Bulletin Today
APhA Staff
The American Diabetes Association (ADA) now recommends that people with diabetes undergo a yearly screening to detect for early heart failure even if they do not currently have any symptoms. The American College of Cardiology endorsed the new guidance, which calls for testing to detect elevated B-type natriuretic peptide levels and/or unusual levels of high-sensitivity cardiac troponin. These are known biomarkers of advanced stage heart failure in individuals with diabetes who are asymptomatic.
“Addition of relatively inexpensive biomarker testing as part of the standard of care may help to refine [heart failure] risk prediction in individuals with diabetes,” ADA noted in its consensus report in Diabetes Care. “Substantial data indicate the ability of these biomarkers to identify those in stage A or B [heart failure] at highest risk of progressing to symptomatic [heart failure] or death.”
ADA also said targeted intervention with an SGLT-2 inhibitor or multidisciplinary treatment—including smoking cessation, nutrition, weight loss, and other specialized care—might slow or prevent this progression. ■
Pharmacists reviewing antimicrobial prescriptions in transitions of care practice model reduced harm
A study in JAMA Network Open found that pharmacists can play a key role in enhancing antimicrobial prescribing during transitions of care.
The study took place across 5 hospitals in the Henry Ford Health System in southeastern Michigan from September 2018 through August 2019. Researchers examined an intervention implemented in 17 distinct units at the hospitals, where clinical pharmacists worked with primary care teams to identify patients set to be discharged with antimicrobial prescriptions, determine those who may be eligible to complete the antimicrobial course with oral therapy after discharge, and provide other recommendations to optimize therapy.
Working with CDC, researchers assessed adult patients at the 5 hospitals with urinary tract, respiratory, skin, and other soft-tissue and intra-abdominal infections who were prescribed antimicrobials at discharge. The primary endpoint was the frequency of optimized antimicrobial prescriptions at discharge.
Of 400 preintervention and 400 postintervention patients, the most common diagnoses were pneumonia, upper respiratory tract infection and/or acute exacerbation of chronic obstructive pulmonary disease, and UTI. Patients in the postintervention group were more than 5 times more likely to have an optimal antimicrobial prescription compared with those in the preintervention group. The increase in optimized prescribing at discharge in the postintervention period was seen in both the academic and community hospital settings, with slightly varying methods used.
Reductions in prolonged durations of therapy, nonguideline-concordant antimicrobial selection, and treatment of asymptomatic bacteriuria contributed the most toward enhanced discharge prescribing, according to the researchers. ■
Pediatric melatonin ingestion spikes over last decade, CDC says
The number of children reported to ingest melatonin, a sleep hormone, increased fivefold nationwide each year between 2012 to 2021, according to a new CDC study.
The study monitored a total of 260,435 melatonin ingestions among children, of which 94.3% were accidental. Nearly 83% of these children were asymptomatic. However, 4,097 children required hospitalization during the 10-year period and 287 required intensive care. Two children died.
The agency noted there was considerable variability in melatonin content across products and discrepancies with label claims. CDC said public health efforts should concentrate on raising awareness of the risks of melatonin intake, including gastrointestinal, cardiovascular, and central nervous system problems. Sales of melatonin rose by approximately 150% between 2016 and 2020.
The largest yearly increase in pediatric melatonin ingestions occurred between 2019 and 2020, corresponding with the onset of the COVID-19 pandemic, when total ingestions rose nearly 38%. CDC recommended the use of child-resistant packaging and health care provider warnings to parents about the potential harmful effects of melatonin exposure. ■
New screening guidelines for diabetes and prediabetes seem to lead to better detection rates
A new analysis finds that the uptake of 2021 U.S. Preventive Services Task Force (USPSTF) guidelines and 2022 American Diabetes Association (ADA) recommendations has had a positive effect on detection rates for prediabetes and undiagnosed diabetes.
Data from the 2015–2022 National Health and Nutrition Examination Survey informed the study, which focused on a sample population of 4,480 adults aged 20 years and older. Among these men and women with no history of confirmed prediabetes or diabetes, researchers found that the recent USPSTF and ADA guidance, which lowers the starting threshold for diabetes screening to age 35 years, increased eligibility substantially.
With the USPSTF recommendations, which are based on age and body mass index, the share eligible for screening climbed from 36.3% with the 2015 document to 43.0% under last year’s update.
Screening eligibility per ADA, which considers a broader range of risk factors, widened from 76.7% under the 2003 guidance to 82.9% under recommendations issued in 2022.
“Starting diabetes screening at age 35 years may place even greater demands on clinicians to care for younger populations,” the study authors wrote. “Expanding health care access, developing targeted outreach for high-risk individuals, and scaling prevention programs will be critical.” ■
PTCB launches regulatory compliance certificate for pharmacy techs
The Pharmacy Technician Certification Board’s (PTCB’s) new regulatory compliance certificate provides technicians with the opportunity to verify their knowledge about pharmacy laws, regulations, legal requirements, and practice standards to ensure compliance and quality assurance in various practice settings.
PTCB Executive Director and CEO William Schimmel said “By earning credentials like our specialty certificate in regulatory compliance, technicians can demonstrate their dedication to their careers, patient care, and medication safety.”
The certification covers areas such as the Federal Controlled Substances Act, Risk Evaluation and Mitigation Strategies, principles for pharmacy laws and ethics, and patient safety and quality assurance strategies. The certification shows that its holders have the knowledge and drive to ensure pharmacy compliance.
To be eligible for PTCB’s regulatory compliance certificate, pharmacy technicians must hold active PTCB Certified Pharmacy Technician (CPhT) certification and complete a PTCB-recognized regulatory compliance education/training program.
David Holmberg, CPhT-Adv and store manager at Leslie’s Pharmacy in Vineyard Haven, MA, said “This area is very different and more managerial than the ‘typical’ pharmacy technician duties. It is satisfying being able to grow my career in a way that I didn’t know was possible when I first began on this path.” ■
PCSK9 inhibitors seem to benefit those with high cardiovascular risk
PCSK9 inhibitors appear to lower nonfatal myocardial infarction in adults with high or very high cardiovascular risk but not in those with low or moderate risk, according to a new study published in the BMJ.
Results from 14 randomized controlled studies informed this network meta-analysis measuring the effect of ezetimibe and PCSK9 inhibitors on cardiovascular outcomes in 83,660 adult patients regardless of statin use.
The researchers also found that initiating ezetimibe or PCSK9 inhibitors as an add-on in patients receiving maximally tolerated statin therapy or in patients who cannot tolerate statins seems to have no significant effect on cardiovascular mortality nor on death for any other reason.
Prescribing ezetimibe or PCSK9 inhibitors “should be considered among appropriate candidates with very high or high cardiovascular risk patients to achieve desired cardiovascular benefits,” the authors wrote. ■