Gloria R Grice

St. Louis College of Pharmacy, San Luis, Missouri, United States

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Publications (23)74.29 Total impact

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    ABSTRACT: Objective: Evaluate curricular changes related to health literacy and determine impact on independent-living senior residents as part of an introductory pharmacy practice experience for third-year student pharmacists.Design: Students were randomly assigned a resident whom they visited multiple times to conduct assessments and provide various services using three methods: Ask Me 3™ Four Habits Model, and Teach-back.Setting: The study was conducted at independent-living apartments within a 24-mile radius from the St. Louis College of Pharmacy, St. Louis, Missouri. Patients, Participants: Participants (n = 147 to 173, across all three years) were volunteer, elderly residents, living at a facility that collaborated with the research.Interventions: Within one academic year, students collected medical and medication histories, conducted household safety checks, performed screening assessments, assessed adherence, and provided general recommendations to a resident.Main Outcome Measure(s): Outcomes included resident satisfaction, student satisfaction, and correlations between student use of health literacy tools and resident satisfaction.Results: Exit surveys indicated resident overall satisfaction with the program, increased understanding of health-related information, increased confidence in asking health care professionals questions about their health, and greater commitment to medication adherence as a result of the experience. Students were highly satisfied with the program. Analyses reveal some correlations between a previously determined performance level of student communication and resident satisfaction.Conclusions: Students' use of health literacy communication tools during encounters with independent-living senior residents can result in greater patient understanding and empowerment, which may in turn help improve medication adherence.
    The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists 04/2014; 29(4):240-53.
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    ABSTRACT: Creating opportunities for students of multiple health professions to achieve the interprofessional competencies is critical to prepare them to enter the health care system and provide effective team-based care. Challenges can be experienced by any health profession school when establishing these opportunities; independent, private schools with limited health profession degrees may experience even greater difficulty. As an independent, private college, St. Louis College of Pharmacy (STLCOP) has successfully created interprofessional courses with three neighboring schools. In Interprofessional Team Seminar (IPTS), students participate in an interprofessional experience at St. Louis University (SLU) as part of the required Introductory Pharmacy Practice Experience in professional year (PY)-3. SLU students enrolled in medicine, nursing, physical therapy, occupational therapy, social work, and physician assistant programs join with STLCOP student pharmacists to discuss patient cases with an emphasis on patient safety, prioritizing goals, and teamwork. An elective course, “Indigent Populations: Focus on Health Literacy” is co-coordinated with Washington University in St. Louis (WUSTL) and Goldfarb School of Nursing at Barnes-Jewish College (GSN) faculty and allows PY-2 and PY-3 student pharmacists to work collaboratively with students from GSN to serve the homeless in the city. The aim is to describe lessons learned and share strategies for successful interprofessional education design and implementation among similar institutions.
    Currents in Pharmacy Teaching and Learning 11/2013; 5(6):626–631.
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    ABSTRACT: Objective To outline a student-led academic honor code initiative and the impact student leadership and involvement had in the overall development, implementation, and acceptance of the St. Louis College of Pharmacy Academic Honor Code and Integrity Policy (AHCIP). Methods The AHCIP was developed between January 2010 and April 2011. A survey was conducted in the spring of 2010 to assess student and faculty views on academic dishonesty. Key stakeholders were then provided additional opportunities for feedback through focus groups and regularly scheduled meetings. Multiple versions of the AHCIP were drafted, and the policy was approved by students, faculty, and the administration in April 2011. Implementation followed in August 2011. Results As a result of a highly transparent and collaborative process, a successful and sustained implementation of a student-developed AHCIP occurred at St. Louis College of Pharmacy. Data on AHCIP reports are recorded each semester for continued evaluation. At the end of the first semester (Fall 2011), 23 potential violations were reported and evaluated by a judicial panel; 14 were found to be violations, while nine were considered not to be violations. At the end of the following semester (Spring 2012), four reports were received and reviewed by the judicial panel, and three were considered to be violations of the AHCIP. Conclusion A student-led initiative with emphasis on transparency and engagement from key stakeholders can lead to successful implementation and college-wide acceptance of an academic honor code at a professional school.
    Currents in Pharmacy Teaching and Learning 11/2013; 5(6):637–644.
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    ABSTRACT: Objective. To determine the feasibility of using a validated set of assessment rubrics to assess students' critical-thinking and problem-solving abilities across a doctor of pharmacy (PharmD) curriculum. Methods. Trained faculty assessors used validated rubrics to assess student work samples for critical-thinking and problem-solving abilities. Assessment scores were collected and analyzed to determine student achievement of these 2 ability outcomes across the curriculum. Feasibility of the process was evaluated in terms of time and resources used. Results. One hundred sixty-one samples were assessed for critical thinking, and 159 samples were assessed for problem-solving. Rubric scoring allowed assessors to evaluate four 5- to 7-page work samples per hour. The analysis indicated that overall critical-thinking scores improved over the curriculum. Although low yield for problem-solving samples precluded meaningful data analysis, it was informative for identifying potentially needed curricular improvements. Conclusions. Use of assessment rubrics for program ability outcomes was deemed authentic and feasible. Problem-solving was identified as a curricular area that may need improving. This assessment method has great potential to inform continuous quality improvement of a PharmD program.
    American journal of pharmaceutical education 10/2013; 77(8):166. · 1.21 Impact Factor
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    ABSTRACT: Objective. To determine whether there is a difference in student pharmacists' learning or satisfaction when standardized patients or manikins are used to teach physical assessment. Design. Third-year student pharmacists were randomized to learn physical assessment (cardiac and pulmonary examinations) using either a standardized patient or a manikin. Assessment. Performance scores on the final examination and satisfaction with the learning method were compared between groups. Eighty and 74 student pharmacists completed the cardiac and pulmonary examinations, respectively. There was no difference in performance scores between student pharmacists who were trained using manikins vs standardized patients (93.8% vs. 93.5%, p=0.81). Student pharmacists who were trained using manikins indicated that they would have probably learned to perform cardiac and pulmonary examinations better had they been taught using standardized patients (p<0.001) and that they were less satisfied with their method of learning (p=0.04). Conclusions. Training using standardized patients and manikins are equally effective methods of learning physical assessment, but student pharmacists preferred using standardized patients.
    American journal of pharmaceutical education 05/2013; 77(4):77. · 1.21 Impact Factor
  • Alexander W Ogweno, Gloria R Grice
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    ABSTRACT: OBJECTIVES To shed light on the growing prevalence of type 2 diabetes in sub-Saharan Africa and to highlight the important role that pharmacists can play in addressing this growing global concern. SUMMARY The combination of scarce health care resources, a lack of general awareness and data to drive new policies, and the severe shortage of health workers has contributed to the escalation of chronic disease in sub-Saharan Africa. The profession of pharmacy offers extensive knowledge on disease and medication management that has proven to yield positive health outcomes. Deploying pharmacists from the United States who can train and support community health workers in sub-Saharan Africa and in other resource constrained settings may help address many of the challenges that currently exist. CONCLUSION Despite the many challenges sub-Saharan Africa faces in overcoming the current and growing burden of chronic disease, pharmacists can make substantial contributions in addressing these challenges and creating sustainable solutions.
    Journal of the American Pharmacists Association 11/2012; 52(6):e292-5.
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    ABSTRACT: OBJECTIVE: To assess whether student pharmacists' communication skills improved using the Four Habits Model (FHM) at the St. Louis College of Pharmacy. METHODS: During the Fall of 2009 and 2010, student pharmacists in the third professional year learned and practiced the FHM. They were given feedback by faculty on three of the four Habits, used the FHM for self and peer assessment, and were formally evaluated on all four Habits during a standardized patient encounter. RESULTS: Student pharmacist performance significantly improved from baseline during both Fall 2009 and Fall 2010 in the majority of the Habits assessed. CONCLUSION: Use of the FHM in pharmacy education can improve a student pharmacists' ability to display the four Habits of communicating and developing relationships with patients. Tailoring of the FHM to pharmacy encounters will further enhance the utility of this communication framework. PRACTICE IMPLICATIONS: Use of the FHM enhances the measurement and assessment of the relational aspects of student pharmacist-patient communication skills. Consistent use of the FHM over time is likely necessary to fully develop and retain communication skills. The overall goal is to improve patient's health literacy and appropriate medication use by improving communication and the pharmacist-patient relationship.
    Patient Education and Counseling 09/2012; · 2.60 Impact Factor
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    ABSTRACT: By guiding initial warfarin dose, pharmacogenetic (PGx) algorithms may improve the safety of warfarin initiation. However, once international normalised ratio (INR) response is known, the contribution of PGx to dose refinements is uncertain. This study sought to develop and validate clinical and PGx dosing algorithms for warfarin dose refinement on days 6-11 after therapy initiation. An international sample of 2,022 patients at 13 medical centres on three continents provided clinical, INR, and genetic data at treatment days 6-11 to predict therapeutic warfarin dose. Independent derivation and retrospective validation samples were composed by randomly dividing the population (80%/20%). Prior warfarin doses were weighted by their expected effect on S-warfarin concentrations using an exponential-decay pharmacokinetic model. The INR divided by that "effective" dose constituted a treatment response index . Treatment response index, age, amiodarone, body surface area, warfarin indication, and target INR were associated with dose in the derivation sample. A clinical algorithm based on these factors was remarkably accurate: in the retrospective validation cohort its R(2) was 61.2% and median absolute error (MAE) was 5.0 mg/week. Accuracy and safety was confirmed in a prospective cohort (N=43). CYP2C9 variants and VKORC1-1639 G→A were significant dose predictors in both the derivation and validation samples. In the retrospective validation cohort, the PGx algorithm had: R(2)= 69.1% (p<0.05 vs. clinical algorithm), MAE= 4.7 mg/week. In conclusion, a pharmacogenetic warfarin dose-refinement algorithm based on clinical, INR, and genetic factors can explain at least 69.1% of therapeutic warfarin dose variability after about one week of therapy.
    Thrombosis and Haemostasis 12/2011; 107(2):232-40. · 5.76 Impact Factor
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    ABSTRACT: Via generation of vitamin K-dependent proteins, gamma-glutamyl carboxylase (GGCX) plays a critical role in the vitamin K cycle. Single nucleotide polymorphisms (SNPs) in GGCX, therefore, may affect dosing of the vitamin K antagonist, warfarin. In a multi-centered, cross-sectional study of 985 patients prescribed warfarin therapy, we genotyped for two GGCX SNPs (rs11676382 and rs12714145) and quantified their relationship to therapeutic dose. GGCX rs11676382 was a significant (p=0.03) predictor of residual dosing error and was associated with a 6.1% reduction in warfarin dose (95% CI: 0.6%-11.4%) per G allele. The prevalence was 14.1% in our predominantly (78%) Caucasian cohort, but the overall contribution to dosing accuracy was modest (partial R2 = 0.2%). GGCX rs12714145 was not a significant predictor of therapeutic dose (p = 0.26). GGCX rs11676382 is a statistically significant predictor of warfarin dose, but the clinical relevance is modest. Given the potentially low marginal cost of adding this SNP to existing genotyping platforms, we have modified our non-profit website (www.WarfarinDosing.org) to accommodate knowledge of this variant.
    Thrombosis and Haemostasis 10/2010; 104(4):750-4. · 5.76 Impact Factor
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    ABSTRACT: Well-characterized genes that affect warfarin metabolism (cytochrome P450 (CYP) 2C9) and sensitivity (vitamin K epoxide reductase complex 1 (VKORC1)) explain one-third of the variability in therapeutic dose before the international normalized ratio (INR) is measured. To determine genotypic relevance after INR becomes available, we derived clinical and pharmacogenetic refinement algorithms on the basis of INR values (on day 4 or 5 of therapy), clinical factors, and genotype. After adjusting for INR, CYP2C9 and VKORC1 genotypes remained significant predictors (P < 0.001) of warfarin dose. The clinical algorithm had an R2 of 48% (median absolute error (MAE): 7.0 mg/week) and the pharmacogenetic algorithm had an R2 of 63% (MAE: 5.5 mg/week) in the derivation set (N = 969). In independent validation sets, the R2 was 26–43% with the clinical algorithm and 42–58% when genotype was added (P = 0.002). After several days of therapy, a pharmacogenetic algorithm estimates the therapeutic warfarin dose more accurately than one using clinical factors and INR response alone.
    Clinical Pharmacology &#38 Therapeutics 04/2010; 87(5):572-578. · 6.85 Impact Factor
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    ABSTRACT: Warfarin demonstrates a wide interindividual variability in response that is mediated partly by variants in cytochrome P450 2C9 (CYP2C9) and vitamin K 2,3-epoxide reductase complex subunit 1 (VKORC1). It is not known whether variants in calumenin (CALU) (vitamin K reductase regulator) have an influence on warfarin dose requirements. We resequenced CALU regions in a discovery cohort of dose outliers: patients with high (>90th percentile, n = 55) or low (<10th percentile, n = 53) warfarin dose requirements (after accounting for known genetic and nongenetic variables). One CALU variant, rs339097, was associated with high doses (P = 0.01). We validated this variant as a predictor of higher warfarin doses in two replication cohorts: (i) 496 patients of mixed ethnicity and (ii) 194 African-American patients. The G allele of rs339097 (the allele frequency was 0.14 in African Americans and 0.002 in Caucasians) was associated with the requirement for a 14.5% (SD +/- 7%) higher therapeutic dose (P = 0.03) in the first replication cohort and a higher-than-predicted dose in the second replication cohort (allele frequency 0.14, one-sided P = 0.03). CALU rs339097 A>G is associated with higher warfarin dose requirements, independent of known genetic and nongenetic predictors of warfarin dose in African Americans.
    Clinical Pharmacology &#38 Therapeutics 03/2010; 87(4):445-51. · 6.85 Impact Factor
  • 2009 American College of Clinical Pharmacy Spring Practice and Research Forum; 04/2009
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    ABSTRACT: Purpose: (1) Retrospectively, to develop pharmacogenetic and clinical dose-refinement algorithms to predict the therapeutic warfarin dose after 4 days of therapy and (2) prospectively, to compare 30-day laboratory and clinical outcomes of these two algorithms. Methods: In orthopedic patients beginning warfarin therapy, we used stepwise regression to develop pharmacogenetic and clinical dose-refinement algorithms and prospectively validated the accuracy and safety of these algorithms. Results: The pharmacogenetic algorithm used CYP2C9 genotype, smoking status, perioperative blood loss, liver disease, INR values, and initial warfarin doses to predict the therapeutic dose (VKORC1 did not appear to be as useful in dose-refinement as it was in dose-initiation algorithms). The R2 was 82% in a derivation cohort (N = 86), and 70% when used prospectively (N = 146). The R2 of the clinical algorithm that used INR values and initial warfarin doses to predict the therapeutic dose was 57% in a derivation cohort (N = 179), and 48% in a prospective validation cohort (N = 146). After 30 days, the percent time spent in the therapeutic range was 7% higher (95% CI: 2.7%-11.7%) in the pharmacogenetic cohort. The risk of laboratory or clinical adverse event was also significantly reduced in the pharmacogenetic cohort (Hazard Ratio 0.54; 95% CI: 0.29-0.97). Conclusions: In this non-randomized study of orthopedic patients, pharmacogenetic dose refinements were associated with more time spent in the therapeutic range, fewer laboratory or clinical adverse events, and correlated more closely with therapeutic dose. To facilitate gene-guided warfarin dosing we created www.WarfarinDosing.org.
    2008 American College of Clinical Pharmacy Annual Meeting; 10/2008
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    Journal of Thrombosis and Haemostasis 09/2008; 6(9):1445-9. · 6.08 Impact Factor
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    ABSTRACT: Warfarin is commonly prescribed for prophylaxis and treatment of thromboembolism after orthopedic surgery. During warfarin initiation, out-of-range International Normalized Ratio (INR) values and adverse events are common. In orthopedic patients beginning warfarin therapy, we developed and prospectively validated pharmacogenetic and clinical dose refinement algorithms to revise the estimated therapeutic dose after 4 days of therapy. The pharmacogenetic algorithm used the cytochrome P450 (CYP) 2C9 genotype, smoking status, peri-operative blood loss, liver disease, INR values and dose history to predict the therapeutic dose. The R(2) was 82% in a derivation cohort (n = 86) and 70% when used prospectively (n = 146). The R(2) of the clinical algorithm that used INR values and dose history to predict the therapeutic dose was 57% in a derivation cohort (n = 178) and 48% in a prospective validation cohort (n = 146). In 1 month of prospective follow-up, the percent time spent in the therapeutic range was 7% higher (95% CI: 2.7-11.7) in the pharmacogenetic cohort. The risk of a laboratory or clinical adverse event was also significantly reduced in the pharmacogenetic cohort (Hazard Ratio 0.54; 95% CI: 0.30-0.97). Warfarin dose adjustments that incorporate genotype and clinical variables available after four warfarin doses are accurate. In this non-randomized, prospective study, pharmacogenetic dose refinements were associated with more time spent in the therapeutic range and fewer laboratory or clinical adverse events. To facilitate gene-guided warfarin dosing we created a non-profit website, http://www.WarfarinDosing.org.
    Journal of Thrombosis and Haemostasis 08/2008; 6(10):1655-62. · 6.08 Impact Factor
  • Gloria R Grice, Marsha K Mertens
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    ABSTRACT: Gabapentin has been approved in the United States for the treatment of epilepsy and postherpetic neuralgia. Gabapentin has also demonstrated proven efficacy for the treatment of diabetic peripheral neuropathy and trigeminal neuralgia, although these represent off-label uses of the drug. However, to our knowledge, no data have been published regarding the efficacy of gabapentin for treating sciatica. We describe two patients with sciatica who were successfully treated with gabapentin. The first was a 32-year-old man with severe shooting pain in his left leg that was later diagnosed as sciatica secondary to a fifth lumbar-first sacral intervertebral disk herniation. The patient was treated with acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), narcotics, and muscle relaxants; he reported only limited pain relief with any of these agents or combination of agents. He was then prescribed gabapentin 300 mg once/day; his pain substantially improved, even after the first dose. The drug was titrated gradually up to 900 mg 3 times/day with good results. The patient subsequently underwent a laminectomy and diskectomy on the advice of his neurosurgeon, who assured him that the result would be immediate pain relief. After surgery, the patient continued to experience pain; however, his pain resolved completely after several weeks of receiving gabapentin 600 mg 3 times/day. The second patient was a 68-year-old Caucasian woman with renal insufficiency who experienced severe burning pain and numbness of abrupt onset in the posterior right leg; this was diagnosed as sciatica. The patient had contraindications for NSAID therapy and was intolerant of hydrocodone. Initial therapy with propoxyphene and acetaminophen, self-started by the patient, was ineffective. Gabapentin 100 mg at bedtime was started and then titrated up to 100 mg twice/day with 200 mg at bedtime. The patient's pain improved rapidly, and at follow-up approximately 5 weeks later, she was experiencing good pain control with gabapentin. Gabapentin is widely prescribed for management of peripheral neuropathic pain syndromes. To our knowledge, however, these two case reports are the first to describe sciatica successfully controlled with gabapentin. Because gabapentin has the potential to prevent central sensitization, consideration should be given to prescribing this therapy early in the course of sciatica. Further research using randomized, placebo-controlled trials are needed to validate the benefit of gabapentin in the treatment of sciatica.
    Pharmacotherapy 04/2008; 28(3):397-402. · 2.31 Impact Factor
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    ABSTRACT: Initiation of warfarin therapy using trial-and-error dosing is problematic. Our goal was to develop and validate a pharmacogenetic algorithm. In the derivation cohort of 1,015 participants, the independent predictors of therapeutic dose were: VKORC1 polymorphism -1639/3673 G>A (-28% per allele), body surface area (BSA) (+11% per 0.25 m2), CYP2C9*3 (-33% per allele), CYP2C9*2 (-19% per allele), age (-7% per decade), target international normalized ratio (INR) (+11% per 0.5 unit increase), amiodarone use (-22%), smoker status (+10%), race (-9%), and current thrombosis (+7%). This pharmacogenetic equation explained 53–54% of the variability in the warfarin dose in the derivation and validation (N= 292) cohorts. For comparison, a clinical equation explained only 17–22% of the dose variability (P < 0.001). In the validation cohort, we prospectively used the pharmacogenetic-dosing algorithm in patients initiating warfarin therapy, two of whom had a major hemorrhage. To facilitate use of these pharmacogenetic and clinical algorithms, we developed a nonprofit website, http://www.WarfarinDosing.org.
    Clinical Pharmacology &#38 Therapeutics 02/2008; 84(3):326-331. · 6.85 Impact Factor
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    G R Grice, P E Milligan, C Eby, B F Gage
    Journal of Thrombosis and Haemostasis 02/2008; 6(1):207-9. · 6.08 Impact Factor
  • Journal of Thrombosis and Thrombolysis 01/2008; 25(1):102-102. · 1.99 Impact Factor
  • Journal of Thrombosis and Thrombolysis 01/2008; 25(1):100-100. · 1.99 Impact Factor

Publication Stats

612 Citations
74.29 Total Impact Points

Institutions

  • 2007–2013
    • St. Louis College of Pharmacy
      • Department of Pharmacy Practice
      San Luis, Missouri, United States
  • 2011
    • Intermountain Medical Center
      Salt Lake City, Utah, United States
  • 2007–2010
    • Washington University in St. Louis
      • Department of Medicine
      Saint Louis, MO, United States
  • 2008
    • University of Missouri - St. Louis
      Saint Louis, Michigan, United States
    • University of Washington Seattle
      • Division of General Internal Medicine
      Seattle, WA, United States