2 and 42.4+/-24.2, respectively; p=0.379), as well as the O2 saturation (94.6+/-4.6 and 92.3+/-6.1; p=0.194).
Significance was also not found for the other clinical or economic outcomes assessed in this study.
Conclusions: There was not a significant difference between poractant and beractant in FiO2, O2 saturation, or in the other clinical outcomes
evaluated in this study.
35. Title: Attitudes and Knowledge of Medical Students Regarding the Role of Pharmacists
Project Advisor(s): Rebekah Jackowski, PharmD
Student(s): Amanda S. Klein
Specific Aims: To determine the attitudes of medical students towards pharmacists and the roles they play on the healthcare team and how these
views change after attending an inter-professional workshop with other University of Arizona healthcare students.
Methods: Questionnaires administered during a regularly scheduled class collected rating of teamwork and collaboration, roles for pharmacists in
health care settings, and medical student’s expectations of the pharmacist when they are practicing physicians. Previous inter-professional
workshop experience, negative experience with a pharmacist, age and sex was also collected.
Main Results: Medical students’ attitudes regarding the roles of pharmacist in health care settings became more positive after attending the IPE
workshop compared to their attitudes before attending the IPE workshop (X2 = 7.671, p-value = 0.005) and was maintained 1 year after the
workshop (X2 = 6.304, p-value = 0.012). Medical students expected pharmacists to be more capable and had higher expectations for them after
attending the IPE workshop (X2 = 17.393, p-value = <0.001) and was maintained 1 year after the workshop (X2 = 5.955, p-value = 0.015).
Conclusions: This study demonstrated that the inter-professional workshop is successful in changing the attitudes of medical students towards
pharmacists and the roles they play on the healthcare team. The medical students maintained this change in attitude one year after the interprofessional workshop.
12
36. Title: Effect of Providing Pharmacists with Patient Diagnosis on Electronic Prescription Orders: A Pilot Study
Project Advisor(s): Terri Warholak, PhD
Student(s): Guntur Kurniawan
Specific Aims: To evaluate the effect on the incidence and nature of pharmacists’ drug utilization review (DUR) interventions of including patient
diagnosis on electronic prescription (e-prescription) orders.
Methods: This prospective pre-post evaluation was conducted in the outpatient pharmacy of a federally funded community health center over
two consecutive four-week periods. During the pre-phase, a clinical pharmacist in the clinic’s onsite pharmacy prospectively reviewed the eprescriptions received from the clinic’s primary care providers using a standard prospective DUR process and recorded all therapy-related
interventions. In the post-phase, providers added a diagnosis on each e-prescription. Interventions were documented using a standard intervention
form that has been used in previous research. Chi square and t-tests were used to assess the nominal and interval data, respectively (α=0.05). The
Institutional Review Boards of the two collaborating universities approved the study.
Main Results: Pharmacist intervention rates on problematic e-prescription orders significantly decreased (4% pre vs. 1% post, p<0.001). Drug-drug
interactions (17.5% pre vs. 20% post) and missing information (15% pre vs. 20% post) were the most frequently cited problems that prompted the
need for the pharmacist’s intervention. The medication classes most frequently involved in interventions were antibiotics (53% pre vs. 50% post)
and central nervous system agents (17% pre vs. 10% post). After receiving clarification, the pharmacist most often dispensed the prescription
(33.3% pre vs. 38.4% post) and educated the patient regarding their treatments (18.8% pre vs. 7.7% post).
Conclusions: In this small pilot project, including the patient’s diagnosis on e-prescription orders significantly reduced the incidence of
pharmacists’ DUR-related interventions. If duplicated in larger studies, our results suggest that providing pharmacists with additional targeted
clinical information could reduce confusion and uncertainty thereby decreasing the number of unnecessary pharmacist contacts with prescribers
and improving workflow and efficiency for both.
37. Title: A Pilot Study Assessing the User Benefit of Skin Photoprotectants Perceived by University of Arizona Pharmacy Students
Project Advisor(s): Georg Wondrak, PhD
Student(s): Jared LaBuda and Paul Wojcik
Specific Aims: To perform a pilot survey assessing the user benefit perceived by University of Arizona students regarding topical photoprotectants
and their ability to prevent solar skin damage, including sunburn and carcinogenesis. In addition, to analyze the data obtained from the survey to
identify incongruence between the FDA defined indication for the OTC sun protectants and the anticipated benefit expressed by University of
Arizona students.
Methods: An anonymous, paper based questionnaire consisting of four demographic questions and ten questions pertaining to sunscreen
knowledge and use was distributed to students at the beginning of a full class. Questionnaires that were not at least ninety percent complete were
excluded. All available students in the college of pharmacy in years one, two, and three were invited to participate.
Main Results: Based on the survey analysis, 75% of pharmacy students have insufficient knowledge of FDA-approved use and guidelines for this
class of OTC drugs.
Conclusions: A need for training/instructional measures that aim at increasing adequate drug competency and consumer counseling skills has been
identified in the area of FDA-regulated sunscreen products. An opportunity for an increased involvement of professional pharmacists in optimizing
consumers' sunscreen selection and use has been identified.
38. Title: Evaluation of the Brainstem Spinal Cord Preparation in the Neonatal Rat as a Model for Prenatal Nicotine Exposure
Project Advisor(s): Richard Vaillancourt, PhD and Ralph Fregosi, PhD
Student(s): Richard Levine
Specific Aims: The goal of this project was to evaluate the use of a preparation of the brainstem and spinal cord of neonatal rats that has been
widely used for observing and quantifying central nervous activity, as well as the response to pharmacological manipulation. To achieve this, we
specifically aimed to remove the intact brainstem and spinal cord of newborn rats, and develop a preparation that would maintain physiological
function and allow for recording of electrical activity.
Methods: Multiple dissections were performed on neonatal rats. Conditions during the dissections were controlled to maintain physiological
function. Once removed, the intact brainstem and spinal cord was placed in a preparation that allowed for manipulation and access to nerve
rootlets. Finally, glass suction electrodes were used to record electrical activity directly from the nerve rootlets. Once recorded, the data were
stored on a hard drive for further analysis.
Main Results: We were successful in isolating the intact brainstem and spinal cord in neonatal rats while maintaining physiological conditions and
nervous activity. The preparation allowed for easy access to nerve roots as well as customization for different experiments. We were also
successful in recording nerve activity in the preparation and collection of data for use in future experiments
Conclusions: We conclude that the brainstem spinal cord preparation described in this study is a valuable tool that allows for recording and
analysis of nerve activity, and specifically for measurement of respiratory motor output. This is a preparation that can be used in a variety of
experiments that attempt to observe or quantify the activity of central nerve cells and allows for pharmacological interventions that could be
applied in various experiments.
13
39. Title: Student Pharmacists’ Knowledge and Attitudes towards Herbal Medications: A Pilot Test at One University
Project Advisor(s): Jeannie Lee, PharmD
Student(s): Jessica Ling and Diana Tang
Specific Aims: To determine pharmacy students' knowledge and attitudes towards herbal medicine, and to identify factors that have the most
influence on herbal knowledge.
Subjects: Students in the 1st, 2nd, 3rd, or 4th years of the Doctor of Pharmacy program at the University of Arizona.
Methods: Questionnaires administered during regularly scheduled classes and email collected knowledge, attitudes, and demographic data. This
included age, gender, highest level of education, completion of herbal medication/OTC course, practice site, availability of herbals and herbal
information at the practice site, and use of herbal medication in a family member.
Main Results: Questionnaires were completed by 270 out of the 395 students enrolled in pharmacy school. An average of 4.8 ± 3.02 out of the 14
questions (34%) were answered correctly on the knowledge section. Pharmacy students agreed that providing information about herbal
medication is a pharmacist's professional responsibility and that an elective course on herbal medications would be useful (mean = 3.31 ± 1.52 and
3.73 ± 1.32 respectively on a scale of 0-5 where 5 = strongly agree and 0 = do not agree). Pharmacy school year and completion of an herbal/OTC
course were the largest contributing factors to higher scores on the knowledge portion.
Conclusions: With an average knowledge score of less than 50% and average rating of less than 2.5 out of 5, pharmacy students have a weak
understanding and a low confidence level in recommending and counseling patients on herbal medications. Requiring a course that includes herbal
medications may be beneficial.
40. Title: Pharmacy student perceptions on geriatric quality of life
Project Advisor(s): Jeannie Lee, PharmD
Student(s): James Loui, Ashorena Mezdo and Nikita Patel
Specific Aims: To review overall quality of life (QOL) in active geriatric patients and to observe different attitudes toward aging in the student
comparison groups. Subjects: Current students, regardless of academic year, attending the University of Arizona College of Pharmacy with a
university email account.
Methods: Data was collected using an electronic questionnaire. A link to the questionnaire was sent out via email to all University of Arizona,
College of Pharmacy students. Another email containing the link to the questionnaire was sent two weeks after the initial notification. The
questionnaire consisted of 36 questions requesting students to express their perspective on the health status, mental status and physical abilities
of the elderly.
Main Results: Geriatric patients tended to have a more positive view on their overall health when compared to students' perceptions of geriatric
QOL (86.7% versus 35.7%, P <0.05). Students were also more likely to have the perception that geriatric patients had limitations in regular activities
due to physical health and emotional problems when compared to the actual responses of older adults (72.6% versus 40.0%, P <0.05; and 60.0%
versus 16.7%, P <0.05; respectively). There was a significant difference (P<0.05) between responses from students and geriatric patients to every
question.
Conclusions: There appears to be a noteworthy difference between pharmacy student perceptions of geriatric QOL and actual older adult QOL
responses that may warrant an educational intervention.
41. Title: The Knowledge, Attitudes, and Beliefs Regarding Geriatric Care among Student Pharmacists
Project Advisor(s): Jeannie Lee, PharmD
Student(s): Nirav Makadia, Amit Shah and Ankur Shah,
Specific Aims: The purpose of this study was to assess the attitudes, beliefs and knowledge of pharmacy students regarding geriatric care.
Methods: A questionnaire was administered to first, second and third year pharmacy students to assess the impact of geriatric curriculum on
students at the University of Arizona College of Pharmacy. The primary grouping variable was whether or not students had previously taken a
course focused on geriatrics.
Main Results: A total of 193 pharmacy students completed the questionnaire which resulted in a response rate of 64.33%. There is no comparison
group for the first year class as all students in this class had never taken a geriatric-focused course. Therefore, no tests for statistical significance
could be performed for this class. Students in the second year class who have taken a geriatrics-focused course scored higher than those without
course experience on all four of the attitude and beliefs questions (p = 0.104, p = 0.042, p = 0.045, p = 0.025). The same held true for the third year
class (p = 0.006, p <0.001, p = 0.050, p = 0.653). Both classes showed a statistically significant increase in knowledge of geriatric care in those
students who have previously taken a geriatrics-focused course (p = 0.032 for second years, p = 0.022 for third years).
Conclusions: This study showed that pharmacy students at the University of Arizona College of Pharmacy who have previously taken a geriatricsfocused course have more positive attitudes and beliefs regarding geriatric care as well as a stronger knowledge base regarding geriatrics. With an
aging population, it is important that pharmacists be knowledgeable and capable of caring for geriatric patients. Thus, we recommend that all
pharmacy schools include a geriatrics-focused course as part of the standard curriculum for Pharm D. candidates.
14
42. Title: Evaluation of oral fluoroquinolone administration before and after implementation of electronic prepared medication administration
record
Project Advisor(s): Kathryn Matthias, PharmD and Kurt Weibel, PharmD
Student(s): Kevin Malina
Specific Aims: Determine the incidence of scheduled co-administration times in handwritten (paper) and electronic prepared medication
administration records of oral ciprofloxacin and oral moxifloxacin with interacting substances that can affect fluoroquinolone gastrointestinal
absorption. Also, determine the incidence of actual co-administration of oral ciprofloxacin and moxifloxacin with interacting substances that can
affect fluoroquinolone gastrointestinal absorption with electronic and handwritten prepared medication administration records.
Methods: Retrospective data was obtained by a chart review of patients from an academic medical center for a one month period before (May
2010) and after (August 2010) implementation of an electronic prepared medical administration record system. The scheduled time and actual
time given for all fluoroquinolone antibiotics, as well as all possible interacting substances, were recorded.
Main Results: A total of 99 subjects were included in this study (36 paper and 63 electronic). There was no statistical difference (p=0.47) between
the percentage of scheduling errors for the electronic prepared medication administration records, 25.3%, compared to the paper medication
administration records, 22.1%. However, there was a decrease in the percentage of actual co-administrations of fluoroquinolones with interacting
substances for the electronic prepared MARs compared to paper prepared medication administration records; 22.3% and 32.1% respectfully
(p=0.03).
Conclusions: After implementing electronic prepared medication administration records at an academic institution, co-administration errors went
down even though the amount of scheduling errors did not decrease.
43. Title: Evaluation of prophylactic voriconazole and posaconazole concentration monitoring and dose changes in liquid and solid transplant
patients
Project Advisor(s): Kathryn Matthias, PharmD
Student(s): Jill Nguyen and Sarah Workinger
Specific Aims: The primary aim of this study was to determine the incidence of posaconazole and voriconazole concentration monitoring that
occurs in transplant patients receiving antifungal prophylaxis therapy. The secondary aim was to determine whether voriconazole and
posaconazole serum concentrations were used for dose adjustments.
Methods: Patients status post either a liquid or solid organ transplant over the age of 1 year who received invasive fungal infection prophylaxis
with either posaconazole or voriconazole between the dates of February 1, 2010 through January 31, 2011 while admitted to academic medical
center were included in this descriptive retrospective study. This study has been approved by the Institutional Review Board. Data collected on
each subject included demographic information, type of transplant, posaconazole or voriconazole concentrations, and duration and dosage
adjustments.
Main Results: 54 subjects were identified who received either voriconazole or posaconazole for fungal prophylaxis after transplant. For subjects
who were prescribed posaconazole (N = 8), concentration monitoring was performed in 50% of subjects and 0% of posaconazole dose adjustments
were based on concentrations. For subjects who were prescribed voriconazole, concentration monitoring and dose adjustments based on
voriconazole concentrations were performed in 20% and 78% of subjects respectively. Adverse outcomes associated with the use of antifungal
therapy were reported in 0% of the posaconazole therapy group and 17% of the voriconazole therapy group.
Conclusions: Both posaconazole and voriconazole concentrations were obtained from patients who were receiving antifungal therapy for invasive
fungal infection prophylaxis. Adjustments of prophylactic doses are not well characterized.
44. Title: Consumer Knowledge of Acetaminophen Safety, Dosing, and Identification
Project Advisor(s): Terri Warholak, PhD
Student(s): Shannon Sands and Joel Nielsen
Specific Aims: The objective of this study is to evaluate consumers’ knowledge about over the counter (OTC) products containing acetaminophen
(APAP).
Methods: Doctor of pharmacy student researchers set up a booth at consenting community pharmacies and invited consumers to participate in a
10-15 minute knowledge assessment. The booth contained a table displaying several OTC medication bottles/packages. Adult participants: a)
answered baseline questions verbally about their APAP knowledge and associated risks; b) identified OTC products at the booth that contain APAP;
and c) calculated and demonstrated dosing of APAP. The researchers asked follow-up questions and assessed the accuracy of the dosing.
Participants received APAP educational brochures upon completion.
Main Results: Eighty percent of subjects reported not knowing what the abbreviation “APAP” means, and almost half of those who said that they
knew what it means were incorrect. Very few participants were able to correctly identify the products containing APAP even with the product
packaging information, with the percentage of incorrect responses as to whether a product contains APAP or not varying from 4.9% to 31.6%.
More than 40% of the pediatric doses were incorrectly dosed for both of the pediatric formulations, even with the majority of subjects being
parents.
Conclusions: Consumers are not able to identify which over-the-counter products contain APAP even with the product packaging before them, and
they do not know what the abbreviation “APAP” means. Better packaging and product ingredient information should be developed, and the
abbreviation “APAP” should be avoided. Pediatric APAP products should be re-evaluated regarding safety and dosing.
15
45. Title: Accuracy of House, MD Season Five Episodes 1-12
Project Advisor(s): David Apgar, PharmD and Edward Armstrong, PharmD
Student(s):
Adam Nye, Tracy Post and Elisa Vomocil
Specific Aims: This study was performed to assess the accuracy of the presenting signs and symptoms, diagnostic procedures, and treatments
depicted in episodes one through twelve of the fifth season of House, MD.
Methods: This study was a descriptive, retrospective evaluation of the accuracy of the first twelve episodes of the fifth season of House, MD.
Dependent variables in this study were presenting signs and symptoms, diagnostic procedures, and treatment of the final diagnosis for the primary
patient case. A rating of one to four was assigned to each variable, with one being most accurate and four being inaccurate. Statistical analysis
consisted of ANOVA and Tukey HSD post-hoc test
Main Results: The signs and symptoms had a mean of 2.42 ± 0.669 (95% CI 1.99 to 2.84). The diagnostic tests had a mean of 2.42 ± 1.084 (95% CI
1.73 to 3.11). The treatment had a mean of 1.42 ± 0.9 (95% CI 0.84 to 1.99). ANOVA showed a statistically significant difference among the accuracy
ratings of the groups (p = 0.013). Tukey HSD did not show a significant difference between the accuracy of the signs and symptoms and diagnostic
tests (p = 1). The test did reveal a statistically significant difference between accuracy of treatment and both the signs and symptoms (p = 0.027)
and diagnostic tests (p = 0.027).
Conclusions: The treatments shown in House, MD, season five, episodes one through twelve are significantly more accurate than both the
diagnostic tests and the presenting signs and symptoms.
46. Title: Hidden Antimicrobials in Surgical Patients: Usage and Documentation of Antimicrobial Content of Bone Cement
Project Advisor(s): Kathryn Matthias, PharmD
Student(s): Alicia Ortega, Janssen Puracan and Jamie Torner
Specific Aims: To evaluate surgery, infectious disease, and nephrology consult documentation of antimicrobial content in bone cement within 30
days post-surgery; evaluate documentation of antimicrobial cement content by pharmacists in pharmacokinetic drug level evaluations within 6
months post-surgery; assess frequency and severity of adverse drug events associated with antimicrobials in bone cement.
Methods: Retrospective chart review, which utilized a utilized a data collection form to evaluate the dose and type of antimicrobial agents
prescribed, median and range antimicrobial doses per 40 grams of cement, documentation rates of antimicrobial content in clinical notes and
incidence of potential adverse drug effects. Subjects were identified based on an ICD-9 code and their electronic medical records were accessed.
Main Results: The sample size was 24 patients. The surgery notes had the highest rates of documentation with 96% naming the drug and 75%
included the dose. The rates were the same in the infectious diseases consults and pharmacy pharmacokinetics notes with the drug name at 27%
and the dose at 9%. No nephrology consult notes mentioned antimicrobials contained in the cement. Renal dysfunction (sCr≥2) developed in 13%
of patients within 30 days and 25% of patients within 100 days. Approximately 17% of patients with renal dysfunction had the antimicrobial-laden
cement removed.
Conclusions: A variety of antimicrobial agents were embedded in bone cement at various concentrations and documentation from multiple
sources was inconsistent. Likewise, adverse events associated with antimicrobial containing bone cement are not consistent.
47. Title: Stability of Extemporaneously Prepared Captopril Solution
Project Advisor(s): David Lee, RPH
Student(s): Sean Park and Basil Wong
Specific Aims: Assess the stability and sterility of various extemporaneously compounded captopril solution in different storage conditions.
Methods: Extemporaneously prepared captopril standards and solutions tested in a high performance liquid chromatography instrument collected
data on stability. In addition, physical appearance, bacterial growth and pH data were also collected.
Main Results: Stability data was assessed with extemporaneously prepared captopril solutions prepared with standardized captopril powder,
captopril tablets and captopril tablets with ascorbic acid included. Stability was defined as retention of at least 90% of the initial captopril
concentration. Overall, all preparations were stable when stored at 4°C but only the tablet preparation was stable when stored at 25°C and 40°C.
No bacterial growth was observed with any of the captopril solutions.
Conclusions: Extemporaneously prepared captopril solution appears to have a shelf-life of at least 28 days when stored at 4°C.
16
48. Title: Inpatient Cases of Clostridium difficile-Associated Disease in Oncology Patients throughout
the United States
Project Advisor(s): Grant Skrepnek, PhD
Student(s): Stephanie Peterson
Specific Aims: To identify the number of Clostridium difficile-associated disease (CDAD) cases in hospitalized oncology patients between 2005 and
2009. To identify the occurrence of mortality, comorbidities, and the amount of hospital charges in this patient population. Predictive variables for
mortality and hospital charges were also identified.
Methods: Data retrieved from the Nationwide Inpatient Sample were used to retrospectively identify the number of CDAD cases in hospitalized
oncology patients, the occurrence of mortality and comorbidities, and the amount of hospital charges incurred between 2005 and 2009.
Multivariate logistic regression was used to identify predictors of mortality and a lognormal regression was used to identify predictors of inpatient
charges.
Main Results: From 2005 to 2009, we identified 210,449 cases of CDAD in hospitalized adult patients with cancer. Total inpatient charges for all
CDAD cases over the five-year period exceeded 18 billion dollars. The percentage of cases that resulted in death was 13%. Variables that were
found to be predictors of mortality included increased age (OR 1.019, CI 1.018-1.020), chronic pulmonary disease (OR 1.231, CI 1.191-1.272),
coagulopathy (OR 2.085, CI 2.011-2.162), liver disease (OR 1.159, CI 1.072-1.253), fluid and electrolyte disorders (OR 1.561, CI 1.518-1.605), renal
failure (OR 1.405, CI 1.349-1.462), and weight loss (OR 1.408, CI 1.362-1.456)(all p<.001).
Conclusions: This study identified a large number of CDAD cases in hospitalized adult cancer patients. Several factors that appeared to be
predictive of mortality and inpatient charges were also identified, which may be useful knowledge for clinicians who need to identify at-risk
patients.
49. Title: A Systematic Review of the Impact of Public Mental Health Benefit Changes on Patients with a Serious Mental Illness
Project Advisor(s): Lisa W. Goldstone, PharmD and Elizabeth Hall-Lipsy, JD, MPH
Student(s): Marjanne Schnarr and Allison Valenzuela
Specific Aims: The specific aim of this study was to assess the impact of public mental health benefit changes on patients with a serious mental
illness.
Methods: A comprehensive literature search was conducted using several databases. Articles that were included in the analysis met the following
inclusion criteria: 1) Study conducted in the United States 2) Study population composed of adults (≥18) with a diagnosis indicative of a serious
mental illness (psychotic disorders, bipolar disorders, major depressive disorder, anxiety disorders, dysthymic disorder, or a personality disorder)
3) Study evaluated a change or discontinuation of mental health services, 4) Study reported outcomes.
Main Results: Of the 117 studies originally identified, 27 met all the inclusion criteria. Data was then extracted from each study regarding the
design of the study, patient demographics, and impact of the various outcomes. Five studies looked at the implementation of prior authorizations
required for psychiatric medications, which all showed increased rates of treatment discontinuation. Two of these five studies also looked at the
impact on emergency department (ED) visits and hospitalizations with both studies showing increased ED visits, but no effect on hospitalizations.
Three studies looked at the implementation of Medicare Part D, which all showed increased rates of medication access problems and increased
rates of ED visits. Other studies that examined medication access issues found increased rates of suicide ideation or behavior, increased rates of
treatment discontinuation, and increased rates of ED visits.
Conclusions: Given the amount of variability among the studies, it is difficult to determine the impact specific benefit changes have on patients
diagnosed with a serious mental illness. In order to draw conclusions regarding specific benefit changes, more studies looking at similar outcomes
need to be conducted. This is critical as the studies examined, in general, showed negative outcomes for patients with a serious mental illness
when mental health benefit changes were implemented.
50. Title: Inpatient Charges and Mortality of Richter’s Transformation of Chronic Lymphocytic Leukemia in the United States
Project Advisor(s): Dr. Skrepnek
Student(s): Daniel Seok
Specific Aims: The objectives of this study were to determine the financial impact and mortality of CLL and Richter’s transformation in CLL in the
inpatient setting in the payer’s perspective, the common diagnoses at discharge for patients with CLL, and to compare demographics, hospital
characteristics, and co-morbidities for CLL cases versus Richter’s only cases.
Methods: This study was a retrospective cohort of inpatient hospital charges and mortality of CLL patients and CLL patients with Richter’s
transformation in the United States in the perspective of the payer. Using weighted statistical methods, results of this investigation yielded
nationally-representative findings. The hospital charges were analyzed with a gamma regression with log link, and mortality was analyzed with a
generalized linear regression.
Main Results: There were total of 391,287 cases and 7% (27,259) were Richter’s cases. The overall hospital charges for CLL and CLL patients with
Richter’s transformation from 2005 to 2009 were $38,735 (±58859) per case and $53,118 (±77993) per case, respectively. The mortality was 6.3%
(24,520 deaths) overall and 9.1% mortality (2,485 deaths) for Richter’s transformation patients. The significant predictors (p < 0.05) that were
associated with an increase the hospital charges for Richter’s patients was sepsis while sepsis and weight loss were associated with an increase in
mortality.
Conclusions This study adds to the few studies published to show the impact of CLL and Richter’s. However, due to the limitation on
pharmacotherapies, it was not possible to determine therapeutic cost drivers for these cases. Future studies are warranted to determine the cost
of therapies associated to the different stages of CLL.
17
51. Title: Physician Response to Call-Based Medication Therapy Management
Project Advisor(s): Kevin Boesen, PharmD
Student(s): Ashley Sweaney
Specific Aims: To assess physician approval of the MTM services provided. Specifically, to compare cost saving, guideline adherence, and safety
concern interventions.
Methods: A retrospective analysis of pharmacist interventions was performed using the MMC database for 2008. Data were collected on the type
of intervention and approval by physicians. Physician specialty was also collected from state medical boards. Descriptive statistics were used to
generate frequencies of approvals. Chi-square tests were used to compare physician approval by intervention type.
Main Results: Pharmacists initiated 1,563 interventions that were faxed to physicians for approval. Of these interventions, cost saving, guideline
adherence, and safety concerns were 33.2, 58.3, and 8.5 percent, respectively. Interventions primarily targeted diabetes (38.6%), cardiovascular
disease (28.8%), gastroesophageal reflux disease (13.1%), and respiratory disease (8.4%). Physician approval for cost saving, guideline adherence,
and safety concerns were 58.0, 44.4, and 41.0 percent, respectively. Approval for cost saving was greater than guideline adherence (58.0% versus
41.0%, P<0.001) and safety concerns (58.0% versus 44.4%, P=0.005). Approval among primary care physicians (PCP) compared to specialty
physicians was greater for both cost saving (60.6% versus 50.7%, P=0.046) and guideline adherence (43.2% versus 36.2%, P=0.045) interventions.
Conclusions: Results of this investigation provide evidence that there are differences in the types of MTM interventions that physicians will
approve. In an effort to improve patient outcomes, this finding suggests a potential to increase overall physician approval of pharmacist-initiated
MTM interventions in the areas of guideline adherence and safety concerns. Results further suggest that lower approval by specialists compared to
PCPs may call for alternative methods to better reach these providers.
52. Title: Evaluation of Therapy Prescribed for Uncomplicated Urinary Tract Infection in Patients in an Emergency Department
Project Advisor(s): David E. Nix, PharmD; Kathryn Matthias, PharmD, and Asad Patanwala, PharmD
Student(s): Belay Zeleke
Specific Aims:
1• Determine the results of urine culture and susceptibility testing for patients with uncomplicated UTI at an emergency department
2• Determine empiric antibacterial agents prescribed for treatment of uncomplicated UTI in the emergency department
3• Compare pathogen susceptibility pattern specific for patients with uncomplicated UTI compared to the overall institution antibiogram
Examine the use of cephalexin for uncomplicated UTI in emergency department patients
Methods: A retrospective electronic medical records of adult female patients admitted to University Medical Center in Tucson, Arizona,
emergency department with a diagnosis of uncomplicated urinary tract infection (UTI) between June 1, 2010 and May 31, 2011 were collected.
Different aspects of uncomplicated urinary tract infection (UTI) were characterized, and prescriptions for empiric antibiotic treatment were
recorded. Culture results and susceptibility reports as well as antibacterial treatment decisions were studied to evaluate types of pathogens and
resistance patterns along with therapy prescribed. The data was managed and analyzed by using SAS. All data was tabulated and described using
summary statistics.
Main Results: The dominant isolate of the study population was E.coli (88%). Cephalexin was prescribed 76% of the time, nitrofurantoin 8.4%,
ciprofloxacin 7.6%, and TMP/SMX 5% of the time. The susceptibility rate of ampicillin was 50%, cefazolin 91%, ciprofloxacin 98%, nitrofurantoin
92%, and TMP/SMX 76%.
Conclusions: Our study revealed that the resistant rate of TMP/SMX exceeded 20%; however, ciprofloxacin and nitrofurntoin susceptibility
remains high. Cephalexin was the most commonly prescribed treatment, but not included in the antimicrobial susceptibility test (AST) panel.
53. Title: Mortality and Cost Outcomes of Emergency Department Visits Associated with Primary or Disseminated Liver Cancer in the United
States; 2009
Project Advisor(s): Grant Skrepek, PhD
Student(s): Nicholas C. Zielinski
Specific Aims: To evaluate associations between hospital and patient characteristics and mortality and economic outcomes. Included records
were of adult patients age 18 years or older with a diagnosis of primary or disseminated liver cancer.
Methods: This study was a retrospective cohort design that utilized emergency department discharge records from the Agency for Healthcare
Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) National Emergency Department Sample (NEDS). Generalized linear
models were used for analyses to assess outcomes of mortality and total charges. Logistic regression was utilized for mortality; gamma regression
with log-link was utilized for charges.
Main Results: Overall, 239,895 adult records were included in the study with diagnoses of ICD-9 155.x or 197.7. Total charges for all records were
over $8.23 billion in 2009. The average age of the case was 65.07 (±13.8) years with 48.7% being female. Mortality (either in the ED or hospital)
was 11.1% (n=26,701). The mean length of stay was 6.47 (±6.05) days. Charges for each record were $42,874.50 (±53,956.34). Increased mortality
was associated the most with hospital teaching status and primary payer. Increased charges were associated with hospitals located in the Western
region.
Conclusions: The differences in clinical outcomes were primarily from different payers and economical outcomes differed greatly by the Western
region hospital location. Data taken from the nationally-representative investigation reveals that primary and disseminated liver cancer still
remains a clinical high burden-of-illness with an 11.1% mortality rate and total charges approaching $10.3 billion dollars.
18