The Effectiveness of Team-based Case-based Learning Approach on the Learning Outcome: A Single Course Level in a University Setting

Background@#Case-based learning (CBL) is becoming an important approach for improving interprofessional collaboration education. Previous studies have examined learners’ satisfaction with interprofessional education (IPE) in medical institutions.However, there are few studies on the implementation of university-led CBL interventions and their direct effects on learning outcomes. The aim of this study was to evaluate the effectiveness of CBL interventions on changes in the participants’ perception and knowledge acquisition ability. @*Methods@#The CBL approach consisted of team-based case-based learning, self-directed learning, and post-feedback. It was conducted as a single course for pharmacy students in their 5th year in a university setting. Changes in the participants’ perceptions and self-assessments of competence levels were evaluated using survey responses. The effect of the CBL intervention on knowledge acquisition ability was directly evaluated using the exam score. @*Results@#The majority agreed or strongly agreed that team-based case-based learning, and self-directed learning helped them to improve their knowledge and skills to a higher level and to increase the self-assessment of competency level. The average score of knowledge acquisition ability (average score of 75.0, p=0.0098) was significantly higher in the CBL intervention group than the lecture-based learning intervention group (average score of 52.0). @*Conclusion@#The participants positively perceived that CBL intervention helped them to effectively improve their knowledge and the self-assessment of competency level. It also enhanced knowledge acquisition ability. These data, based on the survey responses, suggest that it is necessary to implement CBL interventions in a university-led single professional education.

Current status of interprofessional education learning activities in wards provided by tertiary hospitals and secondary general hospitals and barriers

Background@#The World Health Organization (WHO) has focused on the need for interprofessional education (IPE) to improve interprofessional collaboration competency and patient health outcomes. Accordingly, most European and North American medical colleges have established IPE for students. However, IPE learning activity in medical wards for the clinical experience of pharmacy students has not been fully reviewed in Korea. Therefore, this study aims to examine the current status of IPE learning activities in wards at tertiary and secondary hospitals in order to identify ways to improve the program. @*Methods@#The official document of cooperation consists of six self-administered questions regarding IPE learning activities in wards. The preceptor’s response in each hospital was evaluated. @*Results@#Of the 22 hospitals, 9 tertiary hospitals and 12 secondary general hospitals responded. For the introductory pharmacy practice experience (IPPE), participating in intensive care (IC) was provided at one secondary general hospital (8.3%) and no tertiary hospital. Ward rounds with medical staff members were provided at two tertiary hospitals (22.2%) and one (8.3%) secondary general hospital. A major barrier to executing IPE was lack of rewards and incentives for the faculty and preceptors who participated in the program. @*Conclusion@#In both tertiary hospitals and secondary general hospitals, pharmacy students have limited exposure to IPE learning activities in wards at hospital, and IPPE at most hospitals was carried out in pharmacy settings only. This study suggests that it is necessary for the hospitals to improve and support IPE learning activities in wards in order to improve learners’ competency.

Competency Assessment Tool and Faculty Assessors for Competency-based Pharmacy Education: A Preliminary Study of Its Applications and Advantages

Background@#Recently, the Korean Association of Pharmacy Education has been focusing on competency-based education (CBE) and has established required areas of competencies to improve the graduation competency. However, competency-based assessment (CBA) tools for implementing CBE have not yet been developed for faculty members and students to successfully access the assessment tests. Moreover, the faculty members in charge in pharmacy schools have encountered various barriers in recruiting individuals with integrated clinical experience to act as virtual patients. Therefore, this study aimed to identify the advantages and limitations of applying CBA tool and faculty assessors in the development of CBE to ensure the reliability of this assessment. @*Methods@#Utilizing CBA tool, the students’ communication skills and styles were assessed. students and faculty assessors were surveyed to evaluate the advantages and limitations of the CBA tool. @*Results@#8 assessors and 96 students participated in this study. 100% (8/8) of the faculty assessors and 77.4% (65/84) of the students reported that CBA tool is valuable to assess and improve student’s ability. 90.5% (76/84) of the students felt confident in applying knowledge to patient-centered care. CBA tool can be a valuable for the instructors in identifying the competency level of students but can also be associated with limitations in implementation to ensure the objectivity and reliability of the CBA. @*Conclusions@#The CBA tool can be valuable in assessing the level of students’ competency. Faculty assessors have the advantage of well-prepared themselves for patient roles, so that the time and cost required may be minimized.

Physical Activity and Prevalence of Rheumatoid Arthritis in Korean Adults with Prediabetes in the 2009–2013 National Health Cohort Study

BACKGROUND@#Rheumatoid arthritis is highly prevalent in overweight patients with type 2 diabetes mellitus and can be reduced by physical activity via altered proinflammatory parameters. However, the association between the frequency of physical activity and the prevalence of rheumatoid arthritis in prediabetic patients remains unclear and was evaluated in this study.@*METHODS@#Utilizing the Korean National Health Insurance Sharing Service database, 58,391 adults, who met the research criteria and underwent a general medical check-up between 2009 and 2013, were selected for this study. To analyze the data, a logistic regression with a proc survey logistic procedure was used.@*RESULTS@#The study revealed that the cumulative rheumatoid arthritis prevalence was lower in prediabetic patients compared to that in the control group (OR, 0.64; 95% CI, 0.483–0.840; p=0.001). More frequent physical activity (≥3 days/week) was significantly associated with a reduced rheumatoid arthritis prevalence in both groups (OR, 0.28; 95% CI, 0.039–0.521; p=0.044 vs. OR, 0.15; 95% CI, 0.063–0.237; p=0.007). Additionally, a 3.8-fold higher risk of rheumatoid arthritis development was observed in prediabetic adults with less frequent baseline physical activity (≤2 days/week). Overall, in prediabetes, the prevalence of rheumatoid arthritis was associated with the frequency of physical activity and not with the fasting plasma glucose levels.@*CONCLUSION@#More frequent physical activity is associated with a low risk of developing rheumatoid arthritis in prediabetic patients. Thus, further studies are needed to confirm the clinical outcomes of frequent physical activity in rheumatoid arthritis prevention and control.

Long Term Assessment of Outcome of Essential Competencies in CPPE at Tertiary and Secondary Hospitals Located in Seoul and Gyeonggi-do: College of Pharmacy Students' Evaluation from 2014 to 2018

OBJECTIVE: As the demands of healthcare environment change, it is necessary to advance human health care by improving students' essential competencies including knowledge, skills, abilities, inter-professional collaboration and patient centered care. This study identified long term accomplishment and improvement of the essential competencies in clinical pharmacy practice education (CPPE) at Korean hospitals over time. METHODS: This study was conducted for pharmacy students who completed CPPE evaluation related to tertiary hospitals and secondary hospitals located in Seoul and Gyeonggi-do regional area from 2014 to 2018. RESULTS: Over the past 5 years, overall results of student evaluation on the essential competencies in CPPE at both tertiary and secondary hospitals showed a decreasing trend or did not change. Essential competency in CPPE at tertiary hospitals had been identified as superior on ‘Learn clinical knowledge in the treatment of diseases’ to secondary hospitals [average number of students (%): 210 (72.9%) vs 68 (68.0%)]. On the other hand, essential competencies in CPPE at secondary hospitals had been identified as better at ‘inter-professionals collaborative teamwork and direct patient care’ than tertiary hospitals [average number of students (%): 64 (64.0%) and 56 (56.0%) vs 121 (42.0%) and 90 (31.3%)]. A total of 176 (61.1%) students in tertiary hospitals and 66 (66.0%) in secondary hospitals evaluated that ‘patient-centered care’ education was good. CONCLUSION: In tertiary hospitals, all six essential competency outcomes have not been improved, whereas four essential competency outcomes showed an increasing trend in secondary hospitals. It will be necessary to develop outcome-based CPPE education program to better reflect the essential competencies.

Risk of Fracture Prevalence and Glycemic Control in Korean Older and Middle-aged Patients with Diabetes: A Retrospective Analysis of a Cohort Derived from the Korean National Health Insurance Sharing Service Database, 2009–2013

BACKGROUND: Bone fractures are high in elderly patients with type 2 diabetes mellitus (T2DM). Hyperglycemia and chronic kidney disease may increase the risk of fracture prevalence via altered bone metabolism, but whether glycemic control and kidney function are associated with the risk of fracture prevalence remains unclear. This study evaluated the relationship between glycemic control and baseline estimated glomerular filtration rate (eGFR) and risk of fracture prevalence in older and middle-aged patients with T2DM. METHODS: Patients who underwent a general medical check-up between 2009 and 2013 were selected from the Korean National Health Insurance Sharing Service records. Chi-square test and multiple logistic regression analysis were used to assess the relationship between glycemic control and eGFR and risk of fracture prevalence. RESULTS: Cumulative fracture prevalence were higher in patients with T2DM, irrespective of whether they had tight or less stringent glycemic control (fasting blood glucose [FBG] ≥ 110 mg/dL). After adjustment for baseline age and FBG, tight and less stringent glycemic control was significantly associated with increased adjusted risk of fracture prevalence in middle-aged patients with T2DM (OR=1.13, 95% CI, 1.05–1.21, p=0.0005 vs OR=1.13, 95% CI, 1.06–1.20, p=0.0001), but not in older patients. Baseline eGFR was not significantly related to fracture prevalence in either older or middle-aged patients. CONCLUSION: Less stringent glycemic control significantly increased the adjusted risk of fracture prevalence in middle-aged patients with T2DM. Further studies are needed to confirm the effect of tight glycemic control on fracture prevalence.

The Effect of Metformin on Antipsychotic-induced Weight Gain in Patients with Schizophrenia or Schizoaffective Disorder: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials

BACKGROUND: In this systematic review and meta-analysis, the effect of metformin on weight loss was assessed to determine whether metformin should be recommended for the prevention or treatment of weight gain in patients receiving antipsychotic medication for the treatment of schizophrenia or schizoaffective disorder. METHODS: The PubMed, Embase, and Cochrane Library databases were searched for all published randomized controlled trials (RCTs) from inception to June 2018. In addition, the references of relevant articles were also examined. Using Review Manager 5, the pooled estimates of the weighted mean difference (WMD) of the changes in body weight and body mass index (BMI) and the corresponding 95 % confidence intervals (CIs) were calculated. RESULTS: The meta-analysis included 15 RCTs. The pooled analysis showed that compared with placebo, metformin led to significant reductions in body weight (WMD: −2.09, 95% CI: −2.59, −1.60; p<0.00001) and BMI (WMD: −0.90, 95% CI: −1.08, −0.72; p<0.00001). The effect of metformin on weight loss was greater in patients receiving olanzapine than in patients receiving clozapine (body weight, WMD: −2.39, 95% CI: −3.76, −1.02; p=0.0006 for olanzapine; −1.99, 95% C: −3.47, −0.51; p=0.009 for clozapine; BMI, WMD: −1.15, 95% CI: −1.74, −0.57, p=0.0001 for olanzapine; WMD: 0.76, 95% CI: −1.23, −0.28; p=0.002 for clozapine). CONCLUSION: Metformin can be recommended to manage olanzapine-induced weight gain in patients with schizophrenia or schizoaffective disorder. The magnitude of the reductionss in body weight and BMI implieds that the use of metformin to attenuate olanzapine-induced weight gain can minimize the risk of coronary heart disease.

Evaluation of Pharmacy Students' Perception on Clinical Pharmacy Practice Experience in the Tertiary and Secondary Hospital settings

BACKGROUND: Clinical Pharmacy Practice Experience (CPPE) is an important curriculum that offers students patient-centered disease prevention and treatment with evidence-based optimal pharmacotherapy for better clinical outcomes. However, few studies have evaluated the perception of pharmacy students regarding CPPE in tertiary and secondary hospitals. This study aimed to evaluate the perception of pharmacy students regarding the learning program of CPPE. METHODS: The survey questionnaire consisted of 15 self-administered questions regarding pharmacy practices, barriers, and improvement of practical training. Fourteen institutional pharmacies located in seven regions responded to a survey questionnaire from March 1 to June 30, 2017. The participants were pharmacy students doing clerkship in a hospital setting. RESULTS: The response rate was 73.6%. Thirty-five participants (22.4%) had used a hospital library, but 121 (77.6%) had never used the library for drug information resources. Eighty-one (50.0%) responded that clinical knowledge and drug information was the most beneficial practice. Thirty-seven (31.1%) respondents in the tertiary hospitals and 19 (46.3%) in the secondary hospitals answered that they were filling prescriptions during the daily break. On the other hand, 72 respondents (60.5%) in the tertiary hospitals and 17 (41.5%) in the secondary hospitals did literature research to prepare for presentation. CONCLUSION: More students in secondary hospitals continue to fill prescriptions during the daily break, as compared to those in tertiary hospitals. Therefore, the authors suggest self-directed learning to improve clinical performance and each institution considers offering onsite or online library service to improve evidence-based CPPE for pharmacy school students.

Management of Chronic Kidney Disease-Mineral Bone Disorder with Sevelamer Hcl Phosphate Binder in Korean Patients with Dialysis

BACKGROUND: Sevelamer is associated with reduced complications of chronic kidney disease-mineral bone disorder (CKD-MBD) resulted from hyperphosphatemia, which may contribute mortality, in CKD patients with dialysis. So far clinical outcomes of sevelamer on mortality and risk of cardiovascular mortality related to CKD-MBD are debating. Purpose of this study was to evaluate the effectiveness of sevelamer HCl on mortality of secondary hyperparathyroidism (SHPT), risk of cardiovascular mortality and, frequency of osteopathy in end stage renal disease (ESRD) patients with dialysis. METHODS: We retrospectively reviewed the electronic medical records of 536 patients with ESRD, who were admitted for moderate to severe SHPT, for 36 months. 75 patients who met inclusion criteria were evaluated for the efficacy of sevelamer (mean serum iPTH = 487.5 pg/mL). RESULTS: Sevelamer intervention was not associated with increased three-year survival time compared with non-sevelamers group [average survival month: 30.4 months in sevelamer group, 26.8 months in non-sevelamer group, p = 0.463]. Sevelamer intervention was not associated with significant mortality benefit and cardiovascular mortality benefit as compared to non-sevelamer group [sevelamer group: non-sevelamer group, all-cause mortality (iPTH > 600 pg/mL): 14.3% (1/34): 20% (1/41) p = 0.962, OR = 0.935, 95% CI, 0.058-14.98, heart disease mortality: 6.67% (2/30): 0% (0/32) p = 0.138]. Sevelamer was not associated with significantly lower cumulative incidence of osteopathy compared to non-sevelamer group (sevelamer group: non-sevelamer group, 5.9% (2/34):9.8% (4/41); p = 0.538; OR = 0.578; 95% CI, 0.099-3.367). CONCLUSION: Sevelamer was not associated with decreased all-cause mortality and risk of cardiovascular mortality compared to non-sevelamer group in ESRD patients with SHPT.