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Objectives/Goals: To describe the evaluation processes of screening services implemented in community pharmacies. Methods/Study Population: A systematic literature review will be conducted from the last 20 years in Ovid Medline, APA PsycINFO, Clinialtrials.gov, and International Pharmaceutical Abstracts. Inclusion criteria are written in English, describes a clinical or health-related screening service in a community pharmacy, and evaluation of said health screening service is included. Approximately 950 articles have been initially identified. Two authors will screen each title, abstract, and full text for inclusion. Subsequent data extraction will occur including elements of 1) evaluation framework, 2) evaluation outcomes assessed, and 3) evaluation results. All elements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be followed. Quality of articles will be assessed using the MMAT. Results/Anticipated Results: Results are expected to show limited evaluation of screening services in pharmacies. Clinical conditions included in the screening services are expected to vary greatly. High-quality evaluations will be noted as templates for future evaluation of screening services in community pharmacies. Discussion/Significance of Impact: This systematic review will describe the current literature on evaluation of health screening services in community pharmacies. This will give readers an overview of how evaluations are currently being carried out in this setting, as well as provide them with templates of high-quality evaluations for future evaluation of screening services.

OBJECTIVES/GOALS: There are two objectives: 1) To identify healthcare providers’ (HCP) barriers and potential solutions towards rural adolescents’ access to mental healthcare. Healthcare providers include pharmacists, physicians, and mental healthcare providers (MHPs). 2) To identify rural high schoolers’ barriers and potential solutions towards access to mental healthcare. METHODS/STUDY POPULATION: Fifteen HCPs will be recruited via email listserv and the snowball method. Perceived barriers of rural adolescents, personal barriers, current practices to address mental health in adolescents, and preferred solutions will be discussed. Twenty student and parent dyads will be recruited using fliers in school systems and will be interviewed individually outside of class time on school grounds or over the phone. Barriers to care and preferred solutions will be discussed. All interviews will be semi-structured, recorded, conducted in person or over the phone, and last for 30 minutes to an hour. Compensation will be$25 for students and parents each, $ 50 for pharmacists and mental health providers and $100 for physicians. Thematic qualitative data analysis will be performed using Atlas.ti software. RESULTS/ANTICIPATED RESULTS: Data collection is ongoing. Anticipated results for barriers include absence of mental healthcare providers in rural areas, inability to access mental healthcare providers further away, stigma towards mental healthcare, and lack of knowledge of mental health conditions and treatment. Anticipated results for potential solutions may include promoting mobile applications to assist with telehealth and self-care. Other solutions may be collaboration among rural healthcare providers for adolescents with mental health conditions. Preferred solutions may also include pharmacists disseminating knowledge to rural adolescents and their parents or referrals to mental healthcare providers. DISCUSSION/SIGNIFICANCE OF IMPACT: This project will identify barriers and solutions to access to mental healthcare among rural adolescents. These solutions can then be applied towards the creation of programs that address salient issues within rural communities with a greater chance of uptake and use so that rates of depression and suicide will decrease. CONFLICT OF INTEREST DESCRIPTION: Funding through UAB TL1 award.

Objectives. To launch and evaluate a comparative effectiveness research education and dissemination program as part of an introductory pharmacy practice experience (IPPE). Methods. First- through third-year PharmD students received training on comparative effectiveness research and disseminated printed educational materials to patients in the community who they were monitoring longitudinally (n=314). Students completed an assessment and initial visit documentation form at the first visit, and a follow-up assessment and documentation form at a subsequent visit. Results. Twenty-three diabetes patients, 29 acid-reflux patients, 30 osteoarthritis patients, and 50 hypertension patients received materials. Aside from the patient asking questions, which was the most common outcome (n=44), the program resulted in 38 additional actions, which included stopping, starting, or changing treatments or health behaviors, or having additional follow-up or diagnostic testing. Small but positive improvements in patient understanding, confidence, and self-efficacy were observed. Conclusions. Dissemination of comparative effectiveness research materials in an IPPE program demonstrated a positive trend in markers of informed decision-making.

This study extends prior social support research by using an ego-centered network approach to explain class differences in perceptions of social support adequacy and, in turn, mental health outcomes (i.e., distress) across class strata. Data come from a 2003 study by the Center for the Study of Public Health Impacts of Hurricane at Louisiana State University. Independent samples t-tests and ordinary least squares regression analyses reveal differences in network capital, perceptions of social support adequacy, and levels of distress across social class. We find that working/lower-class individuals report being embedded in lower-ranging network structures than their affluent middle-class counterparts. Furthermore, for working/lower-class individuals, lower-ranging network structures positively affect perceptions of social support adequacy. We also find that although greater perceptions of social support adequacy reduce psychological distress, there are variations in class in how perceptions of social support affect psychological distress.

Background: Depression is the leading cause of disability in persons over 15 years old. It is estimated that over 7% of people have depression but only 40-50% of those actually receive treatment. Inadequate treatment has sweeping negative effects, including school dropout, decreased work productivity, and suicide. Rural areas are affected to a greater degree due to the increase of the “mental health care gap”: the phenomenon of increasing mental health conditions that are not being kept up with by the number of mental health providers.Pharmacists offer a solution here by being more accessible to rural patients than other mental healthcare providers. Studies have demonstrated the feasibility and patient acceptance of pharmacists offering depression screening services in urban pharmacies; however, the rate of implementation of such services is low. Thus, this project seeks to inform an effective depression screening training program for rural community pharmacies, thus improving implementation of depression screening services in underserved areas by incorporating current practices, strategies to address barriers, and preferred implementation strategies.Hypothesis 1: Knowledge, intention, confidence, attitude, subjective norms, and perceived behavior control of a depression screening service will be improved from pre-training to immediately post-training in pharmacists after participating in a depression screening training webinar.Hypothesis 2: Knowledge, confidence, attitude, subjective norms, and perceived behavior control of a depression screening service will continue to be increased from pre- to 3-months post the depression screening training webinar.Hypothesis 3: Implementation of depression screening services will increase from pre- to 3-months post after the depression screening training webinar.Methods: A survey was developed and pre-tested with a stakeholder panel to identify current community pharmacist depression screening practices, unique barriers/facilitators, stigma towards patients with mental health, and preferred implementation strategies that rural pharmacists may encounter when implementing a depression screening service. This survey was sent to rural pharmacists in Alabama and Mississippi identified with the Hayes directory and RUCA codes 4-10. Subsequently, a live webinar training program was developed using data from the initial survey and a second stakeholder panel to fill in knowledge gaps, address barriers, improve confidence and beliefs, and disseminate preferred implementation strategies to implementing a depression screening service in rural pharmacies. This webinar was delivered to rural and urban pharmacists in Alabama and Mississippi who were identified using the Hayes directory and a continuing education office listserv. Knowledge, intention, confidence, and beliefs were assessed pre, post, and three months post the webinar.Results: Eighty-five rural pharmacists completed the survey for a response rate of 14%. Rural pharmacists reported they have several barriers towards implementing a depression screening service: primarily low confidence, lack of time, and lack of knowledge for themselves and their staff. The training webinar significantly increased pharmacist confidence, knowledge, and beliefs pre-post and maintained the increase 3-months post webinar for every variable except subjective norms. Intention to implement and implementation behaviors did not significantly increase. Barriers towards implementation were primarily lack of time and lack of staff.Conclusion: While the interventional educational webinar increased pharmacists’ knowledge, confidence, and attitudes towards depression screening services, intention to implement as well as actual implementation of these services remained low to non-existent. Further research should be undertaken to gain a better understanding of systematic barriers pharmacists face when implementing depression screening services so that potential solutions may be found.

Alabama standards for Early Learning and Development have shifted to a more academic-based learning approach that moves away from play-based learning. The problem is Alabama early childhood educators are expected to implement a more teacher-directed approach in the classroom. The purpose of this qualitative, exploratory case study was to explore early childhood teachers’ perceptions regarding strategies they use to implement play-based learning while continuing to follow state-based early childhood standards. The constructivist theory served as the theoretical framework with components of theories developed by Piaget and Vygotsky. The sample included eight lead and auxiliary teachers from First Class Pre-K classrooms in rural south Alabama. The participants were identified and selected using the snowball sampling method. Data collection included the use of individual semi-structured interviews and focus group sessions. A thematic data analysis approach revealed that early childhood teachers have positive perceptions and experiences with play and play-based learning and continue to use various strategies to implement a play-based pedagogy in their classrooms, including small groups, large groups, games, and individualized activities. Considering the significance of play, recommendations for practice and future research include additional training for teachers and increasing the study's sample size and demographic location.

A Trauma Certified Registered Nurse Anesthetists Team (TCT) was created and trained to provide trauma-focused anesthesia and resuscitation. The purpose of this study was to examine patient outcomes after implementation of TCT. We conducted retrospective analyses of trauma patients managed with surgical intervention from March to December 2015. During the first five months, patients managed before the development of TCT were grouped No-TCT, patients managed after were grouped TCT. To assess outcomes, we used hospital and intensive care unit length of stay, ventilator days, and a validated 10-point intraoperative Apgar score (IOAS). IOAS is calculated using the estimated blood loss, lowest heart rate, and lowest mean arterial pressure during surgery. Higher IOAS are associated with significantly decreased complications and mortality after surgery. We used t test and nonparametric tests for analyses. Fifty two patients were included (mean age 39 years, 75% male; 46.2% managed with TCT). Patients in the No-TCT group had significantly lower use of vasopressors (0.019), lower mean IOAS (P = 0.02), and spent more days on ventilator (P = 0.005) than patients in the TCT. These results suggest that trauma centers should take into consideration implementation of TCT to improve intraoperative and overall outcomes.

ObjectivesTo compare serum ferritin and RET-He values among extremely low gestational age neonates ELGANs with other markers of iron-deficient erythropoiesis.Study DesignThis is a secondary analysis of the NICHD Darbepoetin Trial. Study data from placebo recipients who had a serum ferritin, a RET-He, and a mean corpuscular volume (MCV) measurement within a 24-hour period were analyzed for correlation.ResultsMixed linear regression models showed no association between ferritin and RET-He at both early (β = 0.0016, p = 0.40) and late (β = −0.0001, p = 0.96) time points. Positive associations were observed between RET-He and MCV at baseline, early, and late time points (p < 0.01, =0.01, <0.001, respectively), while ferritin was not associated with MCV at any time point.ConclusionsOur study shows that RET-He is better correlated with MCV as a marker of iron-limited erythropoiesis than ferritin. The results suggest that ferritin is limited as a marker of iron sufficiency in premature infants.Study IdentificationFDA IND Number 100138; ClinicalTrials.gov number NCT03169881; NRN ID number NICHD-NRN-0058 (Darbe).

The provision of antenatal corticosteroids to pregnant patients at gestational age (GA) 22 6/7 weeks or less remains controversial and lacks support from randomized clinical trials. To compare rates of survival and survival without major morbidities among infants born at GA 22 0/7 to 23 6/7 weeks after exposure to antenatal steroids at 22 6/7 weeks' gestation or less vs no exposure to antenatal steroids. This cohort study enrolled infants born at GA 22 0/7 to 23 6/7 weeks between January 1, 2016, and December 31, 2019, at centers in the National Institute of Child Health and Human Development Neonatal Research Network. Infants who did not receive intensive care and infants with antenatal steroid exposure after GA 22 6/7 weeks were excluded. Infants were classified as having no, partial, or complete exposure to antenatal steroids. The primary outcome was survival to discharge. The main secondary outcome was survival without major neonatal morbidity. The associations of differential exposures to antenatal steroids with outcomes were evaluated using logistic regression, adjusting for GA, sex, race, maternal education, small for GA status, mode of delivery, multiple birth, prolonged rupture of membranes, year of birth, and Neonatal Research Network center. A total of 431 infants (mean [SD] GA, 22.6 [0.5] weeks; 232 [53.8%] boys) were included, with 110 infants (25.5%) receiving no antenatal steroids, 80 infants (18.6%) receiving partial antenatal steroids, and 241 infants (55.9%) receiving complete antenatal steroids. Seventeen infants were exposed to antenatal steroids at GA 21 weeks. Among infants exposed to complete antenatal steroids, 130 (53.9%) survived to discharge, compared with 30 infants (37.5%) with partial antenatal steroid exposure and 239 infants (35.5%) with no antenatal steroids. Infants born after complete antenatal steroid exposure, compared with those without antenatal steroid exposure, were more likely to survive to discharge (adjusted odds ratio [aOR], 1.95 [95% CI, 1.07-3.56]) and to survive without major morbidity (aOR, 2.74 [95% CI, 1.19-6.30]). In this retrospective cohort study, among infants born between GA 22 0/7 and 23 6/7 weeks who received intensive care, exposure to a complete course of antenatal steroids at GA 22 6/7 weeks or less was independently associated with greater odds of survival and survival without major morbidity. These data suggest that the use of antenatal steroids in patients at GA 22 6/7 weeks or less could be beneficial when active treatment is considered.

ObjectiveTo determine whether the duration of noninvasive respiratory support exposure is associated with bronchopulmonary dysplasia (BPD) or death in preterm infants.MethodsMulticenter, retrospective study of infants born at <29 weeks’ gestation. The association between days on noninvasive respiratory support and BPD or death was determined using instrumental variable techniques and generalized propensity score matching to account for potential confounding by illness severity.ResultsAmong 6268 infants 36% developed BPD or died. The median duration of noninvasive respiratory support was 18 days. There was inconsistency in the association between noninvasive support and BPD or death when analyzed by instrumental variable techniques (Average Marginal Effect −0.37; 95% CI −1.23 to 0.50) and generalized propensity score matching (Average Marginal Effect 0.46; 95% CI 0.33 to 0.60).ConclusionFindings on the association between duration of exposure to noninvasive respiratory support and the development of BPD or death were inconclusive.ClinicalTrials.gov IDGeneric Database:NCT00063063.