Eugene Applebaum College of Pharmacy and Health Sciences in the news

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Detroit area hospital systems lean against use of hydroxycholoroquine for COVID-19

A quickly retracted study that found a higher death rate among COVID-19 patients treated with hydroxychloroquine has deepened controversy over the drug worldwide and in Michigan. At least one local health system continues to use the drug while others have abandoned it. Many health care institutions, including the World Health Organization, suspended clinical trials of the drug touted by President Donald Trump after the faulty study was published in the British medical journal The Lancet on May 22. The WHO restarted the trials about a week ago. The observational study of about 96,000 patients hospitalized worldwide with the coronavirus concluded that patients who were treated with hydroxychloroquine had a greater chance of death and heart rhythm problems than those who did not receive the drug. The politicization of medical studies was dismissed by Michael Rybak, a professor of pharmacy and medicine at Wayne State University and the primary investigator on a current study that's trying to determine the optimum dose of hydroxychloroquine for treating COVID-19 patients. In the midst of a worldwide pandemic, he said, doctors were grasping at straws, using an unproven treatment without really knowing if it would benefit or harm patients. "The journals have a lot at stake as well," Rybak said, noting that the publications' reputations are based on the quality of the research they publish. "It was important to get the information out as fast as possible to the prescribing clinicians so they know what to do next because there was no information," he said. "(Journals) are trying to get the information out as fast as possible because they know we're at an hour of need." 

People are being tested post-mortem for coronavirus, but death count may be underestimated

Health officials say they're ramping up testing for COVID-19, leading to a clearer picture of the disease's spread. But, absent more robust testing of both the living and the dead, experts warn the true death toll has been underestimated. The CDC hasn't advised widespread post-mortem testing but urges medical examiners to "use professional judgement to determine if a decedent had signs and symptoms compatible with COVID-19 during life and whether post-mortem testing is necessary." From a public health perspective, post-mortem testing could lead to a better understanding of the disease's fatality rate — a key data point as leaders weigh whether to re-open sections of the economy. The deaths of the elderly and infirm might be chalked up to factors other than coronavirus, Kilgore said, adding that it's unclear how many COVID-19 deaths in Michigan are going uncounted. "We need a study done to look at out-of-hospital deaths," Kilgore said. "The in-hospital deaths are mostly going to be captured."
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Pharmacists could be front-line fighters in battle against opioid epidemic

Professor of Pharmacy Victoria Tutag Lehr penned an article for The Conversation about the role of pharmacists in the battle against the opioid epidemic. “When you stop at your local pharmacy to pick up a toothbrush or an antacid, soon you may also be able to buy an over-the-counter drug to reverse an opioid overdose. The lifesaving drug, naloxone, currently requires a prescription, but it may become available as an over-the-counter purchase in 2020. Despite the national decrease in opioid prescriptions since 2012, the opioid crisis continues. Access to prescription opioids have decreased due to stricter legislation, insurance regulations and the Centers for Disease Control Guideline for Prescribing Opioids for Chronic Pain. At the same time, the use of heroin and illegally manufactured synthetic opioids, such as fentanyl and counterfeit prescription opioids, has escalated.
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Wayne County morgues brings in refrigerated trucks for surge in coronavirus deaths

As COVID-19 deaths continue to rise, the Wayne County Medical Examiner’s Office is gearing up for the inevitable: more bodies than it can hold. To prepare for the surge, the morgue brought in two refrigerated trucks, another is expected this week, and a fourth arrives next week. The morgue can hold 300 bodies, and already has 200; the refrigerated trucks can hold about 35-40 bodies each. Mark Evely, director of the mortuary science program at Wayne State University, said the medical examiner’s office is properly planning for anticipated capacity issues, and addressed the additional precautions taken by funeral directors and funeral homes. “We as funeral directors, we believe very much in the value of having a funeral. We sympathize with the families who need that support of having people attend the funeral,” he said. “Not only have families lost a loved one, they’ve also lost the in-person support that they would have normally had from families and friends.” “
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'Southeast Michigan is burning': Michigan's coronavirus case count doubles every 3 days

Sick people fill intensive care units of already overtaxed southeastern Michigan hospitals at a pace of about 100 new coronavirus patients a day. So far, 111 Michiganders have died, and at least 4,650 had confirmed cases of COVID-19 as of Saturday afternoon, according to the state Department of Health and Human Services. What we do know is that the official coronavirus case count is currently doubling about every three days in Michigan. "Southeast Michigan is burning right now," said Dr. Teena Chopra, medical director of infection prevention and hospital epidemiology at DMC Harper University Hospital and a professor at Wayne State University. "Our hospital systems are being overrun at this point," Chopra said. "They are all struggling. ... We are under-resourced and we need to make sure that we get more help. You know, we are asking, all of us are asking, for help. And the governor knows that." It has been just 19 days since the state reported its first two confirmed cases of COVID-19 on the evening of March 10. Eight days later, a Southgate man in his 50s was the first to die of the disease, and that's when the case counts around the state began to rise rapidly because of "a combination of increased detection of cases through laboratory testing as well as community-wide transmission," said Dr. Paul Kilgore, an associate professor at Wayne State University's Eugene Applebaum College of Pharmacy and Health Sciences. Reducing the rate of COVID-19 infections hinges on how well people adhere to the governor's order, said Kilgore. "The way I've been looking at social distancing is that it's really kind of our vaccine. You're the vaccine. I'm the vaccine. And the extent to which we apply this intervention to the population is exactly the way that we would apply a vaccine. The more people that do social distancing, or the greater the percentage of the population that social distance, that will determine the effectiveness or efficacy of social distancing, just like you would evaluate a vaccine," Kilgore said. 
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Federal restrictions limit marijuana research in Michigan

Randall Commissaris, a Wayne State University associate professor of pharmaceutical sciences, is studying the effects of using marijuana or alcohol when driving vehicles. Wayne State has several research projects underway, including the one by Commissaris, who runs a driving safety lab in the college of pharmacy and is studying the reaction time of people under the influence of marijuana or alcohol. Commissaris said the driving simulation places subjects in a 2001 Chevy Impala and presents a road filled with obstacles to drive around. "We collect data in a flight data-type recorder and look at driving performance using cannabis and while drinking," he said. "We worked with medical marijuana patients for two years, but in December 2018 when recreational became legal we started working with them." Under the influence or marijuana or alcohol, the reaction time is longer, but much of it depends with how much is consumed and their tolerance level. "We are still studying everything, but we are seeing a greater tolerance level with marijuana than alcohol," he said. "If the subject has a history with marijuana they are less affected in the driving test. There is a little evidence of that with alcohol but more with marijuana." Commissaris said Wayne State is planning to begin studies on edible cannabis products. "There is not enough research on cannabis," he said. "We want to do more, but it is complicated because the products and plants are highly variable in concentration." Another study is being conducted by Christine Rabinak, an associate professor in the WSU pharmacy college, who is conducting a study on the use of cannabis on (post-traumatic stress disorder) patients.
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Wayne State University names Dr. Mark Schweitzer new School of Medicine dean, VP of Health Affairs

Wayne State University President M. Roy Wilson today announced the appointment of Mark Schweitzer, M.D., as dean of the university’s School of Medicine and vice president of Health Affairs for the university. Schweitzer, a preeminent radiologist and chair of the Department of Radiology at the Stony Brook University School of Medicine in New York, will join the university and School of Medicine on April 27. “We conducted in-depth interviews with a number of outstanding candidates during a yearlong national search, and Schweitzer’s experience, enthusiasm and vision made him a perfect fit for Wayne State University,” Wilson said. “Our faculty, our students, and the people of Detroit and the surrounding region will see great advances with Schweitzer’s leadership and energy. He will quickly become a leading contributor to our great city’s ongoing renaissance.” In addition to his leadership role in the School of Medicine, as vice president of Health Affairs, Schweitzer will work with the deans of WSU’s College of Nursing and the Eugene Applebaum College of Pharmacy and Health Sciences on clinical training issues. In this role, he will develop avenues to strengthen collaboration between the three schools to advance interprofessional, team-based approaches to healthcare. “I attended inner-city public universities during my undergraduate and medical school training, and I served at public safety net hospitals,” Schweitzer said. “My passion throughout my career has been education at all levels. The DNA of Wayne State University and the city of Detroit are intertwined, and the university’s national reputation is illustrious. I’m very much looking forward to serving the people of greater Detroit and Michigan.” An outstanding medical scholar and educator, Schweitzer is a talented administrator who has served in many hospital and medical practice roles, including vice chair for clinical practice and chair of the Information Management Group for Thomas Jefferson University Hospital. Extensively published and a lecturer for Harvard University Medical School, he holds a number of medical patents. “The Board of Governors is extremely pleased to be hiring someone the caliber of Dr. Mark Schweitzer to assume what is a critically important leadership position,” said Marilyn Kelly, chair of the board. “Wayne State’s health-related education and community programs are a vital part of the university’s identity and mission, and we think that Mark is the right person to lead us into the future.”
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Data: Metro Detroit pharmacies received more than 40 percent of state's pain pill supplies

At least 40 percent of the 2.9 billion prescription pain pills supplied to Michigan in the years preceding the nation’s third wave of opioid overdose deaths landed in Oakland, Wayne and Macomb counties, according to federal data released over the summer. The flood of pills fueled opioid deaths across the region, and some experts are thankful the newly-released Drug Enforcement Administration database can now be used to pinpoint trends and problem areas. Victoria Tutag Lehr, a Wayne State University pharmacy practice professor, said the database is good for verifying some suspected trends. “It has some research helpfulness, (yet) you just can’t assume that all those doses dispensed went to a patient with a prescription,” Lehr said. “People will tell you they’re not afraid of going to jail, losing their house, waking up in an alley … They are afraid of going into withdrawal. It’s a big, big issue.” She would prefer a more zoomed look at prescription opioid pills, such as similar data for census tracts or zip codes. Lehr emphasized that opioids should be part of “multi-modal management” that includes other treatments like topical anesthetics and physical therapy.
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Will an aspirin a day keep COPD from flaring up?

A recent observational study suggests that aspirin might be instrumental in preventing flare ups of chronic pulmonary obstructive disease (COPD), thereby improving quality of life for those who suffer from breathing difficulties because of it. Of the 1,700 participants followed in the three-year study, 764 reported that they took aspirin daily. The aspirin users in the 2019 study reported fewer flare ups and less shortness of breath than participants in a control group that did not use aspirin. The COPD patients who took aspirin also did better on the 50-question St. George Respiratory Questionnaire score, which measures quality of life in patients with diseases of airway obstruction. While daily aspirin users reported a lower incidence of flare-ups, the findings need further confirmation, the authors write. “The study demonstrated only a small effect on moderate exacerbations and didn’t indicate that aspirin is as effective as other therapies in reducing exacerbations,” says Amber Lanae Martirosov, PharmD, MSc, BCPS, clinical pharmacy specialist ambulatory care at Henry Ford Health Systems, and clinical assistant professor in the Department of Pharmacy Practice at Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University. “The observational study design also provides some limitations and should be a starting point, not a reason to change clinical practice.” Martirosov urged caution when interpreting the results because ratios tend to overestimate data in research. “Additionally, the study did not provide information about dosing, adherence, or duration of aspirin therapy,” she says. “As such, we are not able to make sound recommendations about aspirin therapy in terms of dosing or duration.”
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Metrics of Mary Jane monitoring

In November, Michigan voted to become the 10th state to approve the use of recreational cannabis. While medical cannabis avails in 23 others. One wonders how many drivers at any given moment have used the substance? In Detroit, scientists are addressing the dearth of knowledge. On the Tuesday before Thanksgiving, Randy Commissaris and Kawthar Alali were in their lab at Wayne State University putting subjects through exercises. Commissaris, associate professor in the department of Pharmaceutical Sciences, and Alali, a graduate student from Saudi Arabia, installed volunteers behind the wheel of a Chevrolet Impala on loan from Doreen Head, director of the school’s occupational therapy program. Pointing at a large screen for fixed-base simulation of real-world driving, the Impala, outfitted with Drive Safety hardware and sensors, translated driver inputs through an interactive program called HyperDrive. The researchers measured performance of a control: a young male whose blood was first drawn and assessed to assure no trace of THC. And the performance of a medical cannabis user: another  young male — the pair were numbers nine and 10 so far in the study — who had consumed the substance within the hour (his cannabis-free baseline was previously established). Each subject spent an hour in the Impala.
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Have you experienced 'highway hypnosis?'

Randall Commissaris, associate professor in the Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, talked about highway hypnosis. The phenomenon involves drivers who are aware and paying attention while operating their vehicle, yet, they don’t remember doing it. They’re in a routine while driving and not looking for exits – similar to operating on auto-pilot. Commissaris says one of the biggest potential risks is the challenge of dealing with a surprise situation. Commissaris uses a driving simulator and willing volunteers to study driving at Wayne State University.
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Expert views on Michigan's recreational marijuana proposal

At the event hosted by the Wayne State University College of Pharmacy and Health Studies, Christine Rabinak, an associate professor of pharmacy practice at the college, detailed the history of marijuana in the U.S. and the effects and characteristics of different strains. Randall Commissaris, an associate professor at Wayne State, has studied the effects of marijuana on driving ability. He told the audience Tuesday that a "yes" vote on Prop 1 will make Michigan either the ninth or tenth state to legalize recreational pot.