2026 ACCP Annual Meeting Posters

Introduction

Brimonidine, an alpha-adrenergic agonist, is indicated for treatment of open-angle glaucoma. Labile blood pressure (BP) and hypotension have been observed with brimonidine use, but it is not well described or recognized among health care professionals.

Case

A 81 year old female with lightheadedness and labile BP was referred for 24hr ambulatory blood pressure monitoring (ABPM). Past medical history included labile hypertension (2022), open-angle glaucoma, GERD, hyperlipidemia, TIA, and obstructive sleep apnea. Medications included: brimonidine 0.2% 1 drop each eye every 8 hours (2022), metoprolol succinate 25mg twice daily (2024), and furosemide 20mg once daily. BP was recorded at 0, 30, 60, 90, 120, and 150 minutes after her morning and evening doses of brimonidine 0.2%, 1 drop in each eye. Mean SBP/DBP decreases (mm Hg) at 30, 60, 90, 120, and 150 minutes were: -32/-8, -42/-13, -60/-31, -54/-31, and -56/-27. BP values (90/54; morning and 92/52; evening) reached a nadir at 90-150 minutes after eye drop administration. The overall 24hr mean BP was 128/74 mm Hg. Standard deviation of 24hr SBP was greatly increased at 27 mm Hg. Maximum SBP was 181. SBP dipping during sleep was 7.4%.

Discussion

A case of pseudopheochromocytoma secondary to brimonidine with accompanying hypotension, similar to ours, has been reported. Brimonidine Tmax is 1-2 hours and its half-life is 3 hrs. This corresponds with the timing of low BP values we observed. Brimonidine product labeling notes it may lower blood pressure and advises caution when using it with antihypertensives. It is possible the combination of metoprolol and brimonidine has additive effect on blood pressure variability.

Conclusion

Ophthalmic medications can have systemic effects. Brimonidine has been associated with hypotension, hypertension, and labile blood pressure. Greater awareness of this potential adverse event may improve patient care.

Introduction

Existing machine learning prediction models of platinum-based chemotherapy are affected by multiple forms of bias, making the prediction unreproducible in different patient groups.

Research Question or Hypothesis

This study applied fairness and bias assessments to optimize the decision threshold of the machine learning models, ensuring comparable performance in predicting cisplatin- or carboplatin-associated acute kidney injury (AKI) and acute kidney disease (AKD) across patient subgroups.

Study Design

This retrospective study used clinical data collected from three hospitals in Taiwan to develop the machine learning model.

Methods

Three fairness metrics, demographic parity (DP), equalized odds (EO), and predictive parity (PP), were applied to assess model fairness. The model was considered fair across the selected subgroups if the differences in selection rate, true positive rate (TPR), false positive rate (FPR), and precision between each subgroup and the overall population were within 0.1. Sensitive attributes included age, gender, cancer type, and the platinum-based drug administered. Threshold Optimizer was used to mitigate the postprocessing bias.

Results

Both the AKI and AKD prediction models were developed, and sensitive patient subgroups that did not meet the 3 predefined fairness criteria were identified. After optimizing subgroup-specific thresholds, disparities in selection rate, TPR, FPR, and precision between sensitive groups and the overall population were reduced. For the AKI model, the TPR gap for carboplatin recipients and those with lung cancer decreased from 0.373 and 0.143 to 0.007 and 0.017, respectively. For the AKD model, the TPR disparity for patients aged 71-95 and carboplatin recipients reduced from 0.168 and 0.161 to 0.013 and 0.011, while the FPR disparity for patients aged 20-45 reduced from 0.101 to 0.0001. Both models met all fairness criteria after threshold optimization across sensitive groups.

Conclusion

The study applied fairness assessment and bias mitigation to enable fair prediction for platinum-associated AKI and AKD across diverse patient demographics.

Introduction

Medication reconciliation at hospital admission is a National Patient Safety Goal linked to reducing hospital readmissions. Limited availability for pharmacist-led reconciliation due to staffing constraints has prompted pharmacy student integration into this workflow. Evidence supports their accuracy in obtaining best possible medication histories (BPMHs); however, the effect on downstream value-based care outcomes remains understudied.

Research Question or Hypothesis

We hypothesized that pharmacy student-completed admission medication histories (MH cohort) would be associated with a lower 30-day all-cause hospital readmission rate compared to admissions without a completed medication history (NoMH cohort).

Study Design

Retrospective, single-center, 1:1 matched cohort study at The Ohio State University Wexner Medical Center (OSUWMC), an 1,800-bed academic medical center (IRB-approved; STUDY20251558).

Methods

Adults aged 18–89 admitted for ≥48 hours between September 1, 2024 and December 31, 2025 were assigned to the MH cohort (pharmacy student-completed medication history note present) or NoMH cohort (no medication history note present). Patients discharged to hospice, who died during admission, or were incarcerated were excluded. Cohorts were matched 1:1 using nearest-neighbor propensity score matching with exact matching on sex, age ≥65 years, length of stay (LOS) ≥5 days, and medication history acuity score ≥5. The primary outcome was 30-day all-cause readmission.

Results

Pre-match cohorts comprised 4,422 MH and 4,068 NoMH patients with significant baseline differences in age, LOS, and medication history acuity score between groups. After matching, 3,515 pairs were analyzed. The 30-day all-cause readmission rate was significantly lower in the MH cohort compared to NoMH (18.3% [643/3,515] vs. 20.8% [731/3,515]; absolute difference −2.51%, 95% CI −4.39% to −0.62%; p = 0.0082).

Conclusion

Pharmacy student-led admission medication reconciliations were independently associated with a statistically significant reduction in 30-day hospital readmission rates. These findings support integrating pharmacy students into medication reconciliation workflows as an effective value-based care strategy at academic medical centers.

Introduction

The Appalachian region, home to 26.5 million Americans, faces persistent health disparities, including limited healthcare access, high chronic disease burden, and low health literacy. Ambulatory Care Pharmacists, especially Board-Certified Ambulatory Care Pharmacists (BCACPs), can improve medication management, chronic disease outcomes, and patient education, yet their regional distribution is poorly characterized.

Research Question or Hypothesis

We hypothesize that the number and density of BCACPs in Appalachia are significantly lower than national averages, underscoring a critical gap in access to specialized ambulatory care services.

Study Design

This study is a cross-sectional descriptive analysis of publicly available data from the Board of Pharmacy Specialties and the Appalachian Regional Commission.

Methods

A cross-sectional analysis used BCACP data from the Board of Pharmacy Specialties and county classifications from the Appalachian Regional Commission. ZIP codes were mapped to counties and classified as rural or non-rural. BCACP density per 1,000,000 residents was calculated, with Poisson regression estimating rate ratios comparing Appalachia and rural Appalachia to national levels.

Results

Appalachia had 14.0 BCACPs per 1,000,000 residents (24% below U.S. average), while rural Appalachia had 4.9 per 1,000,000 (73% below U.S.) (p<0.001).

Conclusion

BCACPs are underrepresented in Appalachia, highlighting workforce gaps. Recruitment, incentives, training, and telehealth could expand access to specialized pharmacy care.

Service or Program

Embedded primary care clinical pharmacists played a key role in 2023-2024 developing and implementing new services targeted at hypertension (HTN) quality measures at a large university based internal medicine clinic. Since 2024, pharmacists have led sustainable initiatives of this multifaceted HTN quality improvement program, with the most impactful being, implementation and utilization of high-quality out-of-office blood pressure measurements. This included, (1), standardize protocol to assess and evaluate home blood pressure monitor (HBPM) accuracy, (2), documentation of reliable HBPM, and (3), workflows to utilize and record HBPM readings within the electronic health record (EHR). This program was developed to align with the American Medical Association (AMA) hypertension resources and guidelines. Pharmacists monitored these initiatives to ensure sustainability and implemented updates as necessary based on renewability.

Justification/Documentation

The use of high-quality HBPM was identified as a crucial initiative in targeting the Centers for Medicare and Medicaid Services (CMS) quality measure #165, “Controlling High Blood Pressure”. This impacts primacy care clinics’ reimbursement linked to value-based insurance programs. Pharmacists monitored the clinic’s HTN control rate. Prior to 2024, average control was ~65% but has since increased and maintained above 70%, most recently to 75% as of May 2026. Counts of patient HBPM doubled from the end of 2024 at ~800 to ~1,600 as of May 2026.

Adaptability

This model can be implemented in other ambulatory clinics to target HTN quality measures. This intervention does not require significant resources from the system or clinical model practice change. Larger benefits potentially could be seen in rural or underserved areas with limited access to office visit follow-up.

Significance

This demonstrates that pharmacist-led initiatives can sustainably improve quality outcomes. Monitoring and optimizing the use of HBPMs enhanced value-based hypertension care, highlighting the important role of clinical pharmacists in interprofessional primary care teams.

Service or Program

A chronic care management (CCM) telehealth lipid-management pilot service was created in collaboration with a rural primary care provider group to improve statin utilization. Pharmacists utilized a collaborative practice agreement to manage hyperlipidemia, identify medication-related problems, and coordinate care through telephone-based visits for three hours per week over a 4-month period. A patient list was generated by querying the electronic medical record for patients at high risk of cardiovascular disease seen within 12 months.

Justification/Documentation

A growing physician shortage in Georgia has reduced access to care for rural populations, positioning pharmacists to bridge this gap. Investigators collected number of patients screened, outreach attempts, patients enrolled, visits completed, medication-related problems identified, and physician contacts made. During this pilot, 259 patients were screened, 109 outreach attempts were conducted, 19 patients were enrolled, and 42 visits were completed. Each service day averaged 6 patient screenings, 7.8 contact attempts, and 3 patient visits. Overall, 37 medication-related problems were identified, and 20 physician contacts were made.

Adaptability

By utilizing the Consolidated Framework for Implementation Research (CFIR), facilitators and barriers toservice implementation were identified. For the outer setting, barriers related to the EMR query and note template construction were identified. Inner setting facilitators were physician support. Barriers included support staff awareness and communication with investigators, and lack of physical presence. Pharmacist expertise was an identified facilitator, while limited time for service development, unfamiliarity with CCM billing, medication access challenges, and patient reluctance toward unfamiliar providers were noted barriers. The lack of a structured implementation process could have hindered theservice’s success.

Significance

This service demonstrates the impact pharmacists can have on identifying medication-related problems and care coordination through a telehealth model in the rural primary care setting. By utilizing the CFIR framework, identifiedfacilitators and barriers allow others to learn from our process and implement similar services.

Introduction

Identifying statin intolerance (SI) within claims data is challenging due to lack of specific SI billing codes.

Research Question or Hypothesis

What proportion of new statin initiators develop SI using a claims-based algorithm?

Study Design

Retrospective cohort analysis using Symphony Health Solutions data.

Methods

Adults newly initiating statins (03/2019–12/2022) with ≥1-year pre-statin initiation and ≥2-years post-initiation data and meeting continuous enrollment criteria were included. The algorithm was developed through expert consensus. Patients meeting ≥1 of these scenarios were defined as SI: (1) rhabdomyolysis medical claim; (2) ≥3 different statin trials within 12 months; (3) switch from statin to non-statin therapy; (4) medical claim(s) for muscle- or liver-related adverse event (AE) including abnormal liver function test result, antihyperlipidemic drug-related AE, creatine kinase test (CKT), accompanied by statin dose-intensity reduction or switch to lower-intensity statin or pravastatin/pitavastatin (‘statin-switch’); or (5) muscle- or liver-related AE, antihyperlipidemic drug-related AE, CKT, statin dose-reduction, or statin-switch, accompanied by statin discontinuation.

Results

Overall, 4,412,321 adults newly initiating statins were included; 300,307 (6.8%) met algorithm-defined SI criteria. Majority were classified as SI due to the combination of AEs, CKT, or statin changes plus statin discontinuation, followed by switching to non-statin therapy (Table).

Table.

Qualifying Scenario

Statin Intolerant

(N=300,307; 6.8%)

n

%

(a) Any 1: Muscle- or liver-related AE, antihyperlipidemic drug-related AE, CKT, statin dose-intensity reduction, or statin-switch, and (b) Statin discontinuation

147,404

49.1%

Switch to non-statin therapy

108,662

36.2%

(a) Any 1: Muscle- or liver-related AE, antihyperlipidemic drug-related AE, CKT, and (b) Any 1: Statin dose-intensity reduction or statin-switch

43,721

14.6%

≥3 different statins

26,821

8.9%

Rhabdomyolysis

10,673

3.6%

*Scenarios not mutually exclusive; n(%) of each scenario sum to greater than total SI events.

Conclusion

This algorithm uses a comprehensive SI definition, reflecting updated clinical understanding of SI over previously published algorithms. The proportion of identified SI is similar to rates reported in a systematic review (5.9%-9.1%).

Introduction

Trauma patients are at higher risk for venous thromboembolism (VTE), and traditional prophylaxis doses may result in suboptimal anti-factor Xa (anti-Xa) concentrations.

Research Question or Hypothesis

Does a prophylaxis pathway with escalated enoxaparin doses improve anti-Xa attainment in critically ill trauma patients?

Study Design

Retrospective, pre/post-cohort evaluation

Methods

Adult patients admitted to the trauma ICU receiving ≥48 hours of enoxaparin and had ≥1 anti-Xa value were screened and excluded if pregnant/breastfeeding, on therapeutic anticoagulation, sustained a traumatic brain injury, admitted <72 hours, or inappropriately drawn anti-Xa. Patients receiving VTE prophylaxis based on a previous pathway iteration (PRE-group) were compared to those receiving escalated enoxaparin doses per a new pathway (POST-group). The primary outcome was anti-Xa attainment. Anti-Xa values were excluded if drawn prior to steady state or ±2 hours outside recommended collection time. The PRE group monitoring included peak concentrations (4 hours post-dose, goal 0.2-0.4 IU/mL); the POST group monitoring included troughs (12 hours post-dose, goal 0.1-0.2 IU/mL).

Results

A total of 187 patients were included: 112 PRE-group and 75 POST-group. Median age was 49 (32-62), 74.9% were male, and median injury severity score was 17 (10-25). The POST-group had significantly higher weight (85.5 kg [76-109.8] versus 108 kg [99-124]; P<0.001) but similar weight-based enoxaparin dose (0.43 [0.36-0.52] versus 0.41 [0.33-0.54]; P=0.84). Anti-Xa attainment was not significantly different between groups (67.9% versus 56%; P=0.10), although initial anti-Xa values were more often supratherapeutic in the POST-group (5.8% versus 25.0%, P=0.01). VTE occurred in 0.9% PRE-group versus 4% POST-group (P=0.30). Bleeding occurred in 15.2% PRE-group and 13.3% POST-group (P=0.72).

Conclusion

A prophylaxis pathway with escalated enoxaparin dosing did not improve anti-Xa attainment. Higher median weight in the POST-group resulted in equivalent weight-based enoxaparin dosing, which may have decreased the likelihood of anti-Xa attainment. Despite more supratherapeutic initial anti-Xa concentrations in the POST-group, increased bleeding was not observed.

Introduction

Perioperative hyperglycemia is a significant predictor of surgical site infections (SSIs) and other postoperative complications in both diabetic and nondiabetic patients. While current guidelines recommend maintaining blood glucose between 100-180 mg/dL perioperatively, the optimal protocol is unknown.

Research Question or Hypothesis

What is the impact of an institutional perioperative glycemic management protocol implementation on day-of-surgery (DOS) hyperglycemia among scheduled surgery patients?

Study Design

This quasiexperimental study employed the Model for Improvement framework for healthcare QI and was reviewed by the OhioHealth Office of Human Subjects Protections as a QI determination application.

Methods

We developed an evidence-based corrective insulin protocol for the immediate perioperative phases of care at our institution. The protocol was iteratively evaluated across six, 6-week post-implementation periods encompassing April-December 2025, and compared to a baseline period of the 12 months prior to implementation (April 2024-March 2025). Demographic variables, protocol measures, outcomes measures, and balancing measures were trended descriptively (Microsoft Excel v16.0) for scheduled surgery patient classes.

Results

The rate of eligible patients administered insulin increased from 14% pre-implementation to 54% at last post-implementation period. Hyperglycemia on DOS decreased from 15.8% to 10.5% in this timeframe, and hypoglycemia remained limited (≤1%). Very few protocol-related adverse events were detected. Surgical site infections remained rare, and hyperglycemia was prevalent among SSI cases.

Conclusion

An interprofessional QI implementation of a perioperative glycemic management protocol has been associated with increased insulin utilization, less DOS hyperglycemia, and no apparent increase in hypoglycemia. Further analyses are underway to explore insulin dose-response and optimize the protocol for broader adoption as a potential tool for mitigating SSI risk.

Introduction

Societal guideline recommendations for blood pressure goals for patients with mild-to-moderate spontaneous intracerebral hemorrhage (sICH) are currently conflicting and have led to inconsistent practices.

Research Question or Hypothesis

What are the feasibility differences in maintaining a systolic blood pressure (SBP) target of 130-150 mm Hg versus <140 mm Hg in patients with mild-to-moderate sICH?

Study Design

This was a single center, pre-post, retrospective chart review of adults with mild-to-moderate sICH. A goal SBP of 130-150 mm Hg represented the expanded target and a goal SBP of <140 mm Hg represented the narrowed target.

Methods

The primary outcome was SBP time in range (TIR) during the first 24 hours of admission. Secondary outcomes included time above range (TAR), time below range (TBR), SBP variability, hypotension, in-hospital mortality, change in functional status, intravenous antihypertensive utilization, serious adverse events, and neurological deterioration.

Results

Patients with a goal SBP of 130-150 mm Hg had higher TIR compared to patients with a goal SBP of <140 mm Hg (p<0.001). In addition, patients with SBP target of 130-150 mm Hg had a lower TAR (p<0.001) and lower TBR (p=0.014). Patients with an expanded target demonstrated a decrease in nicardipine and hydralazine utilization, but statistically significant higher utilization of labetalol (p=0.037). During admission, there was a numerical decrease of SBP values <130 mmHg and mortality among patients with target SBP of 130-150 mm Hg, but these patients demonstrated an increase in AKI at 48 hours (p=0.038). At discharge, patients with target SBP 130-150 mm Hg showed more improvement in GCS (p=0.048).

Conclusion

An SBP target of 130-150 mm Hg demonstrated improved feasibility of target attainment which may translate to improved clinical outcomes in mild-to-moderate sICH. Future studies should include larger sample sizes, matched patient cohorts, and opportunities to assess the impact of feasibility results on patient outcomes.

Introduction

Critically ill trauma patients are at an increased risk of developing ventilator-associated pneumonia (VAP), which can be reduced by prophylactic antibiotics. It is unclear if there is a difference in incidence of VAP or causative organisms in patients who receive cefazolin versus ceftriaxone as prophylaxis for traumatic injuries.

Research Question or Hypothesis

Does the incidence of early-onset VAP (EO-VAP) in critically ill trauma patients differ with the receipt of prophylactic cefazolin versus ceftriaxone?

Study Design

Single center, retrospective cohort study at a level one trauma center.

Methods

Data were collected via chart review for patients admitted to the trauma ICU between July 1, 2023 to June 30, 2025. Patients were included if intubated within 48 hours of admission and received cefazolin or ceftriaxone for surgical or open fracture prophylaxis within 12 hours of intubation. The primary outcome was incidence of EO-VAP. Secondary outcomes included causative organisms, ICU length of stay, and days of mechanical ventilation. Outcomes were evaluated by regression models using inverse probability of treatment weighting.

Results

Of 1209 patients screened, 249 were included, with 190 patients receiving cefazolin and 59 patients receiving ceftriaxone. The median injury severity score was 21 [14, 29]. Approximately 30% of patients had a traumatic brain injury. There was no difference in baseline characteristics between groups except injury mechanism, with penetrating injury more common in cefazolin patients. The incidence of EO-VAP was lower in the ceftriaxone group versus cefazolin (12% vs. 6.8%, aOR 0.302 (95% CI 0.140-0.654), p=0.002). There was significantly less gram-negative EO-VAP in the ceftriaxone group but no difference in multidrug-resistant causative organisms. Ceftriaxone was associated with a shorter ICU length of stay and a numerical albeit non-significant reduction in days of mechanical ventilation.

Conclusion

A single dose of ceftriaxone within 12 hours of intubation likely reduces the odds of developing EO-VAP in critically ill trauma patients when compared to cefazolin.

Introduction

LGBTQ+ populations experience persistent disparities and frequently encounter barriers to affirming healthcare services. Pharmacists play an important role in reducing these disparities; however, limited data describe student pharmacists’ preparedness with LGBTQ+ patient care during didactic and Advanced Pharmacy Practice Experiences (APPEs).

Research Question or Hypothesis

To characterize graduating pharmacy students’ experiences caring for LGBTQ+ patients and evaluate changes in perceived preparedness and confidence providing LGBTQ+-inclusive care.

Study Design

Multi-institutional cross-sectional survey.

Methods

An anonymous survey was distributed and completed by graduating APPE pharmacy students from 12 U.S. colleges and schools of pharmacy. Survey items assessed pre-APPE preparedness, post-APPE confidence, exposure to LGBTQ+ patient care, didactic and experiential training, and perceptions regarding curricular importance. Descriptive statistics were calculated. A paired Wilcoxon signed-rank test compared preparedness prior to APPEs with confidence following APPEs among respondents with complete paired data.

Results

Of 139 respondents, 129 completed primary survey items. Prior to APPEs, 47.3% reported feeling somewhat or very prepared to provide care for LGBTQ+ patients, compared with 68.2% reporting somewhat or very confident after APPE completion. Post-APPE confidence scores were significantly higher than pre-APPE preparedness scores (W=1477, p<0.001). Despite higher post-APPE confidence, majority of respondents (66.7%) reported that only a few rotations (≤24%) substantially included LGBTQ+ patient care, and 61.2% reported little to no LGBTQ+-focused instruction during APPEs. Additionally, 76% of respondents perceived didactic LGBTQ+ instruction as insufficient with 90.7% reporting only 0–3 didactic hours on LGBTQ+ content. Furthermore, 87.6% indicated that preparing student pharmacists to care for LGBTQ+ patients is somewhat or very important.

Conclusion

Although increased confidence following APPE participation was noted, students reported limited exposure to LGBTQ+ patient care and insufficient didactic and experiential instruction. These initial findings support expansion of LGBTQ+-focused learning within schools of pharmacy to further develop competency in cultural and structural humility, inclusive communication, and person-centered care to support accreditation expectations.

Service or Program

Northeastern University's School of Pharmacy and Pharmaceutical Sciences developed a scaffolded Objective Structured Clinical Examination (OSCE) program to assess PharmD student competency development. Administered through a six-semester integrated lab (ILL) series and governed by a faculty sub-committee, the program was iteratively redesigned beginning in 2024 from a fragmented, course-owned model into a centralized framework mapped to AACP Curricular Outcomes and Entrustable Professional Activities (COEPAs), with activity complexity scaffolded across Miller's Pyramid.

Justification/Documentation

The original model distributed OSCE grading across individual courses, with station selection driven primarily by scheduling availability and course content. This created grading inconsistencies, concentrated assessment burden on high-stakes days, and lacked a mechanism to ensure students were building toward APPE-readiness in a deliberate way. Redesign was informed by a literature review and the AACP Essential Elements for Core Required APPEs, which served to identify specific, observable station activities. A master skills list was developed, mapped to outcomes, assigned complexity levels, and triangulated against existing syllabi. Following consolidation into the ILL, the proportion of the lab grade attributable to OSCEs progressively increases each semester and each station is prospectively mapped to relevant COEPAs with documented complexity levels, reflecting a deliberately structured, verifiable progression from foundational to APPE-ready performance.

Adaptability

The framework is built on nationally standardized documents used by ACPE-accredited PharmD programs and is implementable at any stage of curricular development. Programs can apply the triangulation methodology directly to existing assessments and lab activities and build on program-embedded work already in place.

Significance

Despite widespread adoption of PharmD OSCEs, prospective frameworks that systematically scaffold COEPA coverage across a full didactic curriculum are not well-represented in the literature. This program offers a replicable model for aligning OSCE assessment with competency-driven education principles and ACPE Standards 2025 for demonstrating APPE-readiness, ultimately positioning graduates to deliver competent, practice-ready patient care.

Introduction

Student enjoyment of lecture material has been shown to positively impact student engagement and knowledge retention. Utilization of a themed lecture design, defined as an unrelated topic woven throughout content delivery, to increase student enjoyment in pharmacotherapy material has not been studied.

Research Question or Hypothesis

Does themed lecture design use for pedagogical delivery of pharmacotherapy material increase student perceived engagement?

Study Design

Prospective educational intervention with post-survey quantitative/qualitative analysis.

Methods

Two cohorts of second-year pharmacy students (N=113) enrolled in a Pharmacotherapy course participated in three 80-minute basketball-themed CKD lectures titled “Neph Madness” delivered by one instructor. The lectures were taught using PowerPoint slides with basketball-inspired delivery. This included basketball-themed: pre-class music, Poll Everywhere knowledge checks (e.g. “30 second timeout,” “full timeout”), vignettes with famous player/coach names, and a CKD disease progression analogy with a player injury. The impact of this strategy was assessed using a post-intervention 13-item voluntary survey. Likert-scale questions (5-point) were analyzed using descriptive statistics, and open-ended responses were assessed using two-coder thematic analysis.

Results

Eighty-six students (76.1%) completed the survey. The average age of participants was 23.9 years (SD: 2.5), and most identified as female (69.8%), White (87.2%), and non-Hispanic (95.3%). Sixty-six (76.7%) students reported they had never listened to a themed presentation prior, and eighty-five (98.3%) reported enjoyment of the teaching strategy. Sixty-four (74.1%) students agreed they were more engaged with the content and sixty-six (76.7%) with the lecturer because of the teaching strategy employed. Majority of feedback was positive (n=14), and common themes reported from students included belief the teaching strategy was fun/enjoyable (n=13), engaging (n=6), and effective (n=5).

Conclusion

The use of a themed lecture design is a novel approach and showed an increase in student perceived engagement with the content and lecturer, making this a creative strategy clinician educators can use in their teaching pedagogy.

Introduction

Previous surveys at the University of Wisconsin-Madison demonstrated a desire for an elective course in reproductive health and ethics to address student interest and knowledge gaps. The breadth and complexity of these topics can be challenging to fully address within required curricula.

Research Question or Hypothesis

To design a reproductive health elective informed by students through a three-phase students-as-partners approach.

Study Design

Mixed-methods

Methods

In phase 1, a survey was completed by first- and third- year PharmD students to assess perceived knowledge gaps and interest in reproductive health and ethics topics. Quantitative data was analyzed using descriptive statistics. In phase 2, two PharmD students completed an independent study focused on reproductive health research and elective course design. Students conducted a literature review in PubMed, reviewed data from phase 1, and partnered with faculty to develop a draft course proposal, syllabus, learning activities, and assessments. In phase 3, a focus group including first- and second- year PharmD students was held to identify opportunities for refinement on structure, content, and assessments, and to gauge interest in the course. Focus group data was analyzed using inductive content analysis.

Results

Phase 1 survey findings informed selection of priority content areas. Findings from this phase have been reported previously. In Phase 2, independent study students developed a complete course proposal for a 2-credit course consisting of five units. To assess course knowledge three longitudinal projects were drafted: an oral presentation, addressing misinformation assignment, and a debate. In Phase 3, two themes emerged: (1) focus group participants favored application-focused course structure; (2) reproductive health topics not extensively covered elsewhere (e.g., regulatory considerations, fertility, labor and delivery, and domestic violence) are desired. Recommendations were also provided to effectively promote the course.

Conclusion

Utilizing a students-as-partners approach led to development of a course geared towards student interest which will hopefully enhance student engagement once implemented.

Background

The Food and Drug Administration and European Medicines Agency have statements warning against the use of concomitant parenteral olanzapine and benzodiazepines due to increased sedation, cardiorespiratory depression, and death. However, these are based on post-marketing case reports, and the combination may be needed in the emergency department (ED) to manage agitation. The objective of this systematic review and meta-analysis was to evaluate the safety of coadministration of parental olanzapine and benzodiazepines.

Methods

A medical librarian searched EBSCO CINAHL, Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science Core Collection from January 2000 through September 2025. We included randomized controlled trials, observation trials, and retrospective studies evaluating adults who received at least one dose of parenteral olanzapine for agitation management in the ED or pre-hospital setting. The primary objective was to evaluate the incidence of intubation and hypotension in patients receiving olanzapine plus benzodiazepines versus other antipsychotics. Risk of bias was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials and the New Castle-Ottawa Scale for non-randomized studies. For the meta-analysis, fixed-effects models were applied to estimate the pooled incidence of intubation and hypotension within treatment groups and then compared across treatment groups. Analyses were performed using the meta package in R version 4.4.1.

Results

Twenty-six studies met inclusion criteria including 7 randomized control trials. Among 32,433 patients included, 458 received concomitant olanzapine and benzodiazepines. Among patients receiving olanzapine plus benzodiazepines, intubation occurred in 7/311 (2.3%) and hypotension in 19/380 (5%), with no significant differences compared with other antipsychotics with or without benzodiazepines (p = 0.38 and p = 0.70, respectively).

Discussion

The coadministration of olanzapine and benzodiazepines was not associated with an increased risk of intubation or hypotension compared to other antipsychotic agitation strategies.

Other

No funding was obtained. Registered on PROSPERO, number pending.

Introduction

Immune checkpoint inhibitors (ICIs) can lead to immune-related endocrine toxicities, including checkpoint inhibitor-associated diabetes mellitus (CIADM), a rare adverse event occurring in 0.2–1.9% of patients. CIADM is characterized by rapid β-cell destruction, severe insulin deficiency, and permanent insulin dependence. Early recognition is critical given the risk of life-threatening metabolic complications.

Case

A 61-year-old male in custody with metastatic renal cell carcinoma and pre-existing T2DM initiated pembrolizumab in September 2022 and was managed on glimepiride, insulin glargine, and sliding scale insulin with an A1c of 7.4%. Following prolonged pembrolizumab exposure, he developed laboratory-confirmed DKA meeting standard diagnostic criteria. Reclassification to CIADM was supported by fulminant decompensation from a stable A1c without an identifiable precipitant, a modestly elevated A1c disproportionate to the severity of hyperglycemia, and undetectable C-peptide (<0.1 ng/mL) confirming profound insulinopenia. Concurrent ICI-mediated panhypopituitarism manifesting as adrenal insufficiency and hypothyroidism further supported immune dysregulation as the unifying mechanism. Unlike DKA from other causes, CIADM confers permanent β-cell destruction and lifelong insulin dependence. The clinical pharmacist optimized his regimen to insulin NPH with mealtime insulin aspart, balancing corticosteroid-induced hyperglycemia, glycemic lability from complete β-cell loss, and medication administration constraints within a correctional facility.

Discussion

This case highlights the complications of CIADM and barriers to care within the US prison system. Current evidence suggests pancreatic volume, anti-glutamic acid decarboxylase autoantibody titers, and proinflammatory markers may predict CIADM risk. Clinicians should screen for these markers prior to ICI initiation and engage in shared decision-making to reduce severe adverse events.

Conclusion

Management of ICI-DM presents unique challenges, including irreversible insulin dependence, unpredictable glycemic fluctuations, and compounding endocrine toxicities, such as adrenal insufficiency, that further complicate insulin dosing. Pharmacists play a key role in navigating these complexities through ongoing insulin regimen adjustments and close monitoring to prevent serious events such as DKA and hypoglycemia.

Introduction

We previously evaluated cefiderocol dosing during prolonged intermittent kidney replacement therapy (PIKRT) using pharmacokinetic data from non-critically ill patients due to limited data in critically ill patients receiving kidney replacement therapy (KRT). With the availability of updated pharmacokinetic data from critically ill KRT patients, we re-evaluated cefiderocol dosing during PIKRT and assessed the impact of volume-of-distribution (Vd) expansion.

Research Question or Hypothesis

What cefiderocol regimens achieve pharmacokinetic/pharmacodynamic (PK/PD) targets during PIKRT using updated PK data, and how does Vd expansion affect these recommendations?

Study Design

In-silico Monte Carlo simulation (MCS) study.

Methods

A one-compartment pharmacokinetic model was developed for anuric patients undergoing 8- or 10-hour PIKRT using recently published PK data from critically ill KRT patients. Because Vd was not reported, the prescribing information estimate (18±3.36 L) was used. MCS (n=5,000) evaluated cefiderocol regimens over 48-hours. Optimal regimens were the lowest daily dose achieving ≥90% probability of target attainment (PTA) for 75%fT>MIC (4 mg/L) and 75%fT>4×MIC (16 mg/L). A sensitivity analysis evaluated Vd expansion (30±6 L).

Results

MCS predicted that cefiderocol 500mg q8h or 750mg q12h achieved ≥90% PTA for the standard target (75%fT>MIC) across all modeled PIKRT settings regardless of administration timing. For the more aggressive target (75%fT>4×MIC), a 2g loading dose followed by 1g q8h was the lowest dose regimen achieving ≥90%PTA at the base-case Vd (18 L). In the Vd expansion analysis (30 L), optimal regimens for the standard target were unchanged, while a 2g loading dose followed by 750mg q8h achieved ≥90% PTA for the more aggressive target.

Conclusion

Using updated pharmacokinetic data from critically ill KRT patients, MCS predicted cefiderocol 500mg q8h or 750mg q12h as optimal regimens during PIKRT for the standard PK/PD target and a 2g loading dose followed by 1g q8h for the more aggressive target. Simulated Vd expansion had minimal impact on optimal dosing recommendations. Clinical validation is warranted.

Introduction

Individualized factor VIII replacement therapy is essential for patients with hemophilia A undergoing major surgery, particularly when treatment is complicated by varying pharmacokinetic profiles and limited access to specialized pharmacokinetic tools. This case report evaluated the use of artificial intelligence (AI) to predict factor VIII activity levels and dosing requirements during perioperative management.

Case

A patient with hemophilia A and significant cardiovascular comorbidities underwent coronary artery bypass grafting (CABG) following cardiac catheterization. Recombinant factor VIII replacement therapy was managed using institution-directed pharmacokinetic monitoring and individualized dosing strategies. Both Altuviiio and Xyntha, factor VIII products with distinct pharmacokinetic characteristics and half-lives, were used in the patient's perioperative management. Microsoft Copilot and ChatGPT independently provided patient-specific clinical and pharmacokinetic data to predict perioperative factor VIII activity levels and recommend dosing regimens. The patient successfully underwent CABG without major bleeding complications. Predicted factor VIII activity levels mirrored observed pharmacokinetic trends, with mean percent differences from measured levels of 12.8% for ChatGPT and 5.95% for Microsoft Copilot.

Discussion

Recent hemophilia literature has explored AI for individualized treatment planning and pharmacokinetic-guided care, although most applications remain investigational and require further validation. In this case, AI-generated factor VIII activity predictions and dosing recommendations aligned with institution-directed pharmacokinetic management despite a complex perioperative course involving two factor VIII products with distinct pharmacokinetic profiles. Limitations include reliance on user-entered data, lack of integration with validated pharmacokinetic models, and evaluation in a single patient without external validation. AI-assisted pharmacokinetic estimation may improve the efficiency of individualized factor VIII dosing while maintaining clinical oversight.

Conclusion

While AI may serve as a useful adjunct to pharmacokinetic-guided therapy, clinical judgment and specialist oversight remain essential when managing complex patients. Further investigation is warranted to determine the role of AI-assisted pharmacokinetic modeling in optimizing individualized factor replacement therapy.

Introduction

Individuals in correctional systems face unique challenges to hepatitis C (HCV) treatment, including variable incarceration length and interruptions in care. Sofosbuvir/velpatasvir (SOF/VEL) is widely used, and shortened 8‑week regimens may improve treatment completion. However, predictors influencing selection of shortened therapy in correctional settings remain unclear.

Research Question or Hypothesis

Do demographic and clinical characteristics independently predict selection of 8‑week versus 12‑week SOF/VEL therapy among incarcerated adults?

Study Design

IRB-approved retrospective chart review

Methods

Adults treated with SOF/VEL within the Illinois Department of Corrections from 2016-2025 were included. Patients without documented fibrosis stage or HCV genotype were excluded. Variables included age, race/ethnicity, genotype, fibrosis stage (F0-F1, F2, F3, F4), and ribavirin use. The primary outcome was selection of 8‑week versus 12‑week SOF/VEL therapy. Univariable logistic regression assessed associations between predictors and shortened therapy, and a multivariable model identified independent associations. Odds ratios (ORs) and adjusted ORs (aORs) with 95% confidence intervals were reported.

Results

Of 1,065 adults, 192 (18%) received 8‑week SOF/VEL. Patients receiving shortened therapy were younger (mean 36.2 vs 48.1 years). In univariable analyses, younger age, lower fibrosis stage, White race, and genotype 1b were associated with 8‑week therapy. In multivariable regression, increasing age was associated with lower odds of receiving 8‑week SOF/VEL (aOR 0.93 per year; 95% CI 0.91-0.95; p < .001). Lower fibrosis stage remained strongly associated with shortened therapy compared with F0-F1: F2 (aOR 0.45), F3 (aOR 0.32), and F4 (aOR 0.07). Ribavirin use increased the likelihood of 8‑week therapy (aOR 1.92; p = .002). Race/ethnicity and genotype were not significant predictors after adjustment.

Conclusion

Younger age, lower fibrosis stage, and ribavirin use remained significant predictors of being treated with 8‑week SOF/VEL therapy. These findings provide a framework for pharmacist‑driven assessment of off‑label shortened therapy and support evidence‑informed HCV treatment decisions in resource‑constrained correctional settings.

Introduction

In 2024, 73% of the 53,336 overdose deaths involved opioids and pharmacy naloxone dispensing rates dropped to 0.4 per 100 persons (peaking at 0.6/100 by 2023). Illinois Advance (ILA) is a pharmacist-led academic detailing (AD) program that equips clinicians with evidence-based education to improve naloxone awareness, prescribing, and patient outcomes. Program quality improvement analysis is needed to determine the impact of ILA’s education on naloxone prescribing rates and evaluate any related facilitators and barriers.

Research Question or Hypothesis

AD increases naloxone prescribing rates through personalized clinician education and engagement.

Study Design

Mixed-method quality improvement project.

Methods

The co-primary outcomes were change in naloxone prescribing among detailed clinicians and exploration of factors related to prescribing. Illinois naloxone claims data from detailed clinicians in 2024-2025 were analyzed using descriptive statistics. Naloxone prescribing rates were compared 6 months before and after detailing. Detailers completed post-detailing surveys and provided insights via free response. Thematic analysis was done on the free-response comments to explore perceived facilitators and barriers contributing to naloxone prescribing rates.

Results

Between 2024-2025, 147 unique clinician prescribers were detailed on naloxone. Pre-detailing, 4 clinicians (2.7%) prescribed naloxone for 4 patients, with 4 naloxone dispenses. Post-detailing, 7 (4.7%) prescribed naloxone for 10 patients with 18 dispenses (4.5-fold dispensing increase). The majority (140, 95%) of prescribers did not prescribe naloxone post-detailing. Thematic analysis of detailer post-detailing comments identified themes of clinician attitudes towards naloxone, naloxone workflow integration, and framing patient conversations.

Conclusion

Despite a numeric increase in naloxone prescriptions, prescribing rates remained low post-AD visit. Although clinicians were engaged and recognized underutilization of naloxone, barriers persisted related to patient population access, patient conversations, and workflow integration. Future ILA education will focus on practical strategies to address these barriers for behavior change.

Introduction

Chronic Kidney Disease Epidemiology (CKD-EPI) estimated glomerular filtration rate (eGFR) equations are recommended over Cockcroft-Gault creatinine clearance, but preference compared to measured urinary creatinine clearance (mCrCL) is less uncertain. Both eGFR and mCrCL have unique advantages and limitations. Specifically, serum creatinine (SCr) and cystatin C (cysC) based eGFR (eGFRcr-cys) and 8-hour measured urinary creatinine clearance (mCrCL8) have yet to be compared in acutely ill patients.

Research Question or Hypothesis

There is discordance in kidney function estimation between eGFRcr-cys and mCrCL8 in acutely ill patients.

Study Design

This was an IRB-approved single-center, retrospective, observational cohort study at an academic medical center including adult patients admitted between 1/1/2023 to 8/31/2025 with SCr and cysC (“biomarker pair”) ordered within 72-hours of mCrCL8. The primary outcome was discordance rate between eGFRcr-cys and mCrCL8, defined as the percentage of times the absolute percent difference between the estimations exceeded 30%.

Methods

Data was collected via chart review; eGFRcr-cys was adjusted for individual patient body surface area to mL/min for mCrCL8 comparison. Demographic data was analyzed via descriptive statistics. Statistical analysis was performed by Fisher’s exact test for nominal data, T-test for normally distributed data and Mann-Whitney U test for non-normally distributed data.

Results

The study included 74 patients (95.9% critically ill, 47.3% female; median age 50 [34.5-67.5] years) with a median SCr 0.60 [0.43-1.05] mg/dL and cysC 1.29 [0.96-2.31] mg/L. Median eGFRcr-cys was 75.1 [49.3-117.4] mL/min (p=0.31) and mCrCL8 was 94.8 [43.6-160.9] mL/min (p=0.96). The discordance rate was 59.5%. Discordance was oftentimes resultant from mCrCL8 being higher than eGFRcr-cys (63.6%).

Conclusion

Clinically significant discordance exists between eGFRcr-cys and mCrCL8 when compared in hospitalized patients. Additional studies are needed to determine which estimate is preferred in acutely ill patients.

Background

Hyperkalemia is a potentially life-threatening electrolyte abnormality. Sodium zirconium cyclosilicate (SZC) is a novel potassium binder with presumed rapid potassium-lowering effects, but evidence for use in emergent hyperkalemia remains unclear. This systematic review aims to evaluate the efficacy of SZC in acute care settings.

Methods

This review was conducted using Covidence and reported using PRISMA. Databases searched were Embase, Scopus, PubMed, CINAHL, and ClinicalTrials.gov. Inclusion criteria were observational/experimental studies (publications/conference abstracts) describing adults with hyperkalemia treated with SZC in the emergency department/hospital that reported clinical and/or health services outcomes. Exclusion criteria were pediatric patients, emergent dialysis, chronic hyperkalemia treatment, case series/reports, and non-English/Spanish studies. Two reviewers independently completed each level of assessment, with conflicts resolved by leads. Critical appraisal was performed using JBI checklists.

Results

The search retrieved 2078 studies; with 1092 screened in title/abstract review. Ultimately, 38 studies were evaluated in qualitative synthesis, inclusive of 22 (57.9%) papers and 16 (42.1%) conference abstracts. Most were retrospective cohort (25; 65.8%) or descriptive studies (9; 23.7%), directly assessing changes in potassium (29; 76.3%) or achievement of normokalemia (17; 44.7%) across diverse timeframes (2-72hr). SZC was commonly compared to sodium polystyrene sulfonate (SPS) (18; 47.4%) and patiromer (7; 18.4%). Broadly, SZC demonstrated potassium reduction within 1-4hr and continued improvement through 24-72hr. Mean potassium reductions ranged from 0.7-2.17mEq/L, with larger effects observed in patients with baseline potassium of ≥6mEq/L. Comparisons ranged from SZC being superior (n=2), similar (n=16), or less effective (n=3) to other potassium binding agents. Most studies included SZC use alongside other standard acute hyperkalemia therapies.

Discussion

Current literature suggests SZC is an effective strategy for potassium reduction in acute care settings, although comparative effective to other agents remains unclear. Further prospective studies are needed to confirm optimal place in therapy.

Other

No funding was provided for this unregistered review.

Background

GLP-1 receptor agonists (GLP-1 RAs) may have a role in modifying progression of Parkinson’s disease (PD). Gastrointestinal (GI) effects and muscle loss are concerning in a population vulnerable to dysphagia, malnutrition, and sarcopenia. This study assessed GI and weight effects of GLP-1 RAs on patients with PD.

Methods

A systematic review and meta-analysis were performed according to PRISMA guidelines. A comprehensive search using PubMed, EMBASE, and Cochrane CENTRAL databases was conducted from inception through January 6, 2026. Randomized controlled trials evaluating any GLP-1 RA in PD patients and reported outcomes including GI effects or weight changes were included. The Cochrane risk-of-bias tool version 2 for randomized trials was used. Results were pooled using a fixed-effect model and dichotomous outcomes were summarized as risk differences with 95% confidence intervals using the Mantel-Haenszel method. Statistical heterogeneity was assessed using the I2 statistic. Analysis was performed with RevMan.

Results

Five studies involving 708 patients were included, with 396 patients in the intervention group and 312 patients in the control group. Studies utilized exenatide (n=3), lixisenatide (n=1), and pegylated exendin-4 (n=1). Compared to control, GLP-1 RAs increased risk of nausea (RD 0.3, 95% CI 0.24-0.37), weight loss (RD 0.12, 95% CI 0.07-0.17), vomiting (RD 0.10, 95% CI 0.06-0.13), and constipation (RD 0.11, 95% CI 0.05-0.17). No significant effects on diarrhea or abdominal discomfort were observed. There was significant heterogeneity between groups for weight loss.

Discussion

This study showed increased prevalence of nausea, weight loss, vomiting, and constipation in patients with PD taking GLP-1 RAs compared to placebo. Limitations included a small number of studies and high heterogeneity for weight loss. Further studies are needed to compare GLP-1 RA tolerability in PD patients versus non-PD patients.

Other

Funding - None

Registration - Registered with PROSPERO CRD420261411905

Introduction

Multimodal analgesia optimizes postoperative pain management while reducing opioid use and associated risks. Pain management is achieved by optimizing the synergistic effects of non-opioid medications with complementary mechanisms of action. The Enhanced Recovery After Surgery (ERAS) Society recommends multimodal analgesia over scheduled opioid therapy for thoracic surgery postoperative pain management. While current evidence highlights the benefits of multimodal strategies, further research is needed to evaluate opioid-sparing effects and clinical impact after thoracotomy.

Research Question or Hypothesis

This study aims to evaluate the efficacy of multimodal pain control using an ERAS protocol compared to usual care in thoracic surgery patients.

Study Design

This single-center, retrospective chart review assessed thoracic surgery patients from March 2017 to September 2025.

Methods

Patients included underwent thoracotomy and received postoperative pain management from a pre-specified order set. Patients were excluded if they were over 80 years or under 18 years of age, receiving renal replacement therapy, or receiving end of life care. The primary outcome was comparison of morphine milligram equivalents (MMEs) in thoracotomy patients utilizing a multimodal ERAS protocol versus usual care with opioids for pain management on post-operative day (POD) 0, POD 1 to 3, and total postoperative hospitalization.

Results

A total of 156 patients were included with 78 patients in each group. Multimodal analgesia was associated with lower inpatient opioid consumption compared with usual care on POD 1 to 3 (83mg vs. 20mg; ratio, 0.19; 95% CI, 0.11–0.34; P<0.001) and total post-operative hospitalization (130mg vs. 55mg; ratio, 0.38; 95% CI, 0.24–0.62; P<0.001). No difference in inpatient opioid consumption was seen between groups on POD 0 (17mg vs. 20mg; ratio, 1.2; 95% CI, 0.68–2.05; P=0.6).

Conclusion

Among patients undergoing thoracotomy, multimodal analgesia utilizing an ERAS protocol was associated with significant reductions in opioid utilization during POD 1 to 3 and total postoperative hospitalization with no difference on POD 0.

Introduction

Therapeutic inertia, defined as the failure to initiate or intensify therapy in response to unmet treatment goals, is a well-documented contributor to the lack of disease control that persists across primary care settings. Embedding clinical pharmacists to support medication management between provider visits is one strategy to close these care gaps. At BronxCare Hospital, Healthfirst Quality Incentive Program (HQIP) data from April 2026 showed that 60% of patients with diabetes achieved an A1c < 9% and 58% of patients with hypertension achieved BP <140/90 mmHg, with one clinic accounting for the highest number of patients not meeting those goals. This clinic does not have an embedded pharmacist to manage its large patient volume between visits, raising the possibility that therapeutic inertia is a contributing factor.

Research Question or Hypothesis

Among patients with uncontrolled diabetes (A1c > 9%) and hypertension (BP > 140/90 mmHg) at an inner-city clinic, how frequently do providers miss the opportunity to optimize medication therapy in response to qualifying laboratory values and vital signs?

Study Design

Single-center, retrospective medication use evaluation at a community-based primary care clinic within a large health system.

Methods

Patients were included if they had an A1c > 9% and two blood pressure readings >140/90 mmHg. Qualifying lab values and vitals, as described by the inclusion criteria, were assessed to determine whether a medication adjustment was indicated. Chart reviews were conducted to determine whether the provider adjusted therapy in response to clinical data. The primary outcome was the proportion of encounters where an indicated medication adjustment was not performed. Secondary outcomes included the proportion of patients with an indication for GLP-1RA, SGLT2i, or insulin without initiation of therapy in the absence of contraindication. Findings will identify opportunities for medication optimization and guide future interventions to improve chronic disease state management. Descriptive statistics will be used.

Results

Results pending.

Conclusion

Conclusion pending.

Service or Program

The PGx ECHO (z.umn.edu/pgxecho) was established in 2021 and focuses on applied PGx. Each session contains a presentation on a drug-gene pair followed by a related real-world PGx patient case presentation with audience participation. To date, 55 case based sessions have been delivered (23 behavioral health, 8 cardiology, 5 oncology, 4 pain management, 15 other) including 37 adult and 15 pediatric sessions with a median attendance of 58 participants (range 23-112). The program provides a learning structure to support clinical reasoning for PGx (e.g. defining and prioritizing the PGx problem, understanding the context when PGx application is appropriate).

Justification/Documentation

The cases start with a question intended to guide audience input. This is followed by pertinent case history, current/previous medications, PGx and laboratory results, and other information. Presenters with the moderator respond to questions and medication suggestions from attendees. If available, the outcome of the case is provided in the context of the application of the PGx results. This program allows sharing of cases among practicing clinicians, access to individuals with expertise in PGx, and a forum to gather suggestions for patient management. Participants are highly engaged, providing feedback and questions to the presenters.

Adaptability

ECHO learning is bidirectional and built on an “all teach, all learn” philosophy where presenters and participants learn from one another through shared discussion and experiences. Compared with traditional continuing education the ECHO model is more interactive, encouraging deeper engagement and a higher level of critical thinking. This ECHO addresses a range of clinical areas related to PGx with cases generally presented by medication therapy management pharmacists and PGx specialists.

Significance

The PGx ECHO has developed into an active community that builds PGx knowledge allowing pharmacists and other clinicians to learn PGx application, strengthen their PGx skills, and connect into a network for knowledge exchange.

Introduction

Current Alzheimer's disease (AD) therapies are limited by modest efficacy, restrictive indications, and safety concerns. Using Connectivity Map (CMAP), Duche et al. (2025) identified 17 compounds and gene targets predicted to reverse AD-associated transcriptional changes. This study evaluated CMAP-identified compounds in completed AD clinical trials and identified convergent therapeutic targets through overexpression profile analysis.

Research Question or Hypothesis

Do CMAP-identified compounds demonstrate benefit in completed AD clinical trials, and which overexpression-nominated gene targets are shared across affected brain regions?

Study Design

Retrospective clinical-trial review with transcriptomic cross-region target analysis.

Methods

CMAP-identified compounds were searched in ClinicalTrials.gov (completed interventional AD trials, 2000–2025) as of October 2025. Manuscripts lacking posted results were retrieved via Google Scholar. Studies were classified by pre-specified criteria as benefit (meaningful improvement vs. placebo/baseline), mixed results (limited or inconsistent findings), or no benefit. Overexpression perturbagens with CMAP connectivity scores ≥90 in the parahippocampal gyrus and temporal cortex were intersected to identify shared and region-specific gene targets. Descriptive statistics summarized outcomes across drug classes and convergent gene-target categories.

Results

Trial data were available for 8 of 17 (47.1%) compounds; 2 (11.8%) had results not yet evaluable (a Phase 4 lithium trial; fasudil still recruiting), 7 compounds (41.2%) had no completed AD trials. Four (23.5%) demonstrated benefit (tideglusib, memantine, levetiracetam in patients with epileptiform activity, and benfotiamine in APOE ε4 non-carriers), 3 (17.6%) showed mixed-effects (nicotinamide, antioxidants, lamivudine), and 1 (5.9%) showed no effect (curcumin). Cross-region analysis identified 2 convergent gene targets (SATB2 and LYN), 4 parahippocampal gyrus-specific targets (DUSP28, IFNB1, CTSL2, HOXA5), and 128 temporal cortex-specific targets.

Conclusion

Transcriptomics-guided repurposing identified compounds with clinical benefit in AD clinical trials and nominated SATB2 and LYN as convergent therapeutic targets, supporting further evaluation of untested CMAP candidates and target-directed drug development strategies.

Introduction

Montelukast is a leukotriene receptor antagonist used for the treatment of asthma, exercise induced bronchoconstriction, and allergic rhinitis. In March 2020, the U.S. Food and Drug Administration (FDA) issued a boxed warning for montelukast due to reports of serious neuropsychiatric adverse events including changes in mood, behavior, and suicidal thoughts. The FDA recommended that healthcare professionals consider the risks and benefits of montelukast when initiating or continuing therapy, counsel patients regarding potential neuropsychiatric effects, and monitor for the development of these symptoms. Previous studies have demonstrated reductions in montelukast utilization following the FDA warning. However, limited data exists regarding its impact on prescribing practices and clinical decision making.

Research Question or Hypothesis

Did montelukast prescribing patterns in an inner-city pulmonary clinic change after implementation of the FDA boxed warning?

Study Design

Retrospective, observational, paired pre-post cohort study.

Methods

This study follows patients who received care in the pulmonary clinic of a large community hospital during the periods before and after implementation of the FDA boxed warning. Eligible patients will be identified through electronic health record review. Montelukast prescribing will be evaluated for each patient before and after implementation of the FDA boxed warning to assess changes in prescribing patterns. Secondary outcomes will include documented neuropsychiatric adverse events (ADEs), discontinuation due to neuropsychiatric ADEs, and documented counseling regarding neuropsychiatric risks. Descriptive statistics will be used to summarize patient characteristics and outcomes. Paired analysis will be used to compare prescribing patterns between the two study periods.

Results

Pending

Conclusion

Pending

Introduction

Two FDA-approved medications (VMAT2-inhibitors [VMAT2i]) are available to treat tardive dyskinesia (TD): valbenazine and deutetrabenazine. Valbenazine demonstrated efficacy at the lowest available dose (40mg) in its Phase 3 pivotal trial, whereas deutetrabenazine required tolerability-based titration and demonstrated efficacy only at daily doses ≥24mg in its Phase 3 fixed-dose trial. There is minimal data of residents in long-term care (LTC) settings utilizing VMAT2i for treatment of TD, a highly comorbid and vulnerable population.

Research Question or Hypothesis

To assess real-world-dosing and utilization of VMAT2i for TD among residents in LTC settings.

Study Design

A retrospective, longitudinal cohort study was conducted using data from Point-Click-Care’s life sciences electronic health record database of residents with TD in LTC settings from July 2017–June 2024.

Methods

Residents were included if they had an incident TD diagnosis (ICD-10-D:G24.01; ≥6 months after LTC admission), subsequent VMAT2i initiation (<30-days after incident TD diagnosis), and ≥6 months follow-up. Outcomes included residents reaching a daily therapeutic-dose per clinical-trial results (valbenazine:≥40mg; deutetrabenazine:≥24mg) and time-to therapeutic-dose based on medication administration data. Inferential statistics were calculated to assess statistical significance.

Results

In this LTC population, 474 residents initiated a VMAT2i (valbenazine:354; deutetrabenazine:120). Mean age was 67.1, with 42.0% having a Charlson Comorbidity Index score ≥3. Mean daily-dose was 53.6mg (SD=18.5) for valbenazine and 16.4mg (SD=10.6) for deutetrabenazine. While all residents on valbenazine (100%) received a therapeutic-dose from day 1, only 25.0% of deutetrabenazine-treated residents reached a therapeutic-dose by the end of 6 months (p<0.001), requiring a mean of 57 days to do so.

Conclusion

In an older, highly comorbid, population of residents in LTC settings with new onset TD, those initiating valbenazine achieved a therapeutic-dose at a four-fold higher rate (100% vs 25%) and nearly 2-months faster than those who initiated deutetrabenazine. Future investigation is needed to assess how discrepancy in therapeutic dosing range attainment impacts outcomes for this vulnerable population.

Service or Program

Discharge delays for hospitalized patients with opioid use disorder (OUD) frequently stem from barriers to accessing outpatient opioid treatment programs (OTPS). These barriers include restricted operating hours, limited intake availability, and regulatory limitations surrounding methadone prescribing and dispensing. Following the Drug Enforcement Administration (DEA) provisions of the ACT to revise 21 CFR § 1306.07(b), our institution implemented a “3-day dispense” and take-home methadone (THM) program, which is a pharmacist-supported discharge workflow to facilitate transitions of care and expand access to medications for opioid use disorder (MOUD). Pharmacists collaborated with physicians, nurses, and informatics teams to develop standardized procedures for ordering, dispensing, documentation, and chain of custody.

Justification/Documentation

From March 22, 2024, to December 31, 2025, 360 THM orders representing 287 unique patients were completed. Of these, 146 THM-facilitated discharges occurred on Fridays or Saturdays, representing potentially avoidable hospital days related to OTP access limitations. These discharges accounted for an estimated 232 hospital nights avoided and approximately $464,000 in cost avoidance, based on hospitalization estimates. Additional implementation efforts included development of electronic health record workflows, outpatient-compliant medication labeling, medication guide integration, and interdisciplinary staff education addressing legal, operational, and stigma-related concerns.

Adaptability

This pharmacist-developed THM workflow may be implementable to other institutions seeking to improve transitions of care in OUD and operationalize the DEA 72-hour rule. Key implementation components include interdisciplinary stakeholder engagement, pharmacy workflow standardization, electronic health record optimization, and staff education.

Significance

Implementation of a standardized THM discharge process expands access to MOUD, facilitates linkage to OTPs, and reduces hospitalization nights. Pharmacists play a critical role in creating sustainable operational workflows supporting discharge efficiency, continuity of care, and harm reduction for hospitalized patients with OUD.

Introduction

Studies have identified counseling gaps for over-the-counter opioid harm reduction (OHR) products. Pharmacists’ personal biases, misconceptions, or discomfort addressing sensitive health topics may contribute to disparities in services. Microlearning is a brief educational strategy delivering content designed to improve learner engagement and knowledge retention. Within pharmacy education, microlearning may reinforce clinically relevant counseling points. Limited data exist evaluating microlearning modules as an adjunct educational tool within PharmD curricula.

Research Question or Hypothesis

What are pharmacy student perceptions of mobile microlearning modules and can modules improve knowledge and counseling confidence on opioid harm reduction topics?

Study Design

This prospective, cross-sectional online study included pharmacy students enrolled at two accredited pharmacy schools in Georgia.

Methods

Three mobile microlearning modules (each ~10-15 minutes), accessible electronically, delivered pharmacy-practice relevant content on OHR strategies. Pharm.D. students across all professional years were invited via email to participate. Knowledge assessments were administered before and after module completion and at 30 days to evaluate retention. Surveys assessed counseling confidence and module usability. Wilcoxon signed-rank tests with Bonferroni correction (p<.017) were used to compare time points.

Results

Of nearly 700 students invited, 42 completed pre- and post-surveys; 30 completed 30-day follow-up. Most students reported feeling extremely or very confident counseling on naloxone, fentanyl test strips, and medication disposal post-intervention (100%, 85.7%, 90.4%, respectively). Confidence improvements were significant across all topics (p<.001). Knowledge scores improved significantly from pre- to post-intervention (Mdn=0.75 to 1.0; p=.002) and remained significantly above baseline at 30 days (p=.014). No significant difference was found between post-intervention and 30-day scores (p=.260) indicating knowledge retention. Students found modules easy to navigate (100%) and preferred microlearning to traditional instruction (84.6%).

Conclusion

Mobile microlearning modules significantly improved student counseling confidence and knowledge. Sustained knowledge retention at 30 days strengthens the case for microlearning as an accessible and effective tool in pharmacy curricula.

Introduction

Cytomegalovirus (CMV) is a common opportunistic infection in solid organ transplant (SOT) recipients. Valganciclovir-associated neutropenia often necessitates mycophenolate (MMF) dose reductions, which may increase the risk of under-immunosuppression and add to monitoring burden. Letermovir, which is not myelosuppressive, may reduce the need for MMF dose reductions and the associated risk of under-immunosuppression.

Research Question or Hypothesis

In CMV high-risk abdominal SOTR, letermovir prophylaxis enables higher mycophenolate dosing compared with valganciclovir.

Study Design

This single-center, retrospective cohort study included CMV high risk abdominal SOTR between 01/16/2023-05/30/2025.

Methods

Subjects received 6-months of CMV prophylaxis with valganciclovir or letermovir. The primary objective was to evaluate the impact of each agent on mycophenolate dosing. Subjects were assigned to cohorts based on the agent prescribed at the end of the 6-month prophylaxis period. Secondary endpoints included differences in white blood cell count (WBC) and absolute neutrophil count (ANC) at 1, 3, 6, and 12 months post-transplant, as well the number of biopsies, graft loss, rejection rate, and re-transplantation.

Results

Seventy-two SOTR (n=48 valganciclovir, n=24 letermovir) were included. No differences in mycophenolate dosing at 1, 3, 6, or 12 months post-transplant were observed between groups (P>0.05). Similarly, no differences were observed in WBC or ANC at any time point post-transplant or in number of biopsies, rates of T-cell-mediated or antibody-mediated rejection, graft loss, or re-transplantation (P>0.05).

Conclusion

These findings diverge from prior literature suggesting that letermovir, due to its lack of myelosuppression, enables optimization of mycophenolate dosing. Future analyses will focus on patients who received letermovir for the full duration of prophylaxis as this subgroup may better reflect its true clinical impact.

Introduction

Individuals transitioning from incarceration to the community experience elevated HIV risk related to substance use, unstable housing, transactional sex, and healthcare access barriers. However, limited data describe HIV seroconversion among individuals released HIV-negative who subsequently return to custody HIV-positive.

Research Question or Hypothesis

Among individuals released HIV-negative from a state correctional system who later return to custody, what is the incidence of HIV seroconversion during community reentry?

Study Design

Retrospective cohort study within a state correctional healthcare system evaluating individuals reincarcerated between July 1–31, 2026.

Methods

Electronic health records, laboratory data, and correctional records will be reviewed to identify documented HIV-negative status before release and subsequent HIV-positive testing. The primary outcome is HIV seroconversion among reincarcerated individuals. Secondary outcomes include time between release and reincarceration, demographic and clinical characteristics, and PrEP offering, uptake, and persistence.

Results

Preliminary data include 1,301 individuals processed through intake; 948 (72.9%) declined HIV testing and 353 (27.1%) were tested, with 21 testing HIV-positive. Thirteen (61.9%) had prior incarceration, with intervals between earliest documented incarceration and first positive HIV test ranging from 0–6,723 days (median 464; mean 1,712). We anticipate that verification of prior HIV-negative results will distinguish likely community-acquired seroconversion from delayed diagnosis. Final findings are expected to identify patterns in HIV acquisition and diagnosis following community reentry and highlight opportunities for earlier testing and prevention among individuals cycling between correctional and community settings.

Conclusion

We anticipate identifying gaps in HIV testing and diagnosis among individuals cycling between correctional and community settings. Findings are expected to clarify patterns of HIV diagnosis following reentry and support expanded intake screening, targeted PrEP interventions, and stronger linkage to HIV prevention services following release.

Introduction

The CDC estimates that over 1.2 million individuals in the United States have indications for pre-expouse prophylaxis (PrEP); however, only 30% receive therapy. This gap in utilization has substantial public health consequences. Persistent inequities in uptake of PrEP are driven by a combination of social health related needs. Incentive-based interventions through cash transfers represent a promising approach to address these barriers; however, existing evidence is limited, lacks direct comparison between incentive structures, and has a scarcity of studies conducted in the U.S. based populations.

Research Question or Hypothesis

To evaluate and compare the effectiveness of unconditional cash transfer (UCT) and conditional cash transfer (CCT) interventions in improving PrEP utilization and stress outcomes through a pharmacist-led intervention at a Federally Qualified Health Center.

Study Design

We will conduct a two-arm randomized pilot trial at a local FQHC.

Methods

Participants will be randomized 1:1 to receive either UCTS or CCTs. Participants in the CCT will receive $20 cash transfers at PrEP initiation and quarterly until 6 months post-initiation, contingent upon completion of predefined health behaviors. Participants in the UCT will receive $20 cash transfers at PrEP initiation and quarterly until 6 months post-initiation without any contingencies. Participants in both arms will complete the Perceived Stress Scale (PSS) at baseline and at quarterly follow-ups.

This study has 80% statistical power to detect a 20% difference between the groups. Primary outcomes to be analyzed will be PrEP initiation and adherence. A chi-square test of independence will be used to determine whether PrEP utilization differs between the two arms. Secondary outcomes, changes in patient reported stress, will be analyzed using a linear mixed-effects model.

Results

We hypothesize that UCTs will improve PrEP utilization and reduce patient reported stress

Conclusion

Upon completion of this study, we expect to develop a better understanding of cash transfers to develop evidence-based, patient-centered PrEP interventions in clinical pharmacy practice.

Introduction

Provision of drug information (DI) is a fundamental responsibility of all pharmacists. Pharmacy education guidance documents suggest DI topics and skills, but do not provide a competency framework suitable to ensure consistent instruction and assessment of DI competency in graduating PharmD students. Variability in delivery and assessment of DI content across the academy could lead to differences in practice-readiness. The academy would benefit from systematically developed, consensus DI competency statements with measurable outcomes and tangible assessments to inform backward design and curricular evolution.

Research Question or Hypothesis

What are the entry-level DI competencies that all PharmD students should be able to demonstrate upon graduation?

Study Design

Multi-phase competency development study using document synthesis, qualitative interviews, expert drafting, and a modified Delphi consensus process.

Methods

Phase 1 of the study will identify pharmacist DI responsibilities through a structured document analysis and semi-structured interviews with DI stakeholders. Phase 2 will develop draft DI competency statements by translating phase 1 results into observable, measurable, and developmentally appropriate recommendations that will undergo quality review by experts. Phase 3 will use a modified Delphi process to establish consensus on the importance, graduation-level appropriateness, expected level of independence, and assessment feasibility of the DI competency statements.

Results

(Anticipated) The final result of this study will be a consensus list of DI competencies that PharmD students can reliably demonstrate upon graduation.

Conclusion

(Anticipated) The consensus set of DI competencies developed by this study will provide a valuable resource for colleges and schools of pharmacy across the academy. These competencies can guide backward design for consistent teaching and assessment of DI, supporting entry-level practitioners and a shared understanding of DI competency across the profession.

Introduction

Financial toxicity, or financial hardship from medical care costs, may disrupt access to medications, appointments, and treatment. Because the ability to pay for out-of-pocket medical costs (OOP) varies between individuals, OOP burden may be better understood relative to household income.

Research Question or Hypothesis

This study examines the association between annualized OOP healthcare spending as a percentage of household income and difficulty paying medical expenses among U.S. adults.

Study Design

Cross-sectional analysis of Understanding America Study (UAS) survey data. UAS is a probability-based internet panel of U.S. adults maintained by the University of Southern California, with participants recruited through address-based sampling. Data collected include healthcare spending, household income, insurance type, demographic characteristics, etc.

Methods

Adults completing UAS693 with sufficient data for analysis were included. Monthly OOP medication and healthcare expenditure were annualized, divided by household income and converted to a percentage. Truncation at 500% was performed to reduce the influence of extreme values. The primary outcome was self-reported difficulty paying medical expenses in the past month. Multivariable logistic regression estimated adjusted odds ratios (ORs) controlling for age, employment, sex, urbanicity, race, education, marital status, prior health-seeking behavior (inferred from past influenza vaccination status), and insurance type.

Results

Among 9,109 respondents, 751 (8.2%) reported difficulty paying medical expenses in the past month. The distribution of annualized OOP burden relative to household income was right-skewed, with a median of 0.6% (IQR 0.0 – 2.7%). After covariate adjustment, each 1-percentage-point increase in annualized OOP spending as a percentage of household income was associated with higher odds of difficulty paying medical expenses (OR 1.02; 95% CI 1.01 – 1.02; p < 0.001).

Conclusion

Greater OOP healthcare burden relative to income was independently associated with cost-related difficulty paying medical expenses. Future analysis should examine whether this financial burden is associated with downstream treatment disruption, including missed appointments, medication underuse, treatment changes, or treatment discontinuation.

Introduction

The selection of antidepressant in atrial fibrillation (AF) patients is challenging. The antiplatelet properties of sertraline may elevate bleeding risk, especially for AF patients treated with anticoagulant, while non-SSRIs alternatives like bupropion brings cardiovascular safety concerns. Direct comparison regarding the bleeding and cardiovascular safety of antidepressants in AF patients remains limited.

Research Question or Hypothesis

Among adults with AF on anticoagulation newly diagnosed with depression, does initiating sertraline increase the risks of major bleeding and major adverse cardiovascular events (MACE) compared to initiating bupropion?

Study Design

This is an active-comparator, new-user, retrospective cohort study using the TriNetX research network. Adult patients with established AF on anticoagulants who received a new depression diagnosis and initiated either sertraline or bupropion were enrolled.

Methods

This study enrolled patients who had confirmed AF and depression diagnoses by ICD-10 codes, active anticoagulant use, and no prior prescription for either study drug in the 180-day lookback period. Patients with prior bleeding events, MACE, or seizure history were excluded. Primary outcome was major bleeding, and secondary outcomes included MACE and all-cause mortality. Multivariable logistic regression adjusted for age, comorbidity burden, anticoagulant type, antiplatelet use, and anxiety disorder. Propensity score-matched sensitivity analysis and subgroup analyses were performed.

Results

A total of 19,299 patients were included in the analysis. Sertraline initiation was associated with significantly increased odds of major bleeding (OR 1.18, 95% CI 1.07–1.31, p=0.0008) and MACE (OR 1.30, 95% CI 1.22–1.40, p<0.0001) compared to bupropion. The difference in MACE was primarily driven by all-cause mortality.

Conclusion

Among anticoagulated AF patients with depression, sertraline was associated with increased bleeding and mortality risk compared to bupropion. These findings suggest bupropion may represent a safer alternative for many patients in this high-risk population, though individual patient factors should guide treatment selection. Further research is needed to validate these findings and elucidate underlying mechanisms.

Introduction

Mycophenolic acid (MPA), a first-line immunosuppressant in kidney transplantation, is highly bound to albumin. The fluctuating unbound (“biologically active”)-to-total exposure relationship may lead to unsafe dosing when only the total drug is monitored. Despite the non-linear pharmacokinetics of MPA, a population pharmacokinetic (popPK) model incorporating saturable protein binding remains lacking.

Research Question or Hypothesis

We aimed to develop and evaluate a novel popPK model for unbound MPA and MPA-glucuronide (MPAG) with saturable protein binding linking total to unbound MPA in adult kidney transplantation using published datasets.

Study Design

This is a retrospective, popPK modelling study.

Methods

The Stochastic Approximation Expectation-Maximization algorithm (Monolix, Simulations Plus) was utilized to construct structural and error models incorporating 279 unbound MPA, 283 total MPA, and 283 unbound MPAG concentrations from 41 subjects across 63 occasions with 27 clinical variables. Covariate modelling was conducted using forward inclusion and backward elimination, assisted by the Proposal function in Monolix. Models were evaluated by objective function values, residual plots, visual predictive checks, bootstrapping analyses (1000 replicates), and biological plausibility.

Results

The best model consisted of first-order absorption with lag time (ka=5.29[0.098–6.11]h⁻¹, estimate[95% confidence interval from bootstrapping]; Tlag=0.49 h, fixed), one-compartment for unbound MPA (parent volume Vp=14180.93[325.69–20432.76]L; clearance Cl=5.1 L/h, fixed), one-compartment for unbound MPAG (metabolite volume Vm=18.55[6.35–44.74]L; metabolite clearance Clm=6.35[5.3–12.7]L/h), transfer rate between parent and metabolite (kpm=0.094[0.067–4.1]h⁻¹), and saturable protein binding (maximum binding capacity Bmax=34.44[21.77–55.1]µmol; dissociation constant, kd=0.13[0.031–0.32]µmol). Albumin and tacrolimus-daily-dose influenced Bmax(β=0.93[0.11–2.21] and -0.17[-0.42–0.24], respectively); while p-cresol sulfate trough concentration influenced Clm(β=-0.096 [-0.23–0.077]).

Conclusion

This is the first evaluated popPK model, to our knowledge, describing the saturable protein binding relationship between unbound and total MPA with incorporated MPAG in adult kidney transplantation. This model is being used to establish a Bayesian forecasting method to improve MPA precision dosing.

Introduction

Diabetes mellitus is a chronic progressive disease that can lead to cardiovascular and renal complications unless carefully managed. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of antihyperglycemic medications that show promise in reducing cardiovascular and renal risk

Research Question or Hypothesis

Is there a difference in the incidence of major adverse cardiovascular events and kidney disease progression between Saudi patients with diabetes treated with SGLT2 inhibitors and those not treated with SGLT2 inhibitors?

Study Design

A retrospective cohort study conducted at King Abdulaziz Medical City, teaching tertiary hospital with 751 beds capacity, Riyadh, Saudi Arabia

Methods

This tudy involving 202 patients with diabetes-associated heart failure or chronic kidney disease was conducted. The patients were divided into two groups: those treated with dapagliflozin added to metformin and other antihyperglycemic agents (n=101), and those treated with metformin and other antihyperglycemic agents (n=101). The data were analyzed using SPSS software.

Results

The mean age of the patients in the metformin group was 69.5 ± 10 years, and that in the dapagliflozin plus metformin group was 66.7 ± 11.1 years. Both groups weighed 83 kg at baseline with a body mass index of 32 kg/m2. The dapagliflozin plus metformin group experienced a significantly smaller reduction in the estimated glomerular filtration rate than the metformin-treated group (P=0.033). Additionally, fewer patients experienced nonfatal myocardial infarction in the dapagliflozin plus metformin group. The patients in dapagliflozin plus metformin group also showed significant reductions in weight and body mass index (P<0.01). Although not statistically significant, A1C%, systolic blood pressure, and diastolic blood pressure were lower in the dapagliflozin plus metformin group than in the metformin group.

Conclusion

Dapagliflozin plus metformin may offer benefits for kidney function and cardiovascular risk factors in Saudi patients with diabetes and co-existing heart failure or chronic kidney disease. However, further studies involving larger controlled trials are required to confirm these findings

Introduction

In acute care, pharmacists make a substantial clinical impact, yet it remains unclear which of their services are valued most by the medical team. Consequently, little data exists to help pharmacists prioritize their efforts when faced with competing clinical demands.

Research Question or Hypothesis

To determine how acute care internal medicine physicians perceive the value of various clinical pharmacist activities, including tasks that could potentially be discontinued.

Study Design

Qualitative analysis of semi-structured interviews at a single academic teaching hospital.

Methods

A member of the research team conducted, recorded, and transcribed individual interviews with physician participants. Two investigators independently coded the transcripts, resolving any discrepancies through consensus to identify themes.

Results

Eight internal medicine hospitalists were interviewed. Participants reported an average of 9.3 years in practice with 5.3 years at the study institution. Physicians identified the most valuable pharmacist activities as: 1) providing clinical recommendations based on a deep understanding of a patient’s medical history and current status, 2) performing medication histories, reconciliation, and discharge planning, and 3) maintaining direct availability for consultation. Participants felt pharmacists should prioritize these activities. There was less consensus about activities that pharmacists could stop doing. Suggestions included stopping medication histories, eliminating rounding with the medical team, removing the pharmacist as a communication intermediary between other healthcare providers and the medical team, and reducing involvement in routine clinical decisions like electrolyte repletion and insulin dosing.

Conclusion

Hospitalists highly value clinical pharmacists who possess comprehensive knowledge of the patient context and actively contribute to medication optimization and discharge transitions. Directing pharmacy resources toward these core areas can better align acute care services with physician needs.

Background

Critical thinking is an essential competency for pharmacists and is emphasized in the ACPE Standards 2025. Although numerous educational strategies have been proposed to enhance critical thinking in pharmacy learners, the effectiveness and rigor of these interventions remain unclear. The objective of this study is to characterize educational interventions designed to improve critical thinking among pharmacy students and evaluate the quality of evidence supporting their effectiveness.

Methods

MEDLINE, Embase, and ERIC were searched from database inception through May 2024 without date restrictions. Eligible studies included pharmacy learners, evaluated an intervention intended to improve critical thinking or related constructs (e.g., clinical reasoning, problem-solving), and incorporated a comparison group and/or pre-post assessment. Risk of bias was assessed using the Evidence Project risk of bias tool.Two reviewers independently screened studies, extracted data, and assessed risk of bias.

Results

Of 3,470 records identified, 60 studies met inclusion criteria. Most studies were conducted in the United States (71.7%) and used pre-post designs (61.7%), while nine (15.0%) were randomized controlled trials. Interventions included problem-based learning, team-based learning, debates, simulations, and case-focused activities. Critical thinking outcomes were measured using validated instruments (30.0%), student self-assessment (33.3%), academic performance (31.7%), and critical thinking focused assessments (13.3%). Forty-eight studies (80.0%) demonstrated improvement in critical thinking outcomes, five (8.3%) reported no change, and the remainder reported mixed findings. Risk of bias assessment identified frequent limitations, including inadequate reporting of baseline equivalence and lack of random selection or assignment.

Discussion

Diverse educational interventions show promise for improving critical thinking in pharmacy learners. However, substantial heterogeneity in interventions and outcome measures, coupled with limited use of rigorous study designs and validated assessments, highlights the need for higher quality research to identify the most effective approaches for developing and assessing critical thinking in pharmacy students.

Other

No external funding was received for this systematic review.

Service or Program

This analysis describes the implementation of a pharmacist-facing alert to withhold rifaximin during broad-spectrum antibiotic therapy and its associated reductions in redundant therapy and medication cost.

Justification/Documentation

Rifaximin is a non-absorbable antibiotic recommended as adjunctive therapy for hepatic encephalopathy (HE). However, infection is a common precipitant of HE, requiring treatment with broad-spectrum antibiotics which may provide overlapping antimicrobial therapy. A recent study suggests withholding rifaximin during systemic antibiotic therapy may reduce medication exposure and drug costs without worsening HE outcomes and this is supported by the most recent HE guidelines.

In 2025, Cleveland Clinic Health System implemented a pharmacist-facing antimicrobial stewardship alert to withhold rifaximin for HE in patients receiving broad-spectrum antibiotics. When patients were on rifaximin and broad-spectrum antibiotics concomitantly, this alert triggered review by an Infectious Disease pharmacist for potential discontinuation. Broad-spectrum antibiotic therapy was defined as systemic antimicrobial therapy with activity against gram-positive, gram-negative, and anaerobic organisms. A similar pharmacist-facing alert fired when broad-spectrum antibiotics were discontinued to prompt rifaximin reinitiation.

This alert was implemented with prospective audit and feedback. Adherence was evaluated based on a 24-hour timeframe. Adherence rates were 87.8% for de-escalation and 74.7% for escalation. Median potential cost avoidance was $220.26 to $440.52 per patient based on recent Average Wholesaler Pricing based on withholding rifaximin for a median of 3 (2-6) days.

Adaptability

Similar processes could be developed and implemented for use in a variety of health-systems including rural and academic centers, particularly if paired with provider-facing educational initiatives. There may also be potential to implement prescriber-facing alerts based on local workflow.

Significance

Implementation of a pharmacist-facing alert for withholding rifaximin during broad-spectrum antibiotic therapy was successfully implemented across our health-system. Implementation of this alert led to reduced cost for rifaximin.

Introduction

Metabolic dysfunction associated steatotic liver disease (MASLD) ranges from steatosis to metabolic dysfunction associated with steatohepatitis (MASH), which can progress to advanced liver damage.1,2 Recent studies evaluating semaglutide and tirzepatide for MASLD increased awareness of their potential role in managing this condition.3,4 As such, updated guidelines support the use of a glucagon-like peptide-1 agonist (GLP-1) in MASLD management.5,6 Previous pharmacist-led electronic outreach studies showed high provider acceptance and improved medication management.7,8 However, evidence evaluating student pharmacist-led interventions remains limited. No studies to date have examined the impact of electronic messaging by pharmacists or students on the management of MASLD.

The primary objective was to evaluate clinicians’ responses to student pharmacists’ electronic messaging recommendations in initiating semaglutide or tirzepatide for patients with MASLD.

Research Question or Hypothesis

Clinician outreach from student pharmacists may increase consideration of initiating a GLP-1 among patients with MASLD.

Study Design

This is a quantitative study of a provider outreach intervention conducted remotely by student pharmacists at four NYC sites within the Institute for Family Health.

Methods

Patients with MASLD were identified through a clinical report. Eligible diagnoses included hepatic steatosis, MASLD, NAFLD, MASH, NASH, MAFLD, and fibrosis. Patient records were reviewed by student pharmacists to exclude those currently or previously taking semaglutide or tirzepatide or those with contraindications to the medications. Reviews were overseen by the clinical pharmacist.

For eligible patients, a message was sent to the clinician through the electronic health system recommending pharmacotherapy. Student pharmacists monitor message responses and orders 30 days post-message.

Results

Three hundred twenty-one patients were listed in the report. Once the exclusion criteria were applied, 168 outreach messages were sent. Clinician responses will be presented at the ACCP poster presentation comparing clinician types and sites.

Conclusion

To be presented at the poster presentation.

Background and Purpose

Lack of access to buprenorphine, a gold-standard treatment for opioid use disorder (OUD), at community pharmacies creates gaps in care, which substantially increases risks for opioid-related morbidity and mortality. Many of the studies supporting that claim, were completed prior to the effective removal of the X-waiver, a federal regulation restricting buprenorphine prescribing for OUD.1–4 Despite the removal of this barrier, buprenorphine access remains poor. Additionally, with that prominent upstream barrier now removed, scholars have postulated that the bottleneck community pharmacies pose is increasingly constricting buprenorphine access. Reasons for these bottlenecks include nebulous legal limitations on buprenorphine ordering, financial barriers, bias, and stigma. Ensuring consistent, non-stigmatizing, and accessible buprenorphine access at community pharmacies is necessary in the management of OUD. The purpose of this study was to estimate the availability of buprenorphine in Illinois community pharmacies post X-waiver removal.

Methods

A cross-sectional telephone survey was conducted on 400 community pharmacies randomly sampled from a stratified list by rurality and pharmacy type. Inclusion criteria were actively licensed within Illinois and open to the public, excluding long-term care, closed-door, mail-order pharmacies, and those that only serve special populations. Pharmacies were called up to two times before being deemed a non-responder. The primary outcome was buprenorphine (either sublingual films or tablets) availability. Secondary outcomes include willingness to disclose to patients and providers, and differences in buprenorphine by pharmacy characteristics. Using the standardized scripts, callers identified themselves as researchers with the University of Illinois Chicago (UIC) Retzky College of Pharmacy and inquired about 1.) if buprenorphine was currently in stock, 2.) if pharmacies would disclose the information to a patient call, and 3.) if pharmacies would disclose availability to a provider’s office over the phone. Categorical variables of responding pharmacies are presented as the number and percentages of each group. Between group comparisons based on characteristics such as rurality, county opioid overdose rates, median income of the zip code, and chain versus independent pharmacies were completed using Chi-square tests.

Results

Of the 400 pharmacies sampled, 210 met the inclusion criteria and responded to the survey. Of all participating pharmacies 168 (80%), reported buprenorphine availability. Chain pharmacies (n= 297) had a 57.9% response rate (n=172), and independent pharmacies sampled (n=103) had a response rate of 36.89% (n=38). Chain pharmacies were more likely to endorse buprenorphine availability compared to independent pharmacies (84.88% versus 57.89%, p<0.001). There was no difference in buprenorphine availability based on if the pharmacy was located in a county with an opioid fatality rate less than the state fatality rate compared to a county opioid fatality rate above the state fatality rate (82% versus 78.18%, p=0.49).Of the pharmacies stocking buprenorphine, 112 (66.7%) stated that they would disclose the availability to a patient phone call, with an additional 32 (19.0%) saying that it depends if they would disclose the availability. Pharmacies who stated that they would require more information commonly noted that they would need a prescription on file before disclosing the availability. When asked if they would disclose the availability to a provider’s office inquiring about buprenorphine availability, 150 (89.3%) of the pharmacies stocking buprenorphine stated they would, with an additional 10 (5.6%) saying it would depend. Information pharmacies stated they would need before disclosing availability to providers included if they would be able to verify the provider’s office through caller identification, provision of a DEA number, and if the provider’s office knew exactly what they wanted to prescribe.

Conclusions

Buprenorphine is a first-line treatment of OUD that reduces opioid-related morbidity and mortality. However, buprenorphine only works if the patient can access it. Therefore, the role of community pharmacies in the OUD treatment landscape cannot be overlooked. In this study assessing buprenorphine availability in Illinois community pharmacies, 65.6% of sampled pharmacies reported having buprenorphine in stock. This result is greater than proportions seen in prior studies using secret-shopper methods to audit buprenorphine availability in other states.1–4 Chain pharmacies were more likely to have it in stock. Results from this study may be used to further contextualize OUD treatment deserts within Illinois to prioritize future interventions to increase buprenorphine access state-wide. Study limitations include the callers identifying themselves as researchers, so results may not reflect the actual experiences of patients and providers and are subject to selection and desirability bias. Additionally, this study took place in one state with expanded Medicaid coverage which also covers all buprenorphine products for OUD. This study builds upon the existing body of literature regarding the role of community pharmacies in the substance use disorder treatment landscape and shows promise for expanded access to buprenorphine for OUD.

Diversity, Health Equity, and Inclusivity

Amid an unprecedented increase of pharmacy closures, predominately impacting marginalized and underserved communities, understanding access at the remaining pharmacies is vital to identify further barriers to treatment. Thorough comparisons of buprenorphine availability and willingness to disclose the availability across key structural and community-level characteristics can help to identify priority areas for future research and targeted interventions. These characteristics include rurality, pharmacy type (chains versus independents), county-level opioid overdose rates, and area socioeconomic indicators such as median income and Social Vulnerability Index. Understanding access across statewide regions is imperative to inform key stakeholders, equip prescribers and patients to predict and navigate these barriers, and develop focused strategies to improve buprenorphine access at community pharmacies.

Introduction

Hypertriglyceridemia commonly coexists with diabetes, obesity, hypertension, chronic kidney disease, and other cardiovascular risk factors. Persistently elevated triglycerides (TG) are also associated with increased atherosclerotic cardiovascular disease (ASCVD) risk. However, TG-lowering therapy alone has not significantly reduced cardiovascular events. For adults with or without diabetes, the 2026 ACC/AHA guidelines recommend using the PREVENT risk assessment tool to guide primary prevention and have shifted some therapeutic strategies. Management for individuals with fasting TG 150–499 mg/dL, non-fasting TG 175–499 mg/dL, or diabetes includes a moderate-intensity statin for most patients, whereas high-intensity statin therapy is recommended for individuals with a PREVENT 10-year risk of ≥10% or multiple ASCVD risk factors. Additional TG-lowering therapy may be considered after LDL-C optimization in selected patients. Pharmacists, during their daily review of medication profiles for patients on lipid-lowering therapy (LLT), have the opportunity to help optimize pharmacotherapy.

Research Question or Hypothesis

This study aims to evaluate statin-treated patients with a history of hypertriglyceridemia, to 1) estimate 10-year ASCVD risk using the PREVENT risk assessment tool, 2) evaluate guideline-concordant statin intensity, and 3) identify opportunities for additional TG-lowering therapy.

Study Design

Retrospective, medication use evaluation.

Methods

A chart review was conducted among adults with documented history of hypertriglyceridemia receiving statin therapy from a community health clinic serving a predominantly Hispanic population between May 1, 2025, and April 30, 2026. Of 2,809 patients identified through an electronic health record search, 60 were randomly selected. Demographic and clinical characteristics, such as lipid values, ASCVD history, comorbidities, statin intensity, and use of TG-lowering medications were collected. Ten-year ASCVD risk was calculated using the PREVENT tool. Descriptive statistics will be used.

Results

pending

Conclusion

pending

Introduction

Pulmonary hypertension (PH) is characterized by elevated pulmonary vascular resistance that leads to right ventricular dysfunction and fluid overload. Loop diuretics are used to maintain euvolemia. Furosemide absorption is variable and reduced in anasarca. Evidence guiding optimal loop diuretic selection in patients with PH remains limited.

Research Question or Hypothesis

Among patients with PH admitted for fluid overload, does discharge on the same pre-admission furosemide regimen, compared with switching to bumetanide or torsemide, affect the rate of rehospitalization within 90 days?

Study Design

IRB‑approved, retrospective, multicenter cohort study.

Methods

This study included adults >17 years old admitted between 1/1/2014-1/1/2025 for volume overload requiring IV diuretics. Patients were included if prescribed furosemide PTA and diagnosed with PH Group I, II, or IV. Patients were assigned to Continuation (furosemide) or Change (bumetanide/torsemide) groups based on discharge prescription. Patients were included at a 3:1 ratio (Continuation:Change) for group assignments. The primary outcome was 90‑day all‑cause hospital readmission. Secondary endpoints included changes in weight and BNP, adjunctive diuretic use, PH therapy utilization, and loop diuretic–related adverse events. Statistical analyses included descriptive statistics, chi‑square test, Mann–Whitney U test, and multivariable logistic regression to identify predictors of 90‑day readmission. SPSS v32 was used for statistical analysis.

Results

A total of 130 patients met inclusion criteria (22 Change; 108 Continuation). Patients in the Change group had significantly higher discharge weights, longer index hospitalizations, higher BNP, and more frequent diuretic adjustments. Ninety‑day all‑cause readmission did not differ between groups (50% vs 46%, p=0.751). No significant differences were observed in any secondary outcomes. Loop diuretic selection was not associated with 90‑day readmission.

Conclusion

In this small study of patients with PH hospitalized for volume overload, discharge on bumetanide or torsemide did not reduce 90‑day readmissions compared with continuation of furosemide. Larger studies are needed to determine optimal outpatient loop diuretic strategies in PH post-hospital admission with fluid overload.

Introduction

Heart failure with reduced ejection fraction (HFrEF) is associated with high morbidity and mortality. Although angiotensin receptor-neprilysin inhibitors (ARNIs) are guideline-recommended therapy, their utilization and dose optimization remain suboptimal in clinical practice, with limited data from Saudi Arabia.

Research Question or Hypothesis

What are the rates of angiotensin receptor-neprilysin inhibitor (ARNI) utilization, dose optimization, and clinical inertia among guideline-eligible patients with heart failure with reduced ejection fraction (HFrEF), and what factors are associated with ARNI non-prescription?

Study Design

Single-center retrospective cohort study.

Methods

Adult patients with HFrEF (LVEF ≤40%) evaluated between January 2023 and December 2025 were screened for ARNI eligibility. Patients with absolute contraindications were excluded. Clinical inertia was defined as failure to initiate or up-titrate ARNI without documented justification. Patients were categorized by ARNI prescribing status, and predictors of non-prescription were assessed using Firth-penalized logistic regression. Statistical comparisons were performed using Mann–Whitney U and chi-square tests.

Results

Among 400 patient encounters screened, 377 eligible patients were included. Only 34 patients (9.0%) received ARNI therapy. Clinical inertia accounted for 311 cases (82.5%), including 301 patients (79.8%) who were never initiated on ARNI and 10 patients (2.7%) who were initiated but never up-titrated despite eligibility. Valid reasons for non-prescription were identified in 42 patients (11.1%), while cost prevented dose optimization in 9 patients (2.4%). Overall, 15 patients achieved optimized therapy, representing 4.0% of the cohort and 44.1% of ARNI-treated patients.

Conclusion

ARNI utilization and dose optimization were markedly low among guideline-eligible patients with HFrEF. More than 80% of the treatment gap was attributable to clinical inertia rather than contraindications, intolerance, refusal, or system-related barriers. These findings highlight opportunities to improve adherence to guideline directed medical therapy. Targeted interventions, including structured treatment protocols, prescriber education, and clinical pharmacist-led guideline-directed medical therapy optimization programs, may facilitate timely ARNI initiation and titration and improve HFrEF care.

Introduction

A recent atrial fibrillation (AF)-naïve study found Icopasent Ethyl (IPE), compared to omega-3 acid ethyl esters (DHA/EPA) on statin background, showed a significantly higher AF risk. The effects of sodium/glucose cotransporter 2 inhibitors (SGLT-2i), glucagon- like peptide- 1 receptor agonists (GLP- 1ra), or dipeptidyl peptidase- 4 inhibitors (DPP- 4i) in patients with hypertriglyceridemia remain unclear, despite evidence of AF reductions.

Research Question or Hypothesis

This study evaluated the risk of AF or SVT/VT with SGLT-2i, GLP-1ra, or DPP-4i in patients on IPE or DHA/EPA.

Study Design

A retrospective cohort study using the MarketScan® databases evaluated adult patients initiating either sodium/glucose cotransporter 2 inhibitors (SGLT-2i), glucagon-like peptide-1 receptor agonists (GLP-1ra), or dipeptidyl peptidase-4 inhibitors (DPP-4i) between 07/2016 to 09/2023.

Methods

Eligible individuals were on IPE or DHA/EPA adjunct to statin therapy and AF or SVT/VT naive at the first date of the SGLT-2i, GLP-1ra, or DPP-4i. Three pairwise comparisons were performed using 1:1 propensity score matching. Hazard ratios (HRs) for AF and arrhythmia at 90 and 365 days were estimated using Cox proportional hazards models.

Results

After PS matching, 4,712 pairs were identified for SGLT-2i vs GLP-1ra, 2,303 for SGLT-2i vs DPP-4i, and 2,154 for GLP-1ra vs DPP-4i. At 90 days, AF risk was comparable across treatment groups. At 365 days, SGLT-2i and GLP-1ra showed a non-significant lower AF risk compared with DPP-4i (SGLT-2i vs DPP-4i HR 0.91, 95% CI 0.67-1.23; GLP-1ra vs DPP-4i HR 0.95, 95% CI 0.70-1.29). SGLT-2i vs GLP-1ra resulted in the HR of 0.83 (95% CI 0.67-1.03). For the composite arrhythmia outcome, SGLT-2i was associated with lower risk compared with GLP-1ra (HR 0.85, 95% CI 0.72-0.998).

Conclusion

In patients on omega-3-based with statin therapy, SGLT- 2i, GLP-1ra, and DPP- 4i demonstrated similar AF and SVT/VT arrhythmia risk effects. SGLT-2i showed a lower risk of arrhythmia compared to GLP-1ra at 365 days.

Introduction

Heart failure (HF) remains a leading cause of hospitalization, and effective decongestion with loop diuretics remains essential for symptom relief and prevention of recurrent hospitalizations. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and angiotensin receptor–neprilysin inhibitors (ARNi) have become foundational HF therapies, and both possess natriuretic and/or osmotic diuretic effects that may reduce loop diuretic requirements. However, current HF guidelines do not provide specific recommendations for loop diuretic management following initiation of these therapies as existing evidence regarding timing and magnitude of diuretic dose adjustments is inconsistent. Additionally, existing evidence has primarily evaluated the effects of each agent independently in managing loop diuretic requirements, and the effects of combined therapy have not yet been elucidated.

Research Question or Hypothesis

How does inpatient initiation of combined SGLT2-i and ARNi affect the change in loop diuretic dose requirements within 30 days of discharge for patients with HF?

Study Design

Single-center, retrospective cohort study

Methods

This single-center, retrospective cohort study included adults admitted between September 2019 and March 2025, with a primary diagnosis of heart failure who were newly initiated on both SGLT2i and ARNi prior to discharge. Eligible patients were required to have a follow-up clinic visit addressing heart failure within 30 days of discharge. Patients were excluded if they were receiving either medication before admission, discontinued either therapy within 30 days after discharge, or were prescribed a thiazide or thiazide-like diuretic. Additionally, patients with past medical history of cardiac amyloidosis, durable ventricular assist devices, or heart transplant were excluded. The primary outcome was the percent change in oral furosemide-equivalent dose within 30 days of discharge. Secondary outcomes included early changes in oral furosemide-equivalent dose within 7 and 14 days, percent changes in serum creatinine and estimated glomerular filtration rate, 30-day rehospitalization, and 30-day mortality.

Results

Currently ongoing

Conclusion

Currently ongoing

Background: The transthyretin (TTR) tetramer in patients with variant ATTR-CM (ATTRv-CM) is less stable than wild-type TTR, leading to earlier disease onset, more rapid progression, and worse outcomes. The p.V142I variant is the most common variant in the USA and has a higher mortality vs wild-type. Acoramidis is an approved oral treatment for ATTR-CM and achieves near-complete (≥90%) TTR stabilization. In the phase 3 ATTRibute-CM study and the first 12 months of its open-label extension (OLE), continuous acoramidis reduced all-cause mortality (ACM) with consistent treatment effects across p.V142I and non-p.V142I subgroups. Long-term efficacy and safety outcomes through Month (M) 54 in variant subgroups, including p.V142I, have not been fully characterised. This analysis is the first to report M54 mortality outcomes in p.V142I and to characterize serum TTR (sTTR) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) trajectories within the OLE variant subgroup population through M54.

Purpose: To evaluate the long-term efficacy and safety outcomes of acoramidis in participants with ATTRv-CM, including the p.V142I subgroup.

Methods: In ATTRibute-CM, participants were randomized 2:1 to receive acoramidis HCl 800 mg or placebo twice daily for 30 months. After M30, participants were invited to enrol in the OLE, in which all received acoramidis. Exploratory post-hoc analyses were conducted in the p.V142I and non-p.V142I variant subgroups (n=56) of the full analysis set. ACM, cardiovascular-related mortality (CVM), and changes from baseline in sTTR and NT-proBNP concentrations were assessed over 54 months. Data are summarized descriptively.

Results: Thirty-five participants with ATTRv-CM (62.5%) had the p.V142I variant (acoramidis=23; placebo=12) and lower mean sTTR and higher median NT-proBNP at baseline than non-p.V142I participants. Through M54, ACM and CVM were markedly lower in the continuous acoramidis arm vs placebo-to-acoramidis across variant subgroups (Figure 1A). Twenty-seven participants with ATTRv-CM enrolled in the OLE after M30 (continuous acoramidis, n=22; placebo-to-acoramidis, n=5). During 24 months of OLE (M31–M54), 3 ACM events occurred in the 17 participants with p.V142I (Figure 1B); no ACM events occurred in the 10 participants with non-p.V142I. Continuous acoramidis achieved sustained increases in sTTR and persistent attenuation of NT-proBNP rise through M54 in both participants with p.V142I or non-p.V142I variants (Figure 2). Long-term treatment was well tolerated, with no new safety signals in either the p.V142I or non-p.V142I subgroups.

Conclusions: These M54 findings extend the survival benefit and favourable biomarker trends previously reported at M30, demonstrating the long-term durability of efficacy and safety of acoramidis in ATTRv-CM, including in the p.V142I subgroup.

Service or Program

This abstract describes an AI-enabled decision-support tool for pharmacist-led Chronic Care Management (CCM) in community pharmacy, developed in response to barriers identified by Tennessee Regional Integrated Transformation Zone (RITZ) participants — a multistakeholder practice transformation initiative now housed at UTHSC College of Pharmacy. Using large language model (LLM) technology, the tool generates standardized outputs across five phases: (1) site readiness; (2) contracting and payment structure; (3) CMS audit-ready documentation; (4) monthly coding support; and (5) equity and SDOH integration, targeting community pharmacists partnering with physician billing practices under CPT 99490/99439.

Justification/Documentation

Tennessee RITZ participants — representing health systems, community pharmacies, FQHCs, and academic institutions — identified documentation workflows, billing infrastructure, and coding expertise as primary sustainability barriers. Despite Medicare Part B reimbursement of approximaely $62/patient/month under CPT 99490, only 1.1–3.4% of eligible Medicare beneficiaries receive CCM annually; 30–37% of pharmacist CCM time is non-reimbursable. The AI tool addresses these practitioner-identified gaps through automated projections, contract drafting, audit checklists, and documentation prompts, requiring pharmacist and billing professional verification of all outputs.

Adaptability

The framework is platform-agnostic, deployable via free-access LLMs (ChatGPT, Claude, Gemini, Microsoft Copilot) without proprietary software or dedicated staff. RITZ implementation across multiple states (Tennessee, North Carolina, Utah, Minnesota) supports broad pharmacy applicability. Prompts are modifiable to local reimbursement rates, panel size, and contract terms, enabling a single pharmacist to launch CCM services.

Significance

Grounded in real-world needs from the Tennessee RITZ — sustained beyond initial NACDS Foundation funding at UTHSC — this framework positions community pharmacists as Medicare Part B CCM providers, establishing a dispensing-independent revenue pathway aligned with value-based care. With HHS OIG actively auditing CCM payments (March 2026), the audit-ready documentation focus is timely and practice-defining. Phase 5 equity integration targets rural and underserved populations with high chronic disease burden and low CCM uptake.

Service or Program

Howard University College of Pharmacy (HUCOP) and the DC Department of Employment Services (DOES) launched a pharmacy-technician certificate for adults from underserved wards in August 2024. Each cohort completes 15 weeks of competency-based didactics and must pass a comprehensive exam before a 160-hour community-pharmacy externship. Three cohorts have enrolled 31, 26, and 25 learners, with 7, 10, and 18 advancing to externship. A joint HUCOP–DOES workgroup directs recruitment, learner support, and continuous quality improvement. Currently, 13 learners are in cohort 4.

Justification/Documentation

District pharmacies face technician vacancies exceeding 25 %, pulling pharmacists away from clinical services. A literature review reported few academic–government workforce pipelines existed. Attrition in Cohort 1 (35 % progression) exposed math/science gaps and social barriers (child-care, transit, Wi-Fi). The curriculum was then front-loaded with a virtual STEM boot camp and needs-based stipends, boosting externship progression to 46 % in Cohort 2 and 72 % in Cohort 3. Four graduates secured full-time positions, three earned national certification, and one applied to a PharmD program and was accepted to Howard University College of Pharmacy.

Adaptability

Government-supported, hybrid preparatory modules, and accredited community-pharmacy externships make the model portable to other regions confronting technician shortages. Mapping to PTCB outcomes and relying on existing college faculty allow rapid adoption by any ACPE-accredited school or health-system education office. The schedule can shift to evenings or weekends for working adults, and the boot-camp concept is scalable to resource-limited settings.

Significance

The partnership offers a pragmatic solution to technician shortages while widening entry into pharmacy careers for historically excluded populations. By freeing pharmacists for direct patient care and seeding interest in the PharmD pipeline, the program advances ACCP workforce and patient-care standards and provides a replicable template for strengthening clinical pharmacy services. The program might be able to increase the number of applicants to PharmD program.

Introduction

The high-acuity of neurosurgical patients, polypharmacy, comorbidities, and altered pharmacokinetics, alongside the need for time-sensitive interventions, increasing the risk of drug-related problems (DRPs). Evidence regarding DRPs and pharmacist's role in this specialty remains limited.

Research Question or Hypothesis

Does the implementation of clinical pharmacist interventions in a neurosurgical intensive care unit effectively reduce DRPs and improve medication management outcomes for high acuity patients?

Study Design

A retrospective cross-sectional study was conducted in the trauma intensive care unit, neurosurgical care unit, and neurosurgical ward of a tertiary hospital in Thailand from November 2025 to April 2026.

Methods

A dedicated clinical pharmacist provided services 4 days weekly and delivered interventions to the multidisciplinary team. DRPs, patient acuity, and severity were classified using Pharnaceutical Care Network Europe (PCNE) v9.1, Intensive Care Society (ICS) 2009, and the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index, respectively. Outcomes included DRPs categories and frequency, intervention type, and healthcare team acceptance rates. Data were analyzed using descriptive statistics, including frequency and percentage, with Microsoft Excel.

Results

Among 102 patients, 306 DRPs were identified (3.0 DRPs per patient). A majority of patients were high acuity (68.4%, ICS level 2-3). Overall, 80% of DRPs related to treatment effectiveness, primarily involving drug and dose optimization. The predominant medication groups were anti-infective agents (46%), central nervous system agents (12%), and cardiovascular agents (11%). Most DRPs were identified and addressed at non-harmful stages through proactive medication surveillance. Pharmacist recommendations were accepted in 89.0% of cases.

Conclusion

Most DRPs were related to treatment effectiveness, underscoring the critical role of clinical pharmacists in drug and dose optimization. Pharmacist-led interventions demonstrated strong acceptance by the multidisciplinary team, enhancing patient safety and strengthening medication management in high-acuity neurosurgical care.

Introduction

Sepsis is a leading cause of death in U.S. hospitals and timely administration of early treatment interventions, as measured by SEP1 bundle compliance, is associated with lower rates of mortality. However, patient demographics have historically been associated with disparities in sepsis outcomes, with higher rates of mortality being observed in Black patients and other minority groups. This study extends previous findings on the influence of race, gender, and age on patient outcomes with sepsis.

Research Question or Hypothesis

Is patient race, gender, or age associated with mortality in sepsis?

Study Design

Single-center, retrospective, observational cohort.

Methods

Adult patients with a diagnosis of sepsis admitted to a 427-bed community teaching hospital between March 2024 and February 2025 were included. The primary outcome was mortality and secondary outcome was SEP1 100% bundle compliance. Outcomes were compared across race, gender, and age groups using Chi-squared, and Mann-Whitney U tests for categorical and continuous variables, respectively, with p<0.05 indicating statistical significance.

Results

The 2283 included patients comprised 75.7% White, 20.1% Black, and 4.2% other/unknown race; 48.8% male; 56.4% aged ≥65 years; and initial lactate was the same across all groups except patients ≥65 years (1.1 mmol/L vs. 1.7 mmol/L, p<0.001). Mortality was higher in patients ≥65 years (mortality 4.7% vs. 6.9%, p=0.048. There was no difference in SEP1 100% bundle compliance across any groups and no difference in mortality across gender or race.

Conclusion

Higher sepsis mortality was observed in older patients despite both age groups achieving SEP1 100% bundle compliance. While higher mortality in older patients may be expected, a higher initial baseline lactate value may indicate more severe illness. Interestingly, no mortality difference observed between race and gender contrasts with studied disparities in current literature. Although limited by single-center data collection, future research to explore relationships between patient demographics and sepsis treatment outcomes is warranted.

Introduction

Constipation is common in mechanically ventilated (MV) intensive care unit (ICU) patients receiving continuous opioid infusions. At the study institution, providers may order an optional as-needed bowel regimen; however, its effectiveness has not been evaluated.

Research Question or Hypothesis

Does the use of an as-needed bowel regimen reduce constipation in MV ICU patients receiving continuous opioid infusions?

Study Design

retrospective, observational cohort

Methods

Adult ICU patients admitted between January-December 2024 who required MV within 24 hours of admission and received continuous opioid infusion were included. Exclusion criteria were ICU length of stay (LOS) <72 hours, comfort care orders within 72 hours, lactulose for hepatic encephalopathy, and significant gastrointestinal surgery, gastric dysmotility, or ostomy. The primary outcome was constipation, defined as >72 hours without defecation during ICU admission. Secondary outcomes included ICU days without defecation, ICU and hospital LOS, cumulative morphine milligram equivalents (MME), and MV duration. Outcomes were compared between patients who received and did not receive the bowel regimen using Chi-square and Mann-Whitney U tests (with p<0.05 indicating significance).

Results

Of 196 included patients, 85 (43.4%) received the bowel regimen. Baseline characteristics were similar, except for a lower SAPSII score in the bowel regimen group (38 vs. 42, p=0.018). Constipation occurred more frequently among patients receiving the bowel regimen (78.8% vs 63.1%, p =0.012). The bowel regimen group also had higher cumulative opioid exposure (447 vs. 225 MME, p=0.026), more ICU days without defecation (5 vs. 3 days, p<0.001), longer ICU LOS (176.18 vs 118.20 hours, p=0.002) and longer hospital LOS (288.27 vs. 224.93 hours, p=0.015). MV duration was similar between groups.

Conclusion

Use of an as-needed bowel regimen did not reduce constipation in MV ICU patients receiving continuous opioid infusions; differences in illness severity may have contributed. Further studies are needed to evaluate scheduled bowel regimens for prevention of opioid-induced constipation in ICU patients.

Introduction

Constipation in critically ill patients is associated with enteral feeding intolerance, increased ventilator dependence, and increased length of stay. Critically ill trauma patients are at high risk due to prolonged immobility, gastrointestinal surgery, and opioid administration.

Research Question or Hypothesis

What differences exist between constipated and not-constipated critically ill patients with traumatic injuries?

Study Design

Single-center, retrospective cohort study conducted at a level I trauma center.

Methods

Adult patients admitted to the trauma ICU and received ≥3 days of continuous enteral nutrition (EN) during their first week of ICU stay were retrospectively reviewed. Constipation was defined by lack of bowel movements for 3 days during EN or 5 days since admission, and required escalation of laxative therapy to an enema, lactulose, or bisacodyl suppository. Diarrhea was defined by >3 liquid bowel movements per day and discontinuation of laxative therapy. Nominal data was assessed via Chi-Square or Fisher’s Exact test and Wilcoxon Rank Sum test was used for continuous variables. Continuous data are given as median [25th, 75th percentiles]. Significance was defined as a P-value <0.05.

Results

Seventy patients qualified for evaluation. Constipation occurred in 67% (n=47) of patients. Constipated patients received significantly higher doses of fentanyl than those without constipation (200 [136, 327] vs 138 [75, 188] mcg/h, P=0.002). There were no differences between constipated and not-constipated groups in nutritional intake, injury severity scores, number of gastrointestinal surgeries, or clinical outcomes. However, those with constipation tended to have greater ventilator-dependent days (P=0.06) and length of ICU stay (P=0.06). Diarrhea occurred in 11% of patients.

Conclusion

Constipation is prevalent in critically ill enterally fed trauma patients, especially for patients with increased opioid requirements, despite laxative therapy. Further research is required to determine the opioid dosage threshold for escalation in laxative therapy.

Introduction

Large language models (LLMs) are increasingly used to obtain medication information; however, the safety and completeness of LLM-generated direct oral anticoagulant (DOAC) patient education responses remain uncertain, particularly for high-risk medications requiring nuanced counseling.

Research Question or Hypothesis

Does guideline grounding improve the safety and completeness of LLM-generated DOAC patient education responses?

Study Design

Comparative bench evaluation of guideline-grounded versus unguided ChatGPT-generated responses to DOAC patient education questions.

Methods

Forty-four standardized patient education questions (22 apixaban, 22 rivaroxaban) spanning dosing, missed-dose management, contraindications, drug interactions, peri-procedural management, and counseling topics were submitted to ChatGPT under two conditions: unguided and guideline-grounded. Guideline-grounded responses were informed by FDA labeling, clinical practice guidelines, and pivotal DOAC trials. Responses were evaluated using checklists derived from these references. The primary outcome was the proportion of responses classified as Safe & Complete. Responses were classified using a three-point rubric (1 = Safe & Complete, 0 = Incomplete but Safe, −1 = Unsafe). Descriptive analyses were conducted.

Results

A total of 88 responses were evaluated. Guideline-grounded responses demonstrated a higher proportion of Safe & Complete classifications compared with unguided responses (37/44 [84.1%] vs 34/44 [77.3%]). Incomplete but Safe responses occurred less frequently with guideline grounding (5/44 [11.4%] vs 9/44 [20.5%]). Mean response score was higher with guideline grounding (0.80 vs 0.75). Unsafe responses were uncommon, accounting for 3 of 88 responses. Guideline grounding improved inclusion of renal dosing considerations, drug interaction precautions, and peri-procedural guidance. The greatest variability occurred in contraindication/caution and peri-procedural management domains.

Conclusion

Guideline grounding improved the completeness of LLM-generated DOAC patient education responses and increased the proportion classified as Safe & Complete. Performance was strongest in rule based counseling domains and more variable in contraindications and peri-procedural management. These findings support guideline grounding to improve LLM-generated patient education for high-risk medications.

Service or Program

Boston Medical Center Brighton, formerly St. Elizabeth’s Medical Center, hosts government-sponsored international PGY1 and PGY2 Infectious Diseases pharmacy residency programs. Between 2012 and 2026, 24 residents, sponsored by the governments of Saudi Arabia and Kuwait, completed training at our institution. The program is structured to ASHP-accredited U.S. residency standards, delivering clinical training across diverse patient populations, with emphasis on direct patient care, interprofessional collaboration, leadership, and quality improvement.

Justification/Documentation

A cross-sectional survey was distributed to 23 of 24 graduates to assess long-term outcomes. Thirteen responded, yielding a 57% response rate with 84.6% from Saudi Arabia and 15.4% from Kuwait. Results demonstrate substantial, sustained impact: 85% contributed to institutional policy or guideline development; 23% at the national or government level. Sixty-two percent implemented clinical pharmacy services, 54% implemented antimicrobial stewardship programs, and 54% established residency or training programs. Thirty-one percent led medication safety initiatives. Teaching impact was extensive; 69% precept students, 54% precept residents, 54% hold pharmacy faculty appointments, and 31% serve as residency program directors. Seventy-seven percent have published peer-reviewed literature, including two graduates with more than 10 publications. Graduates rated the program’s influence on their careers at a mean of 8.8/10.

Adaptability

This model is replicable at any ASHP-accredited residency program. Key enabling factors include institutional commitment, government sponsorship, and preceptors committed to mentoring cross-cultural learners. The curriculum requires no structural modification as international residents train alongside U.S. residents under identical standards, facilitating seamless integration and mutual enrichment of the learning experience.

Significance

International pharmacy residency programs represent a scalable, high-yield mechanism for advancing clinical pharmacy practice globally. Graduates return to their home countries equipped to build programs, train the next generation, and shape national health policy. This program demonstrates U.S.-based residency training produces a measurable, lasting impact on pharmacy practice in the Middle East, supporting mission of international clinical pharmacy advancement.

Introduction

Pharmacy student test anxiety secondary to written, multiple-choice examinations is well-documented and associated with poor examination performance, well-being, and progression. However, the impact of anxiety on performance on other forms of high-stakes, case-based assessments is less clear. Additionally, evidence is lacking surrounding trends in anxiety throughout repeated exposure to similar assessment types within a course.

Research Question or Hypothesis

Does student self-reported anxiety correlate with academic performance in an evidence-based clinical reasoning (EBCR) course?

Study Design

Retrospective cohort review with a voluntary questionnaire.

Methods

Third year pharmacy students are enrolled in EBCR6, which is the last course in a six-part series, in the spring. In EBCR6, students complete multiple case-based assessments, including verbal defenses (VD) and timed in-class cases (ICC), to optimize critical thinking and clinical decision-making skills. Before each assessment, students voluntarily completed the State-Trait Anxiety Inventory to assess their current anxiety. Anxiety was correlated to performance on each assessment using Spearman correlation and compared throughout the semester with the Wilcoxon-signed rank test.

Results

Twenty-six students consented to participate, and 58 total anxiety questionnaires were completed. Overall, average anxiety was significantly higher before VD compared to ICC (60.3 vs 45, p=0.0002). There was no correlation between anxiety and assessment performance overall (rs=-0.06, p=0.76). However, higher anxiety on VD was positively correlated with higher assessment scores (rs=0.61, p=0.004), whereas higher anxiety trended towards lower ICC scores, although this finding was not statistically significant (rs=-0.41, p=0.06). There was a significant decrease in anxiety with repeated assessments in the course (p=0.023).

Conclusion

Study findings suggest students experience higher anxiety with verbal assessments compared to written work; however, this may lead to better performance. Even in the last course in the series, students appear to demonstrate less anxiety with repeated exposure to the same assessment type. Further research is planned to evaluate anxiety impacts across different cohorts and courses.

Introduction

Board certification by the Board of Pharmacy Specialties (BPS) is increasingly recognized as a marker of advanced clinical pharmacy practice for clinical pharmacists; however, data are lacking to describe exposure and awareness within Doctor of Pharmacy (Pharm.D.) curricula.

Research Question or Hypothesis

To what extent, if any, do Pharm.D. programs include board certification exposure and awareness in their curriculum?

Study Design

A national cross-sectional survey was distributed to administrators involved in curriculum oversight or pharmacy practice department chairs.

Methods

The primary outcome was the percentage of Pharm.D. programs intentionally delivering board certification exposure. Secondary outcomes included delivery methods, faculty perceptions regarding board certification, awareness of BPS student resources, and factors associated with curricular inclusion. Descriptive statistics were utilized. Correlation analysis of each predictor and board certification exposure was subjected to a Pearson chi-square test. If significant, relationship magnitude was conveyed via phi coefficient or Cramer’s V.

Results

The response rate was 71.0% (98/138). Overall, 41.8% intentionally delivered board certification exposure. Among programs providing exposure, required didactic coursework was the most common setting (82.9%), most devoted <1 hour to this content (43.9%), and lecture was the predominant delivery method (82.9%). Only 24.5% of respondents were aware that BPS resources were available for pharmacy students. Carnegie Classification was significantly associated with curricular inclusion of board certification exposure (Cramer's V=0.40; p=0.010) with most being RCU (84.6%) than R1 (40.6%) or R2 (30.8%) CSoPs. Pharm.D. programs who include board certification exposure currently were more likely to indicate that board certification should be included within the curriculum (Cramer’s V=0.46; p=0.001).

Conclusion

Fewer than half of responding Pharm.D. programs intentionally deliver board certification exposure within the curriculum despite general broad support for its inclusion. Exposure typically requires minimal curricular time. Increased awareness and utilization of available BPS student resources may represent an opportunity to enhance professional development and career readiness among pharmacy students.

Implementation of MRSA nares screening into antimicrobial stewardship programs can help reduce unnecessary exposure to anti-MRSA therapy because of its high negative predictive value. Our 545-bed institution recently implemented MRSA nares screening as a stewardship tool. The purpose of this study was to assess the correlation between MRSA nares screening results and anti-MRSA therapy prescribing practices, and to identify opportunities for expansion of use.

A retrospective review of anti-MRSA orders in relation to MRSA nares screening results from January 2025-April 2025 was conducted at city hospital in NY. Patients who received anti-MRSA therapy were categorized based on nares screen result (positive, negative, no screen), then assessed for appropriateness of anti-MRSA therapy. Anti-MRSA therapy was considered appropriate in patients with a positive nares screen, or appropriate based on known MRSA risk factors, clinical decompensation, or microbiologic data in those with negative nares, or no screen conducted. Patients who received anti-MRSA therapy for more than 48 hours prior to nares screen were excluded.

502 patients receiving anti-MRSA orders were included. The most common indications for anti-MRSA therapy were skin and soft tissue infection (23%) and empiric unknown source (18%). Approximately 15% (n=73) had a positive screen, 30% (n=151) had a negative screen, and 55% (n=278) had no screen conducted. Of the 151 patients with negative nares, 52% (n= 79) discontinued anti-MRSA therapy in response to the negative screen. In those with a negative nares who continued anti-MRSA therapy (n=72), continuation was considered appropriate in nearly 90% of patients. Among those with no screen conducted, 82% (n=228) of anti-MRSA therapy use was considered appropriate.

MRSA nares screening was underutilized, with over half of patients not tested. Among those screened, negative results led to discontinuation of anti-MRSA therapy in about half of cases, supporting a correlation with de-escalation. Continued therapy despite negative screens was usually appropriate, highlighting the role of clinical judgment in prescribing. Overall, MRSA nares screening had a small but meaningful impact on prescribing and represents an opportunity to strengthen antimicrobial stewardship efforts.

Introduction

Structured post-exam review sessions have been proposed as a metacognitive strategy to support student learning. Quantitative evidence of their impact remains limited. No published studies have examined a student-reported error attribution taxonomy or characterized correctly answered questions lacking full conceptual understanding in a pharmacotherapy course.

Research Question or Hypothesis

Does post-exam review session attendance improve subsequent exam performance, and what patterns of error attribution and knowledge gaps emerge?

Study Design

Retrospective, observational pilot study in a single second-year PharmD course over one academic semester.

Methods

Following each of three unit exams, students attended voluntary post-exam review sessions, accessing individual exam performance, responses, and faculty-written rationale, then completed a per-question self-reflection form indicating correctness — with notation of full conceptual understanding — or selecting from five error categories: careless mistake, inability to recall, misapplication of knowledge, incomplete understanding or misconception, and test anxiety. Welch's independent samples t-test compared exam performance between attendees and non-attendees. Error attribution frequencies were calculated by category and domain.

Results

Sixty students were included; attendance was 61.7% (Exam 1) and 53.3% (Exams 2–3). Attendees scored significantly higher on Exam 3 (85.74±6.66 vs. 80.90±9.08, p=0.024) and Exam 4 (86.13±8.04 vs. 81.70±8.73, p=0.046); no difference was observed on Exam 2 (p=0.230). Mean Exam 4 scores increased from 80.00±8.76 (0 sessions, n=15) to 85.85±8.30 (3 sessions, n=23), suggesting a dose-response relationship. Overall, 69.4% of responses were correct; 3.0% lacked full conceptual understanding. The most frequent error was inability to recall (35.2%). Pathophysiology and pharmacology errors were predominantly recall-based (41.0% and 59.0%, respectively); pharmacotherapy errors were distributed across recall (28.7%), misapplication (23.8%), and incomplete understanding (22.5%).

Conclusion

Post-exam review attendance was associated with improved exam performance, with a dose-response effect suggesting cumulative benefit. Domain-specific error profiles suggest remediation tailored to predominant error types may offer greater specificity than generalized review. Future studies should examine error attribution longitudinally across multiple cohorts.

Introduction

Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that is found

significantly effective in treating type 2 diabetes as well as weight management by increasing

insulin secretion, decreasing glucagon release, reducing appetite for less food consumption, and

slowing gastric emptying to help stay full longer.

Research Question or Hypothesis

As there is a significant increase in manufacture and consumption of semaglutide for both clinical

and weight management purposes, there must be valid methods for excipients testing to ensure

that the drug is safe to use after being exposed to certain conditions. The purpose of this study is

to validate a stability study through forced degradations where the drug will go under stressed

conditions for compound breakdown detection. High-performance liquid chromatography (HPLC)

technique was used to quantify semaglutide.

Study Design

N/a

Methods

The mobile phase is composed of acetonitrile (ACN) with 0.1% tetra-fluor acetic acid

(TFA) and water with 0.1% tetra-fluor acetic acid (TFA). The stationary phase was a Phenomenex

Luna 3 µm C18 column (150 x 4.6 mm). The column temperature was 30 °C. The ACN

concentration gradient increased from 40% to 55% over 10 minutes. The injection volume was 30

µL while the gradient flow rate was 2mL/ minute. The detection wavelength was set to 205 nm.

This method will be evaluated under standard guidelines of the United States Pharmacopeia (USP).

Results

Semaglutide eluted at 2.4 minutes with a sharp, symmetrical peak. No interfering peaks

were seen during the elution window of semaglutide, indicating specificity of the assay. Six-point

standard curves of semaglutide demonstrated linearity, with correlation coefficients of 0.998.

Conclusion

An optimized method of semaglutide separation was developed. The method is

specific and reproducible and will be subjected to forced degradation and validation for application

to stability studies

Service or Program

A pharmacist-led communication framework was developed and implemented at Shanghai, China, to address the nocebo effect in Chinese cancer patients by targeting unspoken death anxiety— a culturally rooted issue exacerbated by limited societal death education. The five-pillar framework reframes adverse drug reaction (ADR) communication, validates patients’ unspoken fears, builds sustained therapeutic alliances, empowers patients through treatment knowledge, and links medication adherence to life meaning. Integrated into routine oncology medication counseling, it guides pharmacists to act as anxiety “containers” while delivering evidence-based pharmaceutical care, shifting patients’ perception of medications from fear sources to quality-of-life tools.

Justification/Documentation

Clinical observations and literature review confirmed Chinese cancer patients’ ADR fear stems primarily from unprocessed death anxiety, which amplifies the nocebo effect, reduces medication adherence, and compromises treatment efficacy. The framework is justified by psychosocial pharmacology principles and evidence that pharmacist-led empathic interventions improve oncology therapy outcomes. It is documented with clinical application examples, step-by-step communication strategies, and alignment with national clinical pharmacy guidelines for oncology supportive care.

Adaptability

The framework uses modular, actionable strategies requiring no extensive additional pharmacist training, adaptable to diverse oncology settings in China and other regions with similar cultural taboos around death and limited death education. It flexibly tailors to patient preferences—emphasizing education for information-focused patients and emotional validation for others—and integrates into brief routine counseling to address time constraints in busy pharmacy settings.

Significance

This framework is an original culturally adapted practice in China, filling the gap of neglecting existential distress in traditional medication counseling. Its systematic justification and practical documentation support sustainable implementation. High adaptability enables cross-regional replication in culturally similar contexts, advancing international clinical pharmacy by centering cultural psychology in oncology supportive care. It elevates pharmacists’ role in global cancer care, demonstrating how integrated psychological and pharmaceutical interventions can mitigate the nocebo effect and improve medication adherence for non-U.S. patients.

Introduction

Intravenous (IV) benzodiazepines, including lorazepam, are recommended as first-line therapy for acute seizures. The guideline-recommended lorazepam dose is 4 mg for most adults (0.1 mg/kg; maximum dose: 4 mg). During the 2025 injectable benzodiazepine shortage, our university health system’s emergency departments (EDs) transitioned from stocking 2 mg/mL to 4 mg/mL IV lorazepam products. Because clinicians may underdose benzodiazepines due to respiratory depression concerns, this provided an opportunity to evaluate whether lorazepam product selection influenced dosing practices and clinical outcomes. The purpose of this study was to evaluate whether use of 4 mg/mL versus 2 mg/mL injectable lorazepam was associated with differences in dosing, safety, or efficacy among adults treated for acute seizures in the ED.

Research Question or Hypothesis

Does initial lorazepam dosing (2 mg versus 4 mg) affect the incidence of endotracheal intubation among adults treated for acute seizures in the ED?

Study Design

Retrospective cohort study

Methods

ED medication administration records were queried for injectable lorazepam administrations from January 2022 through April 2026. Patient encounters were included if the chief complaint or ED admitting diagnosis was epilepsy or seizure. Exclusion criteria included age younger than 19 years, lorazepam administration for a non-seizure indication, or non-intravenous/intramuscular route. Groups were constructed based on lorazepam product administered (2 mg/mL versus 4 mg/mL) which served as a proxy for standard stocking and shortage periods, as 4 mg/mL products were not routinely stocked when there was not a shortage. The primary outcome was the incidence of endotracheal intubation during hospitalization. Secondary outcomes included initial and cumulative benzodiazepine doses, repeat benzodiazepine administration, and additional antiseizure medication administration. Hospital and intensive care unit (ICU) admission and length of stay (ED, ICU, and hospital) were also evaluated. Continuous variables were compared using the Mann-Whitney U test and categorical variables using the chi-square test.

Results

In-progress

Conclusion

In-progress

Introduction

Rapid sequence intubation (RSI) is commonly used for emergency airway management in critically ill patients. Medication selection is crucial due to the impact that sedatives and paralytics can have on hemodynamics. Etomidate, ketamine, and propofol are among the most frequently used RSI induction agents. Etomidate and ketamine are considered hemodynamically favorable agents in comparison to propofol, which contributes to hemodynamic instability at standard doses. Recent evidence, however, has challenged assumptions about the relative hemodynamic neutrality of ketamine, suggesting that ketamine has an increased risk of post-intubation hypotension and cardiovascular collapse compared to etomidate. Despite these findings, prior studies have not measured vasopressor burden following RSI as a quantitative outcome. Quantifying vasopressor burden using norepinephrine-equivalents may better characterize the magnitude and trajectory of post-intubation shock.

Research Question or Hypothesis

What is the relationship between peri-intubation medication practices and vasopressor burden within the first 24 hours post RSI?

Study Design

Institutional Review Board-exempt, multicenter, retrospective cohort study.

Methods

Patients admitted to the emergency department or ICU at a large health system who underwent RSI with induction agents over a one-year period were analyzed. Groups were defined based on which induction agent was given during RSI. Adult patients were included if they had received at least one pre-induction and post-induction blood pressure measurement. Patients were excluded if no RSI medications were administered, administration timing was unavailable, or cardiac arrest occurred prior to medication administration. The primary outcome was vasopressor burden at specified timepoints over 24 hours post-RSI, expressed as the total norepinephrine-equivalent dose. Secondary outcomes assessed hemodynamic outcomes over a 24-hour period and safety events during the encounter or within 30 days. Statistical tests included Mann-Whitney U and Student’s t-test for continuous data and Chi-squared or Fisher’s exact test for nominal data.

Results

To be presented at the 2026 ACCP Annual Meeting.

Conclusion

To be presented at the 2026 ACCP Annual Meeting.

Introduction

Urinary tract infections (UTIs) account for many emergency department (ED) visits and antibiotic prescriptions. UTI treatment in the ED is challenging due to evolving resistance patterns and often unavailable urine culture (UC) results. We studied appropriate antibiotic selection in patients discharged from the ED with suspected UTIs.

Research Question or Hypothesis

How often are effective antibiotics selected for patients discharged from the ED with a suspected UTI?

Study Design

A retrospective chart review was conducted for adult ED patients from January 1, 2022 to December 31, 2022.

Methods

Patients ≥18 years old who presented to the ED, had a urinalysis (UA) and UC obtained, and who met at least one of the following criteria were included: discharge from the ED on antibiotics to treat a suspected UTI, subsequent positive urine culture (≥ 1,000 CFU/ml) with an identified organism(s), ureterolithiasis diagnosed by CT in the ED. Data analysis was descriptive.

Results

Of 206 screened patients, 50 patients were included for analysis as they were discharged from the ED on antibiotics to treat suspected UTIs. Patients were predominantly female (43, 86%) and had a mean age of 44.96 years (Range 19 – 91, SD = 23.15). Urine cultures were positive in 25 (50%) patients. 24 patients grew bacteria with documented antibiotic susceptibility; antibiotics were effective in 21 (87.5%) patients. Antibiotics were ineffective for patients who grew atypical or resistant organisms including Pseudomonas aeruginosa, Enterococcus faecalis, and rare gram-negative bacteria. The most frequently prescribed empiric antibiotics were cephalexin (24, 48%), cefpodoxime (12, 24%), and nitrofurantoin (8, 16%). Escherichia coli was the most common pathogen identified.

Conclusion

Patients discharged from the ED with suspected UTIs were treated effectively in most cases. Those treated ineffectively were elderly and/or had risk factors for complicated infection which must be considered prior to empiric antibiotic selection. More robust data is needed to further explore this topic.

Background

Continuous glucose monitoring (CGM) enables real-time glucose tracking, potentially improving medication titration and glycemic outcomes in Type 2 diabetes mellitus (T2DM). This review assesses the effectiveness of CGM-guided pharmacotherapy.

Methods

A systematic review (PROSPERO: CRD420260002) was conducted using PubMed, Embase, and Cochrane Library through February 2026. Inclusion criteria: randomized or controlled studies evaluating CGM-guided medication adjustments in adults with T2DM. Exclusion: Type 1 diabetes or observational-only designs. Risk of bias was assessed using Cochrane RoB 2. Random-effects meta-analysis evaluated HbA1c reduction and hypoglycemia events.

Results

Thirty-one studies (n=9,842 patients) were included. CGM-guided therapy reduced HbA1c by −0.9% (95% CI −1.2 to −0.6; p<0.001) compared to standard care. Hypoglycemia incidence decreased by 35% (RR 0.65; 95% CI 0.52–0.81). Interventions included insulin titration (61%), GLP-1 receptor agonists (22%), and combination therapy. Heterogeneity was moderate (I²=48%).

Discussion

Limitations include short follow-up durations and variability in CGM adherence. CGM-guided pharmacotherapy significantly improves glycemic control and reduces hypoglycemia risk. These findings support broader implementation in ambulatory care settings, particularly for high-risk populations requiring intensive medication management.

Other

No external funding was received for this study. The authors declare no conflicts of interest. This systematic review was not registered as no patient-level data were collected.

Introduction

Influenza and pneumococcal vaccination are components of the CMS MIPS Measure 493 quality measure and reduce hospitalization and mortality in adults ≥65 years. Coverage has declined nationally despite universal Medicare eligibility, and demographic and socioeconomic disparities are rarely evaluated jointly within a single health system, limiting quality-improvement targeting.

Research Question or Hypothesis

What proportion of Medicare-eligible adults ≥66 years at University of Colorado Health primary care clinics are up to date on both influenza and pneumococcal vaccination, and how does status vary by demographic, insurance, and comorbidity characteristics?

Study Design

Retrospective cross-sectional quality improvement evaluation of adults ≥66 years with ≥1 primary care encounter at UCHealth clinics between July 2024 and June 2025.

Methods

Vaccination history was extracted from EHR immunization tables and interfaced state registry records. The primary outcome was composite MIPS 493 status: ≥1 influenza dose (7/1/2024–6/30/2025) and ≥1 pneumococcal dose at or after age 66. Covariates included age, race/ethnicity, insurance type, Social Deprivation Index quartile, Annual Wellness Visit completion, and comorbidity risk group (Kobayashi framework). Coverage proportions with 95% Wilson CIs will be reported; multivariable logistic regression (α=0.05) will identify predictors of dual up-to-date status.

Results

Among 30,465 patients, preliminary pneumococcal coverage was 78.0% and influenza coverage was 61.3%, with 48.9% up to date on both per MIPS 493 criteria—exceeding recent national averages. Coverage was higher among patients completing an Annual Wellness Visit (pneumococcal 83.5% vs. 71.6%; influenza 63.8% vs. 58.2%) and varied by race/ethnicity, insurance type, and comorbidity registry status. Additional multivariable and hospitalization-modeling analyses are planned to identify high-yield targets.

Conclusion

Preliminary findings suggest that despite favorable individual vaccine coverage, fewer than half of Medicare-eligible patients meet composite MIPS 493 criteria, indicating a substantial gap in dual vaccination status. Planned analyses will identify high-yield targets for pharmacist-led interventions to reduce vaccine-preventable morbidity in this population.

Introduction

Upadacitinib, a selective Janus kinase-1 (JAK1) inhibitor, has demonstrated efficacy in inflammatory bowel disease (IBD) refractory to biologics. However, hematologic adverse effects, including anemia, have been reported but remain poorly characterized.

Case

We describe a 56-year-old patient who underwent total proctocolectomy with ileal pouch-anal anastomosis (IPAA); pathology later re-classified the disease as Crohn's disease of the pouch. Following failure of prior biologic therapies, upadacitinib 30 mg daily was initiated. Baseline hemoglobin (Hb) of 9.4 g/dL dropped to a nadir of 4.1 g/dL and plateaued at 6.4–6.8 g/dL during the treatment period despite repeated intravenous ferric carboxymaltose infusions totaling approximately 7.5 g of elemental iron. Laboratory findings showed: ferritin 17 μg/L, serum iron 4 μmol/L, total iron-binding capacity (TIBC) 85 μmol/L, transferrin saturation 5%, platelets 571 ×10⁹/L, and normal vitamin B12/folate levels. Peripheral smear showed severe microcytosis and hypochromia. The overall iron-deficiency pattern in the absence of overt bleeding suggested impaired iron utilization rather than loss.

Discussion

The pathophysiology of Upadacitinib-related anemia likely involves off-target inhibition of JAK 2, a key mediator of erythropoietin signaling, and dysregulation of hepcidin production, both of which can blunt erythropoiesis and impede intestinal iron absorption. Although JAK 1 selective inhibition is intended to spare hematopoiesis, in vivo data suggest that even modest JAK2 activity reduction can translate into clinically significant iron-restricted erythropoiesis, particularly in patients with pre-existing malabsorption. This case does not prove causality, but it strengthens the concern that clinically significant iron-deficiency anemia may happen during upadacitinib use in some patients

Conclusion

Severe refractory iron-deficiency anemia can emerge as a rare adverse effect of upadacitinib. Baseline and periodic hemoglobin and iron studies are essential for early detection and management in patients receiving JAK1 inhibitors, without requiring discontinuation of the medication.

Introduction

Pharmacist-led transition-of-care (TOC) interventions improve patient outcomes, yet discharge workflows lack clinical decision support (CDS) to identify and prioritize patients based on medication-related risks. CDS with explainable Artificial Intelligence (xAI) may translate electronic health record (EHR) data into medication-related risk information that is interpretable and actionable for pharmacists.

Research Question or Hypothesis

This study examined how the specificity and actionability of medication-related information in xAI displays influence pharmacists’ perceptions of usefulness and usability during TOC.

Study Design

Mixed-methods exploratory study

Methods

Thirteen pharmacists reviewed four patient vignettes paired with xAI displays designed using EHR data from a health information exchange. Each display included a readmission risk estimate. One risk-only display presented the risk estimate alone, while the other three risk-plus-explanation displays added medication-related readmission risks, explanations of identified risks, and recommended interventions. These displays varied in detail, specificity, and actionability of the risk explanations and recommended interventions. After each display, participants rated questions on usefulness and usability using Likert scales (analyzed with Wilcoxon signed-rank tests; p <0.05 indicates significance) and provided feedback on perceptions of actionability, preference, and information needs (analyzed qualitatively). An eye-tracking device (Tobii Pro Nano) captured pharmacist-display interactions and was analyzed using heatmaps.

Results

On average, participants had 16.3 (SD=14.6) years of pharmacy practice experience. Risk-plus-explanation displays received significantly higher perceived usability and usefulness ratings than the risk-only display across all evaluated items (all p<0.001). Different risk-plus-explanation displays were not statistically significant. Qualitative findings indicated that participants preferred displays that connected medication-related risk factors to more detailed and action-oriented intervention recommendations. Eye-tracking results supported these findings, showing greater visual attention to intervention-related areas when displays included more detailed suggested interventions.

Conclusion

Medication-focused xAI displays were perceived as most useful and usable when they translated readmission risk factors into specific, actionable intervention recommendations. These findings support integrating xAI into pharmacy-led discharge planning for medication-focused TOC interventions.

Introduction

Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disorder characterized by clinical manifestations and persistent antiphospholipid antibodies, including lupus anticoagulant, anticardiolipin antibodies, and anti-β2-glycoprotein I antibodies. Although current classification criteria emphasize specific laboratory assays, clinicians may order non-criteria antiphospholipid antibody tests.

Research Question or Hypothesis

What is the impact of an EHR alert on the volume of non-criteria antiphospholipid antibody tests within a large academic health system?

Study Design

The study design will be a quasi-experimental, observational, pre-post intervention analysis conducted within the University of Utah Hospital systems with the assistance of ARUP Laboratories.

Methods

Monthly APS test orders will be collected for 8 months before and after the alert's implementation (March 2024–June 2025). The intervention consists of an HER alert triggered when clinicians attempt to order non-criteria APS testing. The primary outcome will be the monthly proportion of non-criteria APS tests, defined as the number of non-criteria test orders divided by the total number of non-criteria and reflexive APS panel orders. Segmented regression of interrupted time series data will be used to estimate changes in level and slope of non-criteria testing following the intervention.

Results

A total of (N total) APS test orders were identified during the study period, including orders in the pre-intervention period and orders in the post-intervention period. Prior to implementation, non-criteria APS tests accounted for a mean monthly proportion of (X%) of all APS test orders. Interrupted time series analysis demonstrated an immediate change in level of (β₁ estimate) (95% CI [lower–upper], p = [value]) following implementation of the alert. Overall, the proportion of non-criteria APS tests decreased from (X%) in the pre-intervention period to (Y%) following implementation.

Conclusion

Implementation of an EHR alert was associated with a reduction in non-criteria antiphospholipid antibody testing.

HIV PRN Background:

The HIV PRN was established in April 2014 to provide a forum for those with an interest in the management of people with HIV (PWH) to network and collaborate. From inception to April 2026, membership has grown from 41 members to 397 members, including 178 student members. HIV PRN members represent 43 states and District of Colombia in the United States in addition to 7 other countries including Canada, Egypt, Iran, Saudi Arabia, Taiwan, Turkey, and Republic of Korea.

HIV PRN Subcommittees:

Research subcommittee drafts manuscripts expanding from original research to commentaries. Education and Programming subcommittee plans the PRN Focus Session for the ACCP Annual Meeting. Awards and Nominations subcommittee selects candidates for the trainee Travel award and solicits the PRN officers. Newsletter subcommittee publishes the PRN Newsletter. Advocacy subcommittee updates the PRN on new laws.

HIV PRN 2025 Accomplishments:

The HIV PRN collaborated with the Community-Based PRN to organize the Focus Session at the 2025 Annual Meeting. The session was titled “Making a Difference in the HIV Care Continuum: Opportunities for Management of People Living With HIV in the Community”. The session objective was to outline current antiretroviral therapies, recognize implementation barriers and discuss strategies to overcome those barriers.

Members of the Research subcommittee published two peer-reviewed articles highlighting the impact of HIV clinical pharmacists. The publications are titled “The Role of Clinical Pharmacists in HIV Treatment and Prevention: A Scoping Review of Real-World Evidence” as well as “Need for More HIV-Trained Pharmacists due to Unmet Needs and Expanding Opportunities: An Opinion of the HIV Practice and Research Network of the American College of Clinical Pharmacy.”

The most recent PRN newsletter was published in summer 2025, with articles on updated hyperlipidemia guidelines in PWH, a patient case, conference updates, and a review of the INSIGHT-START trial.

Introduction

Due to the importance of protection against hepatitis B infection among healthcare personnel (HCP), employee health services offers hepatitis B vaccine to unimmunized HCP at the time of hire. Hepatitis B vaccine with CpG adjuvant (hepB-CpG) has shown higher response rates compared to hepatitis B vaccine with aluminum adjuvants (hepB-Alum) in many populations.

Research Question or Hypothesis

Among newly hired HCP, are individuals more likely to mount an immune response to hepB-CpG or hepB-Alum as an initial series?

Study Design

Quantitative, retrospective analysis to examine the hepatitis B immunity status of HCP following series completion.

Methods

Deidentified data were collected from an employee health service database to measure response to primary vaccine series completion. For an individual to be considered eligible, the following criteria must be met: (1) >18 years of age, (2) completion of hepatitis B vaccine series <90 days prior to hire or after, (3) antiHBs >10 mIU/ml following series completion.

Results

Among the 2302 eligible HCP in the study, 774/796 (97%) of those who received the hepB-CpG responded to the series compared to 1407/1506 (93%) who responded to the hepB-Alum series (p<0.001). Of those who responded to hepB-CpG, the mean age was 42.9+12.1 years compared to the hepB-Alum, which was 39.4+11.06 years (p<0.001). The response rate did not differ by sex.

Conclusion

HepB-CpG primary series induced a higher response rate compared to hepB-Alum and should be considered the preferred vaccine preparation for this situation.

Introduction

Amoxicillin/clavulanate is an oral beta-lactam antibiotic that is frequently prescribed at hospital discharge for skin and soft tissue infections, pneumonia, intra-abdominal infections, urinary tract infections, and bacteremia. Limited data exists regarding the appropriateness of discharge dosing and subsequent clinical outcomes.

Research Question or Hypothesis

What proportion of patients receive literature-supported amoxicillin/clavulanate dosing at hospital discharge for select infections? Additionally, what proportion of patients experience treatment failure or adverse effects related to the various doses of amoxicillin/clavulanate?

Study Design

This retrospective cohort study will evaluate the use of amoxicillin/clavulanate 500/125 mg and 875/125 mg dosing regimens for the treatment of select infections at hospital discharge.

Methods

Adult patients prescribed amoxicillin/clavulanate at discharge from a Parkview Health hospital between June 1, 2025 and June 1, 2026 will be included. Patients with creatinine clearance less than 30 mL/min and/or receiving renal replacement therapy will be excluded. A random 20% of the included population will be utilized for data analysis. The primary outcome will evaluate dosing appropriateness based on infection type and literature-supported dosing recommendations. Appropriate amoxicillin/clavulanate dosing regimens will be defined as 500/125 mg every 8 hours or 875/125 mg every 12 hours for community-acquired pneumonia, 875/125 mg every 12 hours for complicated urinary tract, skin and soft tissue, or intra-abdominal infections, and 875/125 mg every 8 hours for uncomplicated gram-negative bacteremia. Secondary outcomes include infection-related hospital readmission, urgent care and/or emergency department visit, recurrent infection, new outpatient antibiotic prescription, and mortality within 30 days of discharge. New onset C. difficile infection within 45 days of discharge will be assessed as a safety outcome.

Results

Data collection and analysis are ongoing; results will be presented at the 2026 ACCP Annual Meeting.

Conclusion

Conclusion will be presented at the 2026 ACCP Annual Meeting.

Introduction

Tracking outpatient antibiotic use is essential, yet difficult. Our objective was to evaluate antimicrobial use trends among Medicare Part D beneficiaries in Illinois.

Research Question or Hypothesis

How do trends regarding antibiotic use and cost per claim vary among Medicare beneficiaries?

Study Design

This quantitative, retrospective study evaluates antimicrobial use among Medicare Part D beneficiaries using publicly available data from the Centers for Medicare & Medicaid Services (CMS).

Methods

Medicare Part D Prescriber data from Illinois were analyzed from 2023 and 2024. Microsoft Power BI was used to determine the three antibiotics with the most claims for all beneficiaries and beneficiaries ages 65 and older. The RUCA system was used to classify urban and rural areas. Trends of average days supply and cost per claim were determined for the top three antibiotics for both beneficiary groups and between urban and rural areas.

Results

This study analyzed 4,023,569 antibiotic claims. Agents with the most claims were amoxicillin (n=617,073), azithromycin (n=437,548), and cephalexin (n=426,243). The average days supply was 7.15, 7.44, and 9.99 days for amoxicillin, azithromycin, and cephalexin, respectively. The average cost per claim was $3.59 for amoxicillin, $6.21 for azithromycin, and $8.17 for cephalexin. For beneficiaries age 65 and older, antibiotics with the most claims remained the same with amoxicillin (n=215,667), azithromycin (n=135,008), and cephalexin (n=122,384). The average days supply was 6.79, 8.96, and 11.19 days for amoxicillin, azithromycin, and cephalexin, respectively. The average cost per claim was $3.45 for amoxicillin, $7.07 for azithromycin, and $8.55 for cephalexin.

Analyses of trends in urban and rural settings is pending.

Conclusion

Amoxicillin was the most prescribed antibiotic, with the shortest duration of therapy and lowest cost per claim across all subgroups. Further analysis, including data from Michigan and Nebraska, will be conducted to find patterns within data across the nation.

Introduction

Lyme disease incidence is increasing in Michigan. Communication with the Bureau of Laboratories suggests that cases are grossly underreported. Prescribing data from electronic health records (EHRs) may provide an additional means of identifying cases.

Research Question or Hypothesis

Lyme disease diagnosis-associated antimicrobial prescribing captured through the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM) will demonstrate temporal patterns consistent with established Michigan Lyme disease surveillance.

Study Design

Retrospective observational study using statewide EHR data submitted by CHARM-partnering healthcare facilities from January 1, 2021 through April 30, 2026.

Methods

Antimicrobial prescriptions associated with a Lyme disease ICD-10 diagnosis code were identified through CHARM. The primary outcome was temporal concordance between monthly CHARM prescribing patterns and established Lyme disease seasonality. Secondary outcomes included annual CHARM-observed Lyme disease diagnosis-associated prescriptions per 100,000 Michigan residents, participating-facility counts, and geographic data completeness. Descriptive statistics characterized annual prescribing rates, monthly distributions, April-September seasonal concentration, and geographical data availability. CHARM temporal patterns were descriptively compared with the MDHHS and CDC surveillance data.

Results

A total of 3,071 antibiotic prescriptions from 2,108 patients were analyzed. Annual CHARM-observed Lyme disease-associated prescription rates were 3.40, 4.58, 6.75, 5.78, and 9.02 per 100,000 residents from 2021-2025, respectively; participating facilities varied annually (50, 58, 120, 62, and 68). Prescribing demonstrated consistent seasonality: 86.2%, 84.3%, 80.6%, and 83.4% of annual prescriptions occurred from April-September in 2021, 2022, 2023, and 2025, respectively. In 2024, 37.7% of cases occurred between April-September, with an atypical November peak of 286 prescriptions. Zip codes were available for 808/3,071 (26.3%) prescriptions.

Conclusion

CHARM demonstrated seasonal prescribing patterns broadly consistent with established Lyme disease surveillance, supporting its potential as a complementary surveillance signal. Variable facility participation limits comparison of annual CHARM-observed prescription rates, while incomplete geographic identifiers and potential misclassification of diagnosis-linked prescriptions further limit interpretation. Comparison to MDHHS and CDC surveillance data are underway.

Introduction

There is limited clinical data evaluating the efficacy of ertapenem for treatment of extended-spectrum beta-lactamase (ESBL) Enterobacterales urinary tract infections (UTIs) in patients with hypoalbuminemia. This study will assess the efficacy of ertapenem in patients with both normal serum albumin and hypoalbuminemia.

Research Question or Hypothesis

Is there a difference in efficacy of ertapenem treatment of ESBL Enterobacterales spp. UTIs in patients with and without hypoalbuminemia?

Study Design

Retrospective cohort study of hospitalized patients receiving ertapenem for an ESBL-producing Enterobacterales urinary tract infection from January 1st, 2024, to June 30th, 2026.

Methods

This multicenter retrospective cohort study evaluated efficacy of treatment in hospitalized patients receiving ertapenem for an ESBL-producing Enterobacterales spp. UTI. Efficacy was determined by measuring rates of relapse of infection within 14 days of treatment, defined as recurrent UTI with the same organism. Patients were excluded if they were under 18 years old, received only 1 administration of ertapenem, received another carbapenem during their treatment course, or if the patient left Against Medical Advice. The primary outcome was incidence rate of relapsed infection within 14 days of treatment. Secondary outcomes included a comparison of 14-day relapse rate of patients with and without hypoalbuminemia, duration of treatment with ertapenem for ESBL UTI infections, 30-day all-cause mortality and readmission rates, and UTI recurrence rate (at least 2 UTIs within 6 months following ertapenem treatment).

Results

An interim analysis was conducted at 50 patients from 3 facilities. The average age was 69.5 years, 38 patients were female (76%), and 19 patients were identified to have hypoalbuminemia (38%). Relapsed infection was observed in 3 patients (6%), all of which had hypoalbuminemia during ertapenem therapy.. The average ertapenem treatment duration was 8.7 days. 30-day all-cause mortality and readmission was identified in 4 (8%) and 18 (36%) patients, respectively. Twenty patients (40%) experienced UTI recurrence.

Conclusion

To be presented.

Introduction

Patients who experience traumatic wounds are at high risk of developing wound infection.

Research Question or Hypothesis

A novel bioadhesive, thermoresponsive antibiotic gel containing omadacycline and polymyxin b will demonstrate beneficial effects in preventing wound infection.

Study Design

A guinea pig wound infection model was utilized.

Methods

10 Hartley guinea pigs were included, 5 in the antibiotic gel group and 5 in the control group (no prophylaxis). Four 8mm wounds were made on the dorsum of each animal using an excisional biopsy tool (20 wounds/group). All wounds received a daily inoculum of MRSA and A. baumannii (Ab). Wounds of the experimental group received antibiotic gel prophylaxis twice daily. Wounds were inspected twice daily by a blinded veterinarian. Infected wounds were graded (scale 0-9) and swabbed for microbiology testing. Histopathology and quantitative tissue cultures were performed.

Results

The antibiotic gel delayed onset of wound infection compared with controls. The median [IQR] time to infection was 2.0 [1.5-2.5] and 1.3 [1.0-1.5] days in the gel and control groups, respectively (p=0.003). Wounds were graded higher (more severe) in the control group (2.65 vs 2.05, p=0.01). All tissue samples exhibited pathological evidence of infection. Cultures revealed an effect of the gel in preventing Ab infection. None of the deep wound swabs or tissue cultures from gel treated animals grew Ab. In contrast, 45% of swabs and 100% of tissue cultures from control animals grew Ab. All wounds in both groups grew MRSA, and MRSA colony counts did not differ between groups. No bacteria other than MRSA and Ab grew in cultures. All MRSA isolates remained susceptible to minocycline, a surrogate for omadacycline.

Conclusion

Beneficial effects were demonstrated by this novel antibiotic gel in a small animal model, particularly in preventing Ab infection. These results support ongoing research and development of this prophylactic agent.

Introduction

Polypharmacy is highly prevalent among patients receiving maintenance hemodialysis due to the burden of comorbidities and dialysis-related complications. Excessive medication use is associated with an increased risk of adverse drug reactions, medication-related complications, and mortality. Despite the growing hemodialysis population in Saudi Arabia, data on the prevalence and predictors of polypharmacy remain limited. This study aimed to determine the prevalence of polypharmacy and identify factors associated with its occurrence among patients receiving maintenance hemodialysis.

Research Question or Hypothesis

What is the prevalence of polypharmacy among patients receiving maintenance hemodialysis, and what factors are independently associated with its occurrence?

Study Design

Multicenter cross-sectional study.

Methods

Adults receiving maintenance hemodialysis at four dialysis centers in Saudi Arabia between October 2024 and October 2025 were included. Polypharmacy defined as the concurrent use of five or more medications. Demographic and clinical data were extracted from electronic medical records. The primary objective was to assess the prevalence of polypharmacy and identify factors associated with its occurrence. Multivariable logistic regression analysis was performed, and results were reported as odds ratios (ORs) with 95% confidence intervals (CIs).

Results

A total of 527 patients were included. Polypharmacy was identified in 369 patients (70.0%), including excessive polypharmacy (10–14 medications) in 22.4% and hyper-polypharmacy (≥15 medications) in 1.9%. In multivariable logistic regression analysis, older age (OR 1.023, 95% CI 1.005–1.042; p=0.012), a greater number of comorbidities (OR 1.405, 95% CI 1.132–1.744; p=0.002), and a higher number of prescribers (OR 3.861, 95% CI 2.950–5.055; p<0.001) were independently associated with polypharmacy.

Conclusion

Polypharmacy is highly prevalent among patients receiving maintenance hemodialysis in Saudi Arabia, affecting 70% of patients. Older age, greater comorbidity burden, and a higher number of prescribers were independently associated with polypharmacy. These findings highlight the importance of routine medication review and improved coordination among healthcare providers to optimize medication use and reduce medication burden in this high-risk population.

Service or Program

"Children's Voice in Safety" is co-designed pediatric medication counseling program at KFAFH outpatient pharmacy, Jeddah. Five interventions engage children aged ≥7 years as active safety partners: child-friendly pharmacist counseling scripts with mandatory teach-back; pictorial medication cards with color-coded dosing aids; a personalized "My Med Story" booklet; a validated pediatric PROM/PREM tool; and a QR-enabled co-designed feedback wall. Pharmacists received structured training in child-centered communication, fully embedded into routine dispensing workflow.

Justification/Documentation

Baseline audit (June–December 2024) at KFAFH found only 42% of children aged ≥7 years could correctly explain their medication purpose and dosing; pediatric near-misses averaged 6.5 per 1,000 visits. Parents reported medication anxiety and absence of child-appropriate communication. No structured child-centered medication counseling model existed in Saudi outpatient pharmacy practice. International literature and the UN Convention on the Rights of the Child support children's active participation in healthcare, yet validated pediatric pharmacy PROM/PREM tools and co-designed counseling frameworks remained absent globally.

Adaptability

All tools require only printing and lamination - no digital infrastructure needed. counseling script adds only 1.4 minutes per encounter, feasible in high-volume settings. The co-design process is replicable wherever children, parents, and pharmacy staff are available. Planned spread includes pediatric emergency, asthma, endocrine, and nephrology clinics within KFAFH, and broader rollout across the MODHS hospital network. Scripts are translatable across languages, and core principles extend to adults with low health literacy.

Significance

This is the first co-designed pediatric medication safety model in Saudi Arabia. Medication understanding improved from 42% to 81%; near-misses fell 68% (6.5 to 2.1 per 1,000 visits); child PROM rose from 48% to 86%; parent PREM from 59% to 90% — with only +1.4 minutes added to dispensing time. Estimated annual savings: SAR 36,880. The model advances clinical pharmacy's role in child-centered health literacy and provides a low-cost, internationally transferable standard for inclusive pediatric pharmacy practice.

Introduction

Measuring changes in dental antibiotic prescribing is difficult because few practices track and report antibiotic utilization patterns. The Collaboration to Harmonize Antimicrobial Registry Measures (CHARM) project applies data from electronic health records (EHR) to quantify and visualize antibiotic trends. This study evaluated prescribing before and after education on antimicrobial stewardship in dental clinics affiliated with a Federally Qualified Health Center (FQHC).

Research Question or Hypothesis

This quality improvement study hypothesized that antimicrobial stewardship education would reduce clindamycin prescribing frequency and shorten antibiotic treatment duration.

Study Design

This retrospective observational study evaluated empirical antibiotic prescribing patterns, including antibiotic selection and duration, using EHR extracts from four CHARM-participating dental clinics before and after an antimicrobial stewardship educational intervention.

Methods

Dental personnel attended one of the two live education sessions from Michigan Antibiotic Resistance Reduction (MARR) focused on implementing antibiotic stewardship practices in dental settings. Participants received tools and resources to support the implementation. Prescribing patterns were compared between pre-intervention (October 2023-August 2024) and post-intervention (January 2025-September 2025) periods. Monthly prescribing frequency and mean duration were compared using independent sample t-tests.

Results

CHARM analyzed 1,258 antibiotic prescriptions from 1,050 patients. Amoxicillin was most prescribed (n=982), followed by clindamycin (n=153), azithromycin (n=81), amoxicillin/clavulanate (n=19), cephalexin (n=19), and other (n=22). Pre-education, clindamycin was prescribed at a rate of 7.27 prescriptions per month compared with 3.44 per month post-intervention (p=0.0083). Pre-education, clindamycin was prescribed for an average duration of 9.15 days compared with 7.68 days post-intervention (p=0.0057). Pre-education, amoxicillin was prescribed for an average duration of 9.18 days compared with 8.15 days post-intervention (p<0.001).

Conclusion

Comprehensive education on antibiotic stewardship for all dental staff at an FQHC was associated with decreases in the rate of clindamycin use and duration of both clindamycin and amoxicillin. The CHARM approach can help establish baseline prescribing patterns and track the impact of stewardship interventions in dentistry.

Introduction

Accurate estimation of renal function is critical for safe drug dosing in hospitalized patients, particularly older adults and those with extreme body weight. Widely used equations—Cockcroft–Gault (CG), MDRD, CKD-EPI, and institution-specific tools (BestCare)—may produce discordant results, potentially leading to underdosing or toxicity of renally cleared medications such as antibiotics and anticoagulants.

Research Question or Hypothesis

To evaluate the impact of glomerular filtration rate estimation equations on renal drug dosing in hospitalized patients and compare agreement between CG, MDRD, BSA-adjusted MDRD, CKD-EPI, and BestCare.

Study Design

We retrospectively analyzed 410 hospitalized patients, mostly critically ill. Renal function was estimated using CG (dosing reference), MDRD, BSA-adjusted MDRD, CKD-EPI, and BestCare.

Methods

Agreement was evaluated using Spearman’s correlation, the Wilcoxon signed-rank test, and non-parametric Bland–Altman analysis. Subgroup analyses evaluated the effects of age and body mass index (BMI) on variability and dosing.

Results

The cohort was clinically complex (mean age 61.8 years; mean BMI 32 kg/m2), with a high prevalence of diabetes, hypertension, and critical illness. Although correlations between equations were strong, clinically meaningful discrepancies remained. MDRD and BSA-adjusted MDRD consistently overestimated renal function compared with CG (mean difference ≈ −2.5 mL/min, p < 0.01), risking overdosing of renally cleared medications. BestCare closely aligned with CG. Variability increased in patients with obesity (especially class III) and among patients >65 years, in whom clinically significant variability persisted despite strong correlations. Bland–Altman analysis confirmed wide limits of agreement across all equations at patient level.

Conclusion

Renal function estimation equations are not clinically interchangeable in hospitalized patients. MDRD-based equations may overestimate renal function and increase drug toxicity, particularly in older adults and obese populations. CG and BestCare provide more reliable guidance for dosing. Individualized assessment and clinical judgment remain important to optimize drug safety and outcomes.

Introduction

Dose modifications are common in clinical oncological practice, but their associations with outcomes are difficult to evaluate because treatment changes are nonrandom and influenced by patient risk, treatment response, and clinical context.

Research Question or Hypothesis

Can a stepwise analytical framework clarify the association between dose modification and clinical outcomes while accounting for prognostic differences and treatment-selection bias in real-world data? Imatinib treatment in chronic myeloid leukemia (CML) as a case study.

Study Design

Retrospective cohort study using electronic health record data from 124 adults with CML who initiated imatinib therapy.

Methods

Dose modification was defined as any dose reduction, interruption, or discontinuation within 12 months of treatment initiation. Outcomes were overall survival (OS) through 24 months and major molecular response (MMR) through 18 months. Four hazard models were applied with progressive adjustment: unadjusted, prognostic risk score-adjusted, inverse probability weighted, and doubly robust models combining both approaches. Hazard ratios (HRs) were estimated across four models. MMR HRs were inverted so that values greater than 1 indicated delayed response.

Results

Dose modification occurred in 62 patients (50.0%). It was consistently associated with poorer OS across models, with similar effect estimates across adjustment strategies (doubly robust model: HR, 3.31; 95% confidence interval [CI], 2.04-5.34). For time to MMR, the unadjusted analysis showed no significant association (HR, 1.25; 95% CI, 0.71-2.22), whereas the doubly robust model revealed a significant association with delayed MMR (HR, 1.93; 95% CI, 1.02-3.67), suggesting that baseline confounding masked treatment associations in unadjusted analyses.

Conclusion

Imatinib dose modification was associated with poorer OS and MMR outcomes after adjustment for prognostic and treatment-selection factors. Stepwise comparison across models makes the influence of confounding transparent and provides a generalizable methodology for evaluating medication modifications in real-world evidence studies.

Introduction

Over half of U.S. overdoses involve opioids, yet current clinical tools have a limited ability to reliably identify high-risk patients. Machine learning (ML) models offer improved risk prediction but are rarely implemented as clinical decision support (CDS) in practice. Grounded in implementation science and human-centered AI principles, we developed an EHR-embedded, ML-driven CDS tool targeting elevated opioid overdose risk within a learning health system.

Research Question or Hypothesis

This study evaluated the feasibility, usability, and real-world effectiveness of implementing this CDS tool in primary care

Study Design

Using a single-arm, pre-post mixed-methods (hybrid) design across 13 UF Health primary care clinics, we deployed an ML model trained on 130,136 adults using EHR data (2016–2020) with 57 predictors spanning demographics, utilization, prescriptions, and comorbidities

Methods

When primary care physicians (PCPs) prescribed opioids to patients at elevated risk (≥92.5th percentile), a ML-driven alert fired with two tailored recommendations: offering a naloxone prescription or confirming existing naloxone access. Outcomes were assessed at the alert level (naloxone access, penetration, usage, override) and provider level (usability, acceptability, and feasibility via validated surveys and interviews).

Results

Between April 2025 and April 2026, risk scores were generated for 8,009 patients; 655 (8.2%) were classified as elevated-risk, with 90 (13.7%) receiving an ML-driven alert (115 total alerts). Among alerted patients, 66 (73.3%) had confirmed naloxone access (38 received new naloxone orders and 28 had existing naloxone availability confirmed). PCPs (n=12) rated the tool positively across all five-rights dimensions (mean scores 3.17–3.67 on a 4-point Likert scale).

Conclusion

The ML-driven CDS tool demonstrated promising real-world uptake, with 73.3% of alerted patients achieving naloxone access and PCPs reporting strong agreement with its utility. Future work should refine alert thresholds, expand to additional settings, and evaluate differential impacts to ensure equitable benefit.

Objective: To celebrate and highlight the Perioperative Care Practice Research Network (PeriopPRN) of American College of Clinical Pharmacy (ACCP), with a focus on its contributions to perioperative care through education, leadership, research, and service.

Background: The PeriopPRN was established in 2014, as a 12-member steering group. In the 2025-2026 year, the PeriopPRN grew to over 230 clinical pharmacists and trainees. This considerable growth is due to intentional outreach and promotion of the PRN. The PeriopPRN supports perioperative practice and research, and fulfills the professional needs of its specialized clinical pharmacist members. With approximately 110 trainee members, the PeriopPRN is well positioned for future recruitment, retention, and clinical pharmacy impact.

Activities and Accomplishments: The PeriopPRN provides opportunities for professional development and connection. These opportunities consist of: leadership roles, three active member-led committees, additional informal leadership roles, and educational sessions. Key virtual educational sessions for 2025-2026 included: starting new perioperative clinical pharmacy services, workflow optimization within an electronic medical record, LAST prevention, cardiogenic shock and vasoplegia, medication formulary and shortage management, and more. Additionally, the PeriopPRN had another successful Focuss Session submission to the ACCP 2026 Annual Meeting, this year focusing on pharmacotherapy and clinical pharmacist roles in cardiothoracic surgery populations across their continuum of care. Educational offerings have purposefully engaged other PRNs, promoting knowledge dissemination, fostering PRN growth, and showcasing PRN member expertise. The PeriopPRN has strategically grown informal leadership roles to further include members in decision-making, including a new Vice Chair for Scholarship. This will create a pipeline for formal leadership positions and facilitate the work of the PeriopPRN.

Impact and Future Directions: The PeriopPRN continues to significantly contribute to advancing the role of pharmacists in perioperative care, by improved patient outcomes and enhanced clinical practices. Ongoing initiatives include expanding educational resources, fostering interdisciplinary research, and advocacy of perioperative clinical pharmacists as integral members of perioperative and surgical teams. The PeriopPRN remains committed to membership growth, enhancing engagement, contributing to the literature, and professional development of clinical pharmacists dedicated to perioperative care.

Conclusion: As the PeriopPRN celebrates the accomplishments to date, it reaffirms its commitment to advancing perioperative pharmacy practice. The network continues to provide essential resources, foster professional growth, and contribute to the overall improvement of perioperative patient care.

Introduction

Warfarin is an anticoagulant with a narrow therapeutic index and wide inter-patient dosing variability. Rural patients tend to face more social health challenges that can lead to suboptimal warfarin management and increased risk of adverse events compared to urban patients. Interventions such as patient self-testing (PST) and patient self-management (PSM) could help improve patients' international normalized ratio (INR) control and time in therapeutic INR range (TTR).

Research Question or Hypothesis

What effect does geospatial location have on warfarin patients' TTR?

Study Design

A retrospective cohort study was conducted to analyze the impact of warfarin patients’ geospatial location on TTR.

Methods

Warfarin patients followed by the University of Utah Health (UUH) Thrombosis Clinic between 8/11/2024 and 8/11/2025 were included. A Wilcoxon rank-sum test was used to compare TTR between rural and urban patients. A Kruskal-Wallis test and Wilcoxon rank-sum test, corrected for multiplicity using the Holm-Bonferroni method, were used to compare TTRs across INR monitoring methods (home health, laboratory, PSM, PST, and mixed monitoring methods).

Results

A total of 961 warfarin patients were included in this study. Median TTR was similar between rural and urban patients (63.3% vs 63.5%; p = 0.99). PSM users had significantly higher TTR than those using home health (p < 0.01), laboratory (p < 0.01), and mixed monitoring methods (p < 0.01). Both laboratory and PST monitoring were associated with higher TTR compared with home health services (p = 0.02 and p = 0.01, respectively).

Conclusion

Rural and urban patients had comparable TTR. These findings suggest that routine clinician management may help support similar warfarin control across rural and urban populations. Patients using PSM had significantly higher TTR than those using most other monitoring strategies. Further studies in rural populations are needed to evaluate the scalability of implementing PSM and PST programs.

Introduction

Integration of pharmacogenetic results into clinical care varies greatly across institutions. Clinicians may receive pharmacogenetic guidance from a variety of avenues such as static reports, alerts within the electronic health record, or via consultative services. However, limited data exists on pharmacogenomics acceptance rates beyond alerts. All internal pharmacogenetic results within our institution are interpreted by a pharmacist who places a clinical note within the electronic health record (EHR) to aid in genotype-guided pharmacotherapy.

Research Question or Hypothesis

What is the acceptance rate of pharmacogenetics recommendations via pharmacist clinical notes?

Study Design

Retrospective chart review

Methods

Automated data extraction was utilized to capture all patients who received pharmacogenetics testing (single or panel based) through our laboratory in which pharmacists completed a clinical note from the EHR. Patients seen in the multidisciplinary pharmacogenomics clinic were excluded from this analysis. Large language models were utilized to extract free-text clinical recommendations specified within the pharmacist note. Acceptance was defined as action in response to the pharmacist's recommendations. Clinician responses were limited to alternative medications or dose modifications. Acceptance rates were analyzed at one month. Pharmacogenetics alerts were not considered within this analysis. Data was analyzed using descriptive statistics.

Results

A total of 29,798 patients met inclusion criteria. A majority of the study population was female (63%) with the median age of 51 years (36-65). A total of 6,499 (21.8%) patients had actionable results. Pharmacists generated 7,475 recommendations to clinicians. At one month, 982 (13.2%) of all actionable results were congruent with pharmacist recommendations. Antiplatelets, opioids, and chemotherapy had the highest acceptance rates. Acceptance rates for antiplatelets were 64.7% and 37.5% for single gene and panel tests, respectively. Acceptance of opioid recommendations was 26%. For chemotherapeutic agents, fluoropyrimidine acceptance was 29% and 12% for thiopurines.

Conclusion

Overall acceptance rate was 13.2%. High alert medication recommendations were more likely to be acted upon by clinicians.

Background and Aims: Enlicitide decanoate is a novel, oral macrocyclic peptide PCSK9 inhibitor and the first oral PCSK9 inhibitor to complete phase 3 studies. We present, for the first time, a comprehensive overview of the clinical pharmacology of enlicitide, including the pharmacokinetics (PK), absorption, distribution, metabolism, and elimination (ADME) properties, and effect of intrinsic and extrinsic factors.

Methods: The PK of enlicitide was evaluated across 26 Phase 1 studies (single doses, 5 mg−300 mg; multiple doses, 5 mg−120 mg, once daily), including studies to characterize the human ADME profile, assess the impact of renal impairment and hepatic impairment on enlicitide PK, evaluate food and beverage effects, and the potential for drug-drug interactions. An integrated population PK analysis was performed to assess the effect of other intrinsic/extrinsic factors on enlicitide exposure.

Results: Orally-dosed enlicitide (20 mg) is rapidly absorbed (median Tmax of 0.5−1 hour). When enlicitide is taken on an empty stomach and food is consumed 30 minutes post-dose, enlicitide PK (AUC, Cmax, Tmax) is comparable to fully fasted conditions. The estimated oral bioavailability of enlicitide is approximately 1%. Enlicitide displays less than dose-proportional PK, with slower clearance at lower plasma concentrations, consistent with binding of enlicitide to PCSK9. The PK profile supports once-daily dosing with an accumulation ratio of 1.42 and near steady-state achieved by day 7. Enlicitide is primarily eliminated unchanged via passive renal excretion. No circulating or excreted metabolites have been identified in plasma, urine, or feces. Intrinsic factors including age, sex, race, body weight, renal impairment, and mild or moderate hepatic impairment, do not have a clinically meaningful effect on the PK of enlicitide. Furthermore, enlicitide does not demonstrate any clinically meaningful drug-drug interactions.

Conclusions: The clinical pharmacology profile of enlicitide suggests that it can be widely used across all patient subpopulations studied, without dose adjustment due to intrinsic factors or concomitant medications.

Service or Program

This study describes a clinical pharmacy–relevant service evaluating medication adherence (MA), treatment satisfaction (TS), and patient–doctor relationship (PDR) among adults with mood disorders in a Saudi tertiary care hospital. A cross-sectional design was implemented using validated Arabic tools (MARS-10, TSQM-1.4, and PDRQ-9) alongside a structured questionnaire to assess sociodemographic and clinical factors. The service reflects routine psychiatric care assessment integrated with patient-reported outcomes to better understand treatment effectiveness and patient engagement in real-world practice.

Justification/Documentation

Mood disorders are highly prevalent and associated with significant disability, while medication nonadherence remains a major barrier to optimal outcomes. This study documented that 79.2% of patients had good adherence, yet 34.23% reported low treatment satisfaction, and only 62.31% had good PDR. Significant associations were identified: better adherence correlated with higher satisfaction and stronger PDR, while factors such as medication burden, stigma, limited social support, and substance use negatively affected outcomes. These findings highlight gaps between treatment availability and patient-centered outcomes, justifying the need for structured clinical pharmacy interventions targeting adherence and satisfaction.

Adaptability

The approach is highly adaptable to other international clinical settings due to its reliance on validated, widely used assessment tools and simple survey-based implementation. The methodology can be integrated into outpatient clinics, especially in mental health or chronic disease management programs. Additionally, the framework allows adaptation to different cultural contexts by incorporating local language tools and considering sociocultural factors such as stigma and family support.

Significance

This study contributes to international clinical pharmacy advancement by demonstrating the interconnected role of adherence, satisfaction, and therapeutic relationships in mental health outcomes. It emphasizes the importance of patient-centered strategies, including education, simplification of regimens, and strengthening patient–provider communication. The findings support the expansion of clinical pharmacy services in psychiatric care, particularly in non-U.S. settings, to improve adherence and optimize therapeutic outcomes.

PURPOSE: To analyze the distribution of telomere length abnormalities and associated genetic variants across different clinical specialties with a focus on clinical characterization to identify the screening requirements for each specialty.

METHODS: We conducted a retrospective analysis of 140 patients who underwent both telomere length testing and/or genetic testing. Patients were categorized by specialty referral: Interstitial Lung Disease (ILD) Pulmonology (n=78), Transplant Pulmonology (n=18), Hematology (n=24), and other specialties (n=20). Telomere results were classified as normal, low, very low, mixed, or unavailable based on a 6-panel assay. Genetic test results were categorized as normal, positive, variant of uncertain significance (VUS), or not performed.

RESULTS: Abnormal telomere lengths (low or very low) were identified in 58% of all patients, with significant variation across specialties. Transplant Pulmonology showed the highest rate of abnormal telomeres (66.7%), followed by ILD Pulmonology (60.3%), Other specialties (55.0%), and Hematology (45.8%). Combined pulmonology patients (n=96) demonstrated more telomere abnormalities than hematology patients (61.5% vs. 45.8%). Hematology patients showed a higher rate of normal telomeres (45.8%) than pulmonology patients (20.8%). Genetic testing identified positive or VUS results in 22.1% of patients, with the highest rate in the other category (50%) and the lowest in ILD Pulmonology (15.4%). The most frequently identified genetic variants occurred in TERT, TERC, and RTEL1 genes.

CONCLUSIONS: Significant differences exist in telomere length patterns and genetic findings across clinical specialties. Pulmonology patients demonstrate a higher prevalence of telomere abnormalities compared to hematology patients, while hematology patients show a more proportional distribution across normal, low, and very low telomere length categories. The distribution and frequency of genetic variants also differ substantially between specialties, though further analysis is needed to review variant distribution and phenotype correlation.

CLINICAL IMPLICATIONS: These specialty-specific patterns suggest that underlying pathophysiological mechanisms may influence telomere biology differently across disease states. The higher prevalence of telomere abnormalities in pulmonology patients highlights the potential importance of telomere biology in lung diseases, particularly in ILD and transplant candidates. Combined telomere and genetic testing may provide complementary diagnostic information, particularly in pulmonology where genetic variants were less common despite more frequent telomere abnormalities. The results indicate that TBD manifestations are variable in patients, emphasizing the need for a reevaluation of current screening guidelines.

Introduction

Perioperative hypotension is common in kidney transplant recipients, requiring vasopressors, and linked with poor allograft outcomes. We use synthetic angiotensin II (AT2S) as the first-line vasopressor in these scenarios. Lack of evidence exists evaluating the impact of obesity on AT2S requirements and allograft function in this population.

Research Question or Hypothesis

We hypothesized that obese kidney transplant patients require increased AT2S duration and dose and experience increased rates of poor allograft function.

Study Design

This was a retrospective, single-center, cohort study comparing AT2S use and allograft function in kidney transplanted patients with and without obesity.

Methods

We included adult patients with an isolated kidney transplant needing vasopressors perioperatively with AT2S. Data was collected from date of transplant until 28 days post-operative. We identified 305 patients from 1/2021-9/2024. Endpoints included differences in vasopressor duration, dose, allograft function, and adverse events. Statistical analysis was performed using descriptive and inferential statistics.

Results

305 patients (N=179 obese, N=126 non-obese) were included with balanced baseline characteristics, except in race, diabetes, hemodialysis (HD) duration, and transplant duration (P<0.05). AT2S duration [17 (3-52.3) vs. 6.5 (1.75-29.4) hours (P< 0.001)], total dose received [13.42 (7.26, 21.75) vs 11.67 (6.96, 17.78) ng/kg/min (P<0.001), and rates of poor allograft function 57.5% vs. 43.7% (P=0.017) were higher in patients with obesity. Linear regression analysis showed ICU LOS, restarting vasopressors, weight, and pre-transplant HD duration were associated with increased AT2 duration and dose (P<0.05). In logistic regression, ICU LOS, weight, and receipt of a DDKT were associated with poor allograft function (P<0.05).

Conclusion

Obese kidney transplanted recipients required higher doses of AT2S for longer durations with a higher incidence of poor allograft function with weight being a key variable predicting AT2 usage and allograft outcomes. This is consistent with prior evidence with other vasopressors. The higher doses may reflect a more profound inflammatory response during surgery in patients of greater weights.

Introduction

Studies have identified counseling gaps for over-the-counter family planning products. Pharmacists’ personal biases, misconceptions, or discomfort addressing sensitive health topics may contribute to disparities in 69services. Microlearning is an educational strategy delivering brief instructional content designed to improve learner engagement and knowledge retention. Within pharmacy education, microlearning may reinforce clinically relevant counseling points. Limited data exist evaluating microlearning modules as an adjunct educational tool within Doctor of Pharmacy curricula.

Research Question or Hypothesis

What are pharmacy student perceptions of mobile microlearning modules, and can modules improve knowledge and counseling confidence on select women’s health topics?

Study Design

This prospective, cross-sectional online study included pharmacy students enrolled at two accredited pharmacy schools in Georgia.

Methods

Three mobile microlearning modules (each ~10-15 minutes), accessible electronically, delivered pharmacy-practice relevant content on select contraceptives. Doctor of Pharmacy students across all professional years were invited via email to participate. Knowledge assessments were administered before and after module completion and at 30 days to evaluate retention. Surveys assessed counseling confidence and module usability. Wilcoxon signed-rank tests with Bonferroni correction (p<.017) were used to compare time points.

Results

Of nearly 700 students invited, 42 completed pre- and post-surveys; 30 completed 30-day follow-up. Most students reported feeling extremely or very confident counseling on levonorgestrel, ulipristal acetate, and progestin-only pill post-intervention (95.2%, 92.9%, 95.3%, respectively). Confidence improvements were significant across all topics (p<.001). Knowledge scores improved significantly from pre- to post-intervention (Mdn=0.80 to 1.0; p<.001) and remained significantly above baseline at 30 days (p=0.001). Significant difference between post-intervention and 30-day scores (p=.005) indicated meaningful score decay. Students found modules easy to navigate (100%) and preferred microlearning to traditional instruction (84.6%).

Conclusion

Mobile microlearning modules significantly improved pharmacy student counseling confidence and knowledge. Booster modules may enhance long-term retention. Findings support microlearning as an accessible and effective adjunct education tool in pharmacy curricula.

Introduction

Acetazolamide is a carbonic anhydrase inhibitor commonly used to treat glaucoma and other conditions. Because it is primarily renally eliminated, patients with end-stage renal disease (ESRD) are at increased risk for drug accumulation and toxicity. Severe neurologic toxicity is uncommon and may be difficult to recognize, particularly when classic metabolic abnormalities are absent.

Case

A 60-year-old male with ESRD on intermittent hemodialysis was transferred to an academic medical center for severe glaucoma and acute altered mental status (AMS). Three days prior, he developed painful vision loss and was treated with acetazolamide and topical glaucoma therapy. On admission, he was lethargic and oriented only to self. Neuroimaging, cerebrospinal fluid analysis, infectious studies, endocrine evaluation, vitamin levels, and electroencephalography failed to identify an alternative etiology. Acetazolamide therapy was continued initially while the workup was pursued. The patient received a cumulative acetazolamide dose of 3,125 mg over 11 days and underwent five hemodialysis sessions. Despite dialysis, encephalopathy persisted. Acetazolamide-induced neurotoxicity was suspected, and the medication was discontinued. A plasma acetazolamide concentration obtained one day after the final dose was 21 mcg/mL, greater than twice the upper limit of the expected therapeutic range. Mental status improved substantially within five days of discontinuation and continued to improve following discharge.

Discussion

Recognition of acetazolamide toxicity in ESRD is challenging because expected findings such as hypokalemia, hyponatremia, and hyperchloremic metabolic acidosis may be absent. In this case, extensive evaluation excluded alternative causes of encephalopathy, while elevated drug concentrations and clinical improvement following discontinuation supported the diagnosis. Persistent symptoms despite hemodialysis highlight the potential for significant drug accumulation.

Conclusion

Clinicians should maintain a high index of suspicion for acetazolamide-induced neurotoxicity in patients with ESRD presenting with unexplained AMS. Early recognition and prompt discontinuation may reduce diagnostic delays and improve neurologic recovery.

Background

Gabapentinoids are widely prescribed as opioid-sparing analgesics, but their pulmonary safety remains uncertain because prior studies have been limited to single settings and have not separated gabapentinoid-only from concurrent opioid exposure. This study aims to estimate the pulmonary risk of gabapentinoid use across surgical and outpatient settings and determine whether it persists without opioid co-administration.

Methods

PubMed, Embase, and CENTRAL were searched from inception through January 2026. Eligible studies were observational studies of adults reporting an adjusted odds ratio, hazard ratio, or relative risk with 95% confidence interval (CI) for a pulmonary outcome; case reports, editorials, and reviews were excluded. Two reviewers independently screened, extracted data, and assessed methodological quality by consensus. Pre-specified subgroups were perioperative use with opioids (Group A), chronic outpatient use with opioids (Group B), and chronic outpatient use in COPD or asthma without opioids (Group C). Estimates were pooled using random- or fixed-effects models; publication bias was assessed by Egger’s test.

Results

Fourteen observational studies encompassing approximately 5,579,100 adults were included. Mean age ranged 49.9-76.0 years; female participants 52.0-100%. Gabapentinoid use was associated with increased pulmonary risk (pooled estimate: 1.26 [95% CI 1.14-1.40]). Subgroup estimates were 1.24 [1.03-1.50] in Group A, 1.15 [0.99-1.33] in Group B, and 1.36 [1.24-1.50] in Group C. Non-invasive ventilation was significantly increased (pooled estimate: 1.34 [1.19-1.52]).

Discussion

Gabapentinoid use is associated with an increase in pulmonary risk. The strongest signal arose in patients with COPD or asthma without concurrent opioids and persisted across diverse comparators, including an active antidepressant cohort, indicating that the risk is not solely a consequence of opioid co-administration or of the underlying pain indication. Findings are limited by observational design, between-study heterogeneity, and variation in outcome definitions. These findings support a more structured risk-benefit assessment before prescribing gabapentinoids to patients with impaired ventilatory reserve.

Other

Registration: PROSPERO, CRD420261359181.

Introduction

Despite the clinical impact of drug extravasation, the epidemiological burden of extravasation in the United States remains poorly characterized.

Research Question or Hypothesis

What are the clinical characteristics, drug-class distribution, severity outcomes, and disproportionality signals for extravasation-associated adverse events reported to the FDA Adverse Event. Reporting System (FAERS) between

Study Design

Retrospective pharmacovigilance analysis of spontaneous adverse event reports.

Methods

FAERS reports from 1997–2026 were analyzed using nine MedDRA Preferred Terms for extravasation. Suspect drugs were categorized as chemotherapy or non-chemotherapy and linked to AHFS drug classes. Descriptive statistics summarized demographics, outcomes, and reporter types. Disproportionality analyses included reporting odds ratios (ROR) with 95% confidence intervals and information component (IC) values, with IC0.25 (> 0) indicating significance. An RF correction estimated US extravasation prevalence. Chi-square and Mann-Whitney U tests compared groups.

Results

After deduplication, 16,954 unique cases were identified (80 duplicates removed). The median age was 58 years (interquartile range [IQR] 42–70); 50.0% were female. Reports were classified as serious in 49.8% of cases. Healthcare professionals submitted 70.0% of reports. Chemotherapy accounted for 17.9% of cases (n = 3,032) and was associated with significantly higher rates of seriousness (69.8% vs. 45.4%, p < 0.001), hospitalization (30.8% vs. 18.0%, p < 0.001), and life-threatening events (2.4% vs. 1.4%, p < 0.001) than non-chemotherapeutic agents. The most frequently reported agents overall were adalimumab (7.2%), etanercept (4.9%), and infliximab (4.3%). Sixteen drugs generated confirmed ROR signals (lower 95% CI > 1.0), with the strongest for infliximab-dyyb (ROR 62.3; 95% CI 23.2–166.9), doxorubicin (44.9; 11.1–181.5), fluorouracil (24.0; 10.7–54.1), and cyclophosphamide (11.4; 6.2–20.9). The annual prevalence estimate of extravasation in the US ranged from 12,694 to 73,253, depending on the estimation method used.

Conclusion

Chemotherapy-related extravasation has a higher severity than non-chemotherapy cases. These findings highlight the need for better surveillance, standardized reporting, and consistent protocols for prevention and management across drug classes.

Service or Program

This transitions of care program is targeted toward established patients with durable left ventricular assist devices (LVADs) transitioning from the inpatient to outpatient setting. Patients are contacted by telephone within 3 business days of hospital discharge for a comprehensive medication reconciliation focusing on recent medication changes and high-risk therapies. Medication knowledge, adherence, tolerability, and access barriers are assessed, and patient questions and concerns are addressed. Additional care is coordinated as needed, such as prescription cost assistance or other care team member communication for non-medication-related issues or concerns. The encounter is documented as a telephone chart note in the patient’s electronic medical record.

Justification/Documentation

Patients with LVADs for advanced heart failure are frequently hospitalized for various reasons and often experience multiple medication changes during admissions. Currently, there is not a dedicated pharmacist at our institution responsible for providing comprehensive discharge medication counseling to LVAD patients. Furthermore, the hospital follow-up outpatient visit may not be scheduled for several days to weeks after discharge, potentially allowing undetected medication discrepancies and errors to cause patient harm. The goal of this outpatient-based transitions of care program is to prevent adverse events, resolve discrepancies, and improve access to the health care system.

Adaptability

Published literature supports pharmacist-led transitions of care programs in improving medication adherence, preventing adverse events, and reducing hospital re-admission rates. This pharmacist-led transitions of care program for LVAD patients can be easily implemented and adapted in other programs with pharmacist support or help provide justification for a pharmacist position.

Significance

This program provides an early post-discharge touch point for comprehensive medication reconciliation and counseling for patients who often experience frequent and multiple medication changes. This service further highlights the important role of the clinical pharmacist within the multidisciplinary team caring for patients with complex cardiovascular disease.

The ACCP Ambulatory Care Practice and Research Network (PRN) conducted a survey of its 1930 members in June 2026. Survey questions were designed to assess members' current practices, training, and confidence in billing for clinical services, identify barriers and viability of billing for clinical services, and explore members' future plans.

Results from 93 respondents were analyzed to identify billing trends and were compared to previous surveys from 2024 and 2025. The respondents were 47.3% very confident or somewhat confident in knowledge of billing and reimbursement mechanisms for clinical services. The reported billing rate for services of 54.8% was comparable to survey results in 2025; however, were both lower than 2024 of 70.3% which may be related to the significant reduction in telehealth services at the end of 2025. Additionally, differences in survey sample size may have influenced these findings and should be considered when interpreting the apparent decline in billing. Additionally, 61.7% of respondents reported no formal billing education, and of those who received training, it was primarily institution-based. The most frequently cited billing codes utilized were incident-to-office visits, followed by continuous glucose monitoring for both 2026 and 2024. Billing was identified as having a major or minor impact on staffing/service growth with over half of respondents indicating that billing had a positive impact.

Approximately 40% of respondents plan for future growth in billing, but common barriers to billing identified were legislative, administrative, and knowledge/education based. In an effort to reduce these barriers, the Ambulatory Care PRN continues to develop programming related to billing and reimbursement practices in ambulatory care pharmacy. This includes developing, implementing, and sustaining ideal models, as well as promoting legislation advocating the role of pharmacists as clinical providers.

Introduction

Despite guidelines recommending short-term use and well-documented risks including falls and cognitive impairment, long-term benzodiazepine (BZD) use persists in a substantial proportion of older adults, underscoring a gap between evidence-based recommendations and real-world prescribing. Pharmacist-led interventions and individualized tapers may increase BZD discontinuation rates, but the certainty of this evidence is low and the role of telehealth in supporting deprescribing remains understudied.

Research Question or Hypothesis

A telehealth pharmacist-led intervention combining patient education with individualized tapers will increase BZD discontinuation rates among older adults on long-term therapy.

Study Design

IRB-exempt, retrospective, single-arm cohort study (August 2022-September 2025).

Methods

Adults patients on daily BZD for at least 3 months who were referred to the program and completed at least two visits were included. The primary outcome was successful BZD discontinuation at 4 weeks, defined as completed cessation or transition to as-needed use.

Secondary outcomes were change in diazepam-equivalent dose at 3, 6, and 12 months after taper initiation; proportion reporting withdrawal symptoms; proportion restarting BZD by 3, 6, and 12 months; and proportion of patients on concurrent opioids who discontinued BZD. Outcomes were summarized with descriptive statistics.

Results

Of 114 patients included, 103 completed the taper, of whom 49.5% (n=51) successfully discontinued BZD with a median taper duration of 3 months (IQR 2–5). Among those who discontinued, 3.9% (n=2) restarted daily BZD use. Mean baseline diazepam-equivalent dose was 12.2 mg, with the greatest reduction (47.6%) by month 3, followed by 9.9% at month 6 and 5.1% at month 12. Among the 3.9% (n=4) on concurrent opioids, 25% (n=1) discontinued. Withdrawal symptoms were reported by 29.8% (n=34) of patients, and the most common barrier was re-emergence of the underlying condition (39.5%, n=45).

Conclusion

A pharmacist-led telehealth tapering program is an effective strategy for reducing long-term BZD use.