The 2014 American Diabetes Association guidelines denote four means of diagnosing diabetes. The first of these is a glycosylated hemoglobin (HbA1c) >6.5%. This literature review summarizes studies (n=47) in the USA examining the significance, strengths, and limitations of using HbA1c as a diagnostic tool for diabetes, relative to other available means. Due to the relatively recent adoption of HbA1c as a diabetes mellitus diagnostic tool, a hybrid systematic, truncated review of the literature was implemented. Based on these studies, we conclude that HbA1c screening for diabetes has been found to be convenient and effective in diagnosing diabetes. HbA1c screening is particularly helpful in community-based and acute care settings where tests requiring fasting are not practical. Using HbA1c to diagnose diabetes also has some limitations. For instance, HbA1c testing may underestimate the prevalence of diabetes, particularly among whites. Because this bias differs by racial group, prevalence and resulting estimates of health disparities based on HbA1c screening differ from those based on other methods of diagnosis. In addition, existing evidence suggests that HbA1c screening may not be valid in certain subgroups, such as children, women with gestational diabetes, patients with human immunodeficiency virus, and those with prediabetes. Further guidelines are needed to clarify the appropriate use of HbA1c screening in these populations.

No abstract

Introduction: The scope of pharmacy practice has evolved over the last few decades to focus on the optimization of medication therapy. Despite this positive impact, the lack of reimbursement remains a significant barrier to the implementation of innovative pharmacist practice models. Summary: We describe the successful development, implementation and outcomes of three types of pharmacist collaborative care models: (1) a pharmacist with physician oversight, (2) pharmacist–interprofessional teams and (3) physician–pharmacist teams. The outcome measurement of these pharmacist care models varied from the design phase to patient volume measurement and to comprehensive quality dashboards. All of these practice models have been successfully funded by affiliated health systems or grants. Conclusions: The expansion of pharmacist services delivered by clinical faculty has several benefits to affiliated health systems: (1) significant improvements in patient care quality, (2) access to experts in specialty areas, and (3) the dissemination of outcomes with national and international recognition, increasing the visibility of the health system.

Objective. To evaluate the effect of educational video podcasts in a self-taught pharmaceutical calculations module by assessing quiz performance and student qualitative feedback. Methods. Six video podcasts were designed and posted online for students to review prior to pharmaceutical calculations quizzes over the course of one year. Video podcasts demonstrated solving the most difficult problems on each of the six quizzes. Quiz performance was compared for the 2017-2018 year (no videos available) and the 2018-2019 year (videos available); students completed a year-end survey to provide feedback on the videos. Results. Overall quiz scores and passing rates improved during the 2018-2019 year. Enhanced performance on three of the six quizzes was demonstrated. The majority of students indicated they strongly agreed that the videos were helpful overall. Conclusion. Video podcasts were effective in improving performance on calculations quizzes and students felt they were helpful in improving math skills and facilitated their learning of the material.

Objective. To implement and evaluate the effectiveness of an interactive health literacy program by measuring pharmacy students' knowledge and confidence. Design. A health literacy module consisting of a lecture and workshop was incorporated into a self-care course for first-year pharmacy students. Active-learning activities included practicing health literacy tools, discussing faculty-created video vignettes, and improving readability of patient education monographs. A non-validated survey assessed knowledge and confidence before and after training. Assessment. Fifty-three students (88%) completed a pre-training survey, and 60 (100%) completed a post-training survey. Students' confidence improved in six of seven areas (p,.001). Students' knowledge significantly improved in three of 14 areas (p,.01) pertaining to the average American reading level, high-risk age groups, and correlation of late prescription refills to low health literacy. Although knowledge increased in other areas, the improvements were not significant. Conclusion. An interactive, multifaceted health literacy training program significantly improved pharmacy students' knowledge and confidence in recognizing and being able to assist patients with low health literacy.

Purpose To describe the development of a collaborative community–academic postgraduate year 1 pharmacy residency program in San Diego that provides a hybrid experience of opportunities in community practice, ambulatory care, and teaching. Summary Residency training programs are being developed to better match the evolving role of the community pharmacist. In 2016, the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences partnered with Ralphs Pharmacy, a division of the Kroger Co., to launch a 1-year community residency to develop community-based pharmacists with diverse patient care, leadership, and education skills. Learning experiences include pharmacy operations, clinical services focusing on chronic disease management and education, teaching, and practice-based research. Training settings include community pharmacy, corporate pharmacy, ambulatory care, and academia. Graduates are prepared to work in these settings as well as capitalize on advanced training opportunities, including postgraduate year 2 residencies and professional certifications. The program has been successfully accredited, and graduates have completed the program: one completed a postgraduate year 2 residency, and both have obtained a management or clinical pharmacist position. Conclusion An innovative community—academic residency program preparing postgraduate year 1 learners for careers in community-based pharmacy, corporate, ambulatory care, and academic settings was developed, with positive preliminary outcomes.

Scant literature exists regarding health effects of fine particulate matter (PM 2.5) pollution at or below national standards. This study examined the relationship between PM 2.5 and acute care use and costs in Honolulu where PM 2.5 is low. Single and distributed lag over-dispersed Poisson models were used to examine hospitalizations/emergency department (ED) visits associated with cumulative PM 2.5 exposure over the current day and seven previous days (lags 0-7) in 2011. A 10-µg/m 3 increase in cumulative PM 2.5 concentration was associated with a 32% increase in respiratory admissions (RR=1.32, p=0.001) costing $486,908 and a 24% decrease in respiratory admissions in the comparison group (RR=0.76, p<0.001). ED visits increased by 12% at lag day 0 for respiratory outcomes (RR=1.12, p=0.03) and cumulatively with increased respiratory visits by 49% (RR=1.49) and increased combined respiratory and cardiovascular issues by 20% (RR=1.20; p<0.

BackgroundSugar cane harvesting by burning on Maui island is an environmental health issue due to respiratory effects of smoke. Volcanic smog (“vog”) from an active volcano on a neighboring island periodically blankets Maui and could confound a study of cane smoke’s effects since cane burning is not allowed on vog days. This study examines the association between cane burning and emergency department (ED) visits, hospital admissions, and prescription fills for acute respiratory illnesses.MethodsThis retrospective study controlled for confounders that could increase respiratory distress on non-burn days by matching each burn day with a non-burn day and then comparing the ratio of patients with respiratory distress residing in the path of sugar burn smoke to those residing elsewhere on Maui on burn versus non-burn days. Patients with acute respiratory distress were defined as those with one or more acute respiratory diagnoses at one of the hospitals or emergency departments on Maui. Separately, patients with acute respiratory illness were identified through prescription records from four community pharmacies, specifically defined as those who filled prescriptions for acute respiratory distress.ResultsThere were 1,256 reports of respiratory distress prescriptions and 686 hospital/ED diagnoses of acute respiratory illness. The ratio of cases within to outside of smoke exposure was higher on burn days for both the ED/hospital data and the pharmacy, though not statistically significant. In post-hoc analyses of the pharmacy data based on the number of acres burned as a proxy for volume of smoke, there was a dose response trend for acreage burned such that the highest quartile showed a statistically significant higher proportion of acute respiratory distress in the exposed versus non-exposed regions (P = 0.015, OR 2.4, 95 % CI [1.2–4.8]).ConclusionsAfter adjusting for confounders on non-burn days, there was a significantly higher incidence of respiratory distress in smoke-exposed regions when greater amounts of acres were burned. Health officials should consider actions to reduce the negative health outcomes associated with sugar cane burning practices.