BCG vaccine has been used for 100 years to prevent tuberculosis. Not all countries, including the United States, adopted the initial World Health Organization recommendation to use BCG. Moreover, many Western countries that had routinely used BCG have discontinued its use. Recent population studies demonstrate lower prevalence of Alzheimer’s disease (AD) in countries with high BCG coverage. Intravesicular instillation of BCG is also used to treat bladder cancer that has not invaded the bladder muscle wall and has been shown to reduce recurrence. Several retrospective studies of bladder cancer patients demonstrated that BCG treatment was associated with a significantly reduced risk of developing AD. Plasma amyloid β assessment has become a fertile area of study for an AD biomarker that is predictive of a positive amyloid PET scan. Mass spectrometry-based plasma amyloid 42/40 ratio has proven to be accurate and robust, and when combined with age and ApoE, is shown to accurately predict current and future brain amyloid status. These parameters, amyloid 42/40 ratio, age and ApoE genotype are incorporated into an Amyloid Probability Score (APS)–a score that identifies low, intermediate or high risk of having a PET scan positive for cerebral amyloid. Community recruitment was used for this open-label pilot study. Forty-nine BCG-naïve, immunocompetent individuals completed our study: prior to BCG prime and boost, as determined by the APS, 34 had low risk (APS 0–35), 5 had intermediate risk (APS 36–57) and 10 had high risk (APS 58–100). The APS range for the participant group was 0 to 94. Follow-up plasma amyloid testing 9 months after vaccination revealed a reduction in the APS in all the risk groups: low risk group (p = 0. 37), intermediate risk group (p = 0.13) and the high-risk group (statistically significant, p = 0.016). Greater benefit was seen in younger participants and those with the highest risk. The small number of participants and the nascent status of plasma amyloid testing will rightfully temper embracement of these results. However, both the favorable direction of change after BCG as well as the utility of the APS—a valuable surrogate AD biomarker—may prompt a definitive large-scale multicenter investigation of BCG and AD risk as determined by plasma amyloid peptide ratios and APS.

Purpose To evaluate the impact of computerized prescriber order entry (CPOE) on 3 elements of medication use system performance: inpatient medication override dispense rates from automated dispensing cabinets (ADCs), medication first-dose turnaround time (TAT), and pharmacist perception of the medication orders management process. Methods A pre-post intervention trial design was used to assess each of the 3 medication use system elements. The intervention was CPOE implementation. The ADC override outcomes evaluated were the total number of overrides and the presence of appropriate documentation for each override. One week random samples of override data from the pre-CPOE and post-CPOE time periods were analyzed. The medication TAT outcomes studied were mean time from order entry by the prescriber to time of order verification and mean time from order entry by the prescriber to time of medication administration. Electronically collected data post CPOE were compared to manually collected data pre CPOE. The primary pharmacist perception outcome assessed was overall satisfaction with the medication orders management process. The pre- and post-CPOE data were collected through an electronic survey conducted after CPOE implementation. Results Following the implementation of CPOE, the relative number of medication override dispenses decreased by 58%, but documentation worsened by 73%. The mean time from order entry to order verification improved by 76%, and the mean TAT for intravenous antibiotics improved by 31%. Pharmacist overall satisfaction with the medication orders management process improved by 23%. Conclusion The implementation of CPOE resulted in improvement in each of the 3 medication use system elements assessed.

IntroductionLimited guidance exists for primary and urgent care ultrasound applications. This study sought to identify the most useful applications for providers in these clinical settings, to create and implement a structured interdisciplinary point-of-care ultrasound (POCUS) curriculum, and to assess the effectiveness of the course. MethodsThis prospective cohort study took place at an urban academic medical center. After a needs-based assessment of ultrasound applications in primary and urgent care, the Emergency Medicine ultrasound faculty and fellows were paired with a primary or urgent care provider (N = 6). The pairings met for scanning sessions in the emergency department to practice image acquisition, documentation, and incorporation of ultrasound into the workflow. Participants were given POCUS pre-work to review before each session. The final bedside session included a formal Objective Standard Clinical Examination (OSCE) to assess learner proficiency to be cleared for independent imaging. The program was assessed using pre-and post-training surveys. ResultsThe survey results demonstrated that renal, gallbladder, and soft tissue scans were the most interesting and useful to primary and urgent care providers after completion of the training course. ConclusionThe course was effective, and efficient, simple, high-yield POCUS applications should be included in future programs and organizational guidelines for primary and urgent care POCUS education.

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Home hospital programs are rapidly becoming a more common patient care model in the market. The impact on hospital pharmacy practices is not well defined. This article describes the development of pharmacy services in a home hospital program in an attempt to help other organizations create their own home hospital pharmacy programs. Summary Caring for acutely ill patients in their home was a novel idea when Mayo Clinic began considering this in January 2020. Since then, the coronavirus disease 2019 (COVID-19) pandemic has rapidly escalated interest in and pursuit of these programs. One question we asked ourselves, and many colleagues are asking us today, is, “How does pharmacy fit in?” Through 2 years of active engagement, innovation, and persistence, our team has developed a robust pharmacy presence in the home hospital care team and a well-articulated approach to medication management for our patients. We have tightly aligned and blended our clinical efforts to mirror our typical inpatient and ambulatory care clinical activities. We have also developed and modified our dispensing functions to serve the unique needs of the care model. Conclusion Home hospital medication management is both complex and ripe with opportunities for pharmacy engagement.