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1.
J Pharm Pract ; 37(1): 239-242, 2024 Feb.
Article in English | MEDLINE | ID: mdl-36656727

ABSTRACT

Eravacycline is approved by the U.S. Food and Drug Administration (FDA) for the treatment of complicated intra-abdominal infections. It is a novel, fully synthetic fluorocycline antibiotic belonging to the tetracycline class with a broad-spectrum of activity and an appealing side effect profile. This report describes a 74-year-old female who presented to the hospital with non-ST-elevation myocardial infarction (NSTEMI) requiring coronary artery bypass graft surgery. After surgery, she developed a sternal wound infection that grew multidrug resistant organisms, leading to a much longer than anticipated hospital stay. Eravacycline was eventually added to the antimicrobial regimen for the persistent infection. Shortly after therapy with eravacycline began, the patient started experiencing muscle pain and the creatine phosphokinase (CPK) level was noted to be elevated. Other causes, such as concomitant administration of an HMG-CoA reductase inhibitor, were explored in this case but not thought to be the cause of rhabdomyolysis. The patient's CPK dropped considerably upon discontinuation of the novel antibiotic, and symptoms resolved. The adverse drug event was reported to the drug manufacturer; however, there are no reports up until this time that address a possible relationship between eravacycline administration and the development of rhabdomyolysis.


Subject(s)
Intraabdominal Infections , Rhabdomyolysis , Female , Humans , Aged , Anti-Bacterial Agents , Tetracyclines/adverse effects , Intraabdominal Infections/chemically induced , Intraabdominal Infections/drug therapy , Rhabdomyolysis/chemically induced , Rhabdomyolysis/diagnosis
2.
Am J Pharm Educ ; 85(8): 8361, 2021 09.
Article in English | MEDLINE | ID: mdl-34615621

ABSTRACT

Objective. To describe the development and implementation of an advanced pharmacy practice experience (APPE) in leadership.Methods. A leadership APPE was created and continuously improved over five years from being mostly content-oriented to being more of an experiential offering by identifying and implementing rich, practical leadership experiences. Activities included PhotoVoice, Power of Full Engagement, What's Your Passion?, Transformational Leadership, Speech Acts, a Mindfulness Retreat, PeoplePack Dynamics, and a rowing experience at an Olympic training facility. After five years of developing and refining the APPE, faculty coordinators sought student feedback on the APPE beyond using a standardized APPE evaluation form students complete at the end of each rotation.Results. The majority of students agreed with all of the evaluation items. Items with the highest mean agreement included: content from previous didactic leadership courses were reinforced in the rotation; relevance of the rotation to one's career; rotation objectives facilitated learning; and a variety of teaching methods helped in applying knowledge to future practice. Analysis of comments regarding the leadership APPE identified three main themes: gratitude, development, and more connection.Conclusion. An elective APPE with the primary purpose of leadership training and development can be created and incorporated into the Doctor of Pharmacy curriculum. This leadership APPE can serve as an example for other institutions interested in implementing a similar experience.


Subject(s)
Education, Pharmacy , Pharmaceutical Services , Pharmacy , Students, Pharmacy , Curriculum , Humans , Leadership
3.
Curr Pharm Teach Learn ; 10(4): 493-498, 2018 04.
Article in English | MEDLINE | ID: mdl-29793712

ABSTRACT

BACKGROUND AND PURPOSE: To report student perceived adequacy regarding didactic content and practical experiences of vaccination clinic business operations. EDUCATIONAL ACTIVITY AND SETTING: Didactic content, a case study, and practical experiences regarding vaccination clinic business operations were implemented in related lectures of a Pharmacy Business and Entrepreneurship (PBE) elective and the college of pharmacy sponsored vaccination clinics. An online survey was used to evaluate student perceived adequacy of didactic content and practical experiences of vaccination clinic business operations. FINDINGS: Mean scaled agreement was compared between students in the PBE elective versus those not in the elective. Student confidence in performing business operations was also assessed. Students in the PBE had higher mean confidence than non-elective students regarding staff management (3.23 vs. 2.73, p = 0.04). SUMMARY: Success of the interventions may be attributed to students in the PBE elective that reported a higher mean perceived adequacy of content and practical experiences and confidence in performing nearly all business operations. Still, further evaluation of interventions is being considered to assess effectiveness of learning.


Subject(s)
Education, Pharmacy/methods , Students, Pharmacy/psychology , Vaccination , Ambulatory Care Facilities , Attitude of Health Personnel , Commerce , Curriculum , Entrepreneurship , Humans , Influenza Vaccines , Longitudinal Studies , Oklahoma , Personal Satisfaction
4.
Res Social Adm Pharm ; 14(3): 262-268, 2018 Mar.
Article in English | MEDLINE | ID: mdl-28356212

ABSTRACT

BACKGROUND: The Center for Medicare and Medicaid Services (CMS) created the Star Rating system based on multiple measures that indicate the overall quality of health plans. Community pharmacists can impact certain Star Ratings measure scores through medication adherence and patient safety interventions. OBJECTIVE: To explore methods, needs, and workflow issues of community pharmacists to improve CMS Star Ratings measures. METHODS: Think-aloud protocols (TAPs) were conducted with active community retail pharmacists in Oklahoma. Each TAP was audio recorded and transcribed to documents for analysis. Analysts agreed on common themes, illuminated differences in findings, and saturation of the data gathered. Methods, needs, and workflow themes of community pharmacists associated with improving Star Ratings measures were compiled and organized to exhibit a decision-making process. Five TAPs were performed among three independent pharmacy owners, one multi-store owner, and one chain-store administrator. RESULTS: A thematically common 4-step process to monitor and improve CMS Star Ratings scores among participants was identified. To improve Star Ratings measures, pharmacists: 1) used technology to access scores, 2) analyzed data to strategically set goals, 3) assessed individual patient information for comprehensive assessment, and 4) decided on interventions to best impact Star Ratings scores. Participants also shared common needs, workflow issues, and benefits associated with methods used in improving Star Ratings. CONCLUSION: TAPs were useful in exploring processes of pharmacists who improve CMS Star Ratings scores. Pharmacists demonstrated and verbalized their methods, workflow issues, needs, and benefits related to performing the task. The themes and decision-making process identified to improving CMS Star Ratings scores will assist in the development of training and education programs for pharmacists in the community setting.


Subject(s)
Community Pharmacy Services/standards , Pharmacists/standards , Centers for Medicare and Medicaid Services, U.S. , Decision Making , Female , Humans , Male , Quality of Health Care , United States
5.
J Am Pharm Assoc (2003) ; 58(1): 21-29, 2018.
Article in English | MEDLINE | ID: mdl-29074146

ABSTRACT

OBJECTIVES: The Centers for Medicare and Medicaid Services (CMS) is moving toward a value-based model, which includes the Five-Star Quality Rating System (Star Ratings). Prescription Drug Plans include multiple pharmacy measures associated with adherence and patient safety that contribute to CMS Star Ratings scores. This study, using the Theory of Planned Behavior (TPB), explored factors associated with community pharmacists' beliefs to improve Star Ratings scores. DESIGN: Exploratory, qualitative, use of focus groups, and the TPB. SETTING AND PARTICIPANTS: Focus groups were performed in conference rooms at the College of Pharmacy main and satellite campuses. Participants were community retail pharmacists with an active Oklahoma license and 1 year of work experience. MAIN OUTCOME MEASURES: Each focus group was audio recorded and the recording transcribed to documents and analyzed with the use of a hybrid deductive and inductive qualitative approach rooted in a constant comparative framework. Coding of the data back to the TPB constitutes a deductive approach. The generation of themes and subthemes from other coded nodes constitutes an inductive approach. Analysts agreed on common themes, differences in findings, and saturation of the data gathered. RESULTS: Four focus groups were conducted with 26 participants in 2 categories: pharmacists with and without experience improving Star Ratings. Pharmacists shared and contrasted in salient, normative, and control beliefs about patient outcomes, data, financial implications, staff, technology, and other stakeholders associated with performance of improving Star Ratings. Themes regarding medication adherence, patient safety, and intention were also found. CONCLUSION: The TPB was used to explore beliefs of community pharmacists about improving Star Ratings scores. Themes that were identified will assist in future research for measuring intention to improve CMS Star Ratings scores and the development of training and education programs.


Subject(s)
Community Pharmacy Services/statistics & numerical data , Pharmacists/psychology , Attitude of Health Personnel , Centers for Medicare and Medicaid Services, U.S./statistics & numerical data , Female , Focus Groups , Humans , Male , Medication Adherence/psychology , Medication Adherence/statistics & numerical data , Pharmacies/statistics & numerical data , Prescription Drugs/therapeutic use , Quality of Health Care , United States
6.
Curr Pharm Teach Learn ; 9(6): 1042-1054, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29233372

ABSTRACT

BACKGROUND AND PURPOSE: The purpose of this article is to describe and assess the effectiveness of an innovative teaching approach in an advanced pharmacy practice experience (APPE) and leadership elective. EDUCATIONAL ACTIVITY AND SETTING: Three cohorts of students [(2014: n = 14), (2015: n = 17), (2016: n = 19)] were introduced to the photovoice (PV) method in their leadership APPE. PV required students to take, present, and discuss photographs within their cohorts. PV was used as a teaching method with the intention that the process would compel students to be involved in leadership development throughout experiential rotations, participate in discussions related to leadership development, and engage in creative activity. Group discussions from the class of 2014 were recorded and transcribed. Students from all cohorts were asked to participate in an electronic survey containing items based on PV learning objectives. All students were asked to participate in semi-structured interviews about PV. FINDINGS AND DISCUSSION: The inductive coding method was used to identify themes from discussion transcripts. Analysis of themes revealed 51.5% of the PV photographs related to emotional intelligence. Development of others and strong teams were themes represented in 44.3% of photographs. Survey data indicated all respondents agreed PV was a valuable method to describe learning in leadership. Interview coding revealed themes related to emotional intelligence and development of teams. SUMMARY: The PV method was an effective teaching tool in a leadership APPE and elective course. PV is a teaching method to be utilized in a variety of experiential learning environments to better enhance the professional development of pharmacy students.


Subject(s)
Education, Distance/methods , Education, Pharmacy/methods , Leadership , Cohort Studies , Curriculum/trends , Humans , Preceptorship/methods , Problem-Based Learning/methods
7.
J Grad Med Educ ; 7(2): 225-9, 2015 Jun.
Article in English | MEDLINE | ID: mdl-26221439

ABSTRACT

BACKGROUND: Availability of reliable, valid, and feasible workplace-based assessment (WBA) tools is important to allow faculty to make important and complex judgments about resident competence. The Minicard is a WBA direct observation tool designed to provide formative feedback while supporting critical competency decisions. OBJECTIVE: The purpose of this study was to collect validity and feasibility evidence for use of the Minicard for formative assessment of internal medicine residents. METHODS: We conducted a retrospective cohort analysis of Minicard observations from 2005-2011 in 1 institution to obtain validity evidence, including content (settings, observation rates, independent raters); response process (rating distributions across the scale and ratings by month in the program); consequences (qualitative assessment of action plans); and feasibility (time to collect observations). RESULTS: Eighty faculty observers recorded 3715 observations of 73 residents in the inpatient ward (43%), clinic (39%), intensive care (15%), and emergency department (3%) settings. Internal medicine residents averaged 28 (SD=8.4) observations per year from 9 (SD=4.1) independent observers. Minicards had an average of 5 (SD=5.1) discrete recorded observations per card. Rating distributions covered the entire rating scale, and increased significantly over the time in training. Half of the observations included action plans with action-oriented feedback, 11% had observational feedback, 9% had minimal feedback, and 30% had no recorded plan. Observations averaged 15.6 (SD=9.5) minutes. CONCLUSIONS: Validity evidence for the Minicard direct observation tool demonstrates its ability to facilitate identification of "struggling" residents and provide feedback, supporting its use for the formative assessment of internal medicine residents.


Subject(s)
Clinical Competence , Educational Measurement/methods , Internal Medicine/education , Internship and Residency/methods , Faculty, Medical , Feedback , Humans , Observer Variation , Reproducibility of Results , Retrospective Studies
8.
Am J Case Rep ; 15: 119-22, 2014.
Article in English | MEDLINE | ID: mdl-24696753

ABSTRACT

PATIENT: Male, 67 FINAL DIAGNOSIS: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome Symptoms: Bilateral wrist swelling Medication: - Clinical Procedure: - Specialty: Rheumatology. OBJECTIVE: Unusual or unexpected effect of treatment. BACKGROUND: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a rare clinical entity characterized by the sudden onset of inflammatory arthritis and marked pitting edema on upper and lower extremities. RS3PE is considered a rheumatic process distinct from rheumatoid arthritis, which may occasionally represent a paraneoplastic syndrome. CASE REPORT: Herein, we describe a rare case of RS3PE associated with insulin therapy in a patient with no evidence of underlying malignancy. CONCLUSIONS: To the best of our knowledge, this is the first case report of RS3PE associated with insulin therapy. Physicians should look at the introduction of drugs as possible triggers for the development of RS3PE.

9.
Acad Med ; 87(2): 185-91, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22189884

ABSTRACT

The Accreditation Council for Graduate Medical Education recommends the structured portfolio as a preferred assessment tool for assessing all six of its core physician competencies. However, compared with other evaluation measures, it may be one of the most resource-intensive for learners and evaluators. Given the time and effort needed to properly develop mentors, train evaluators, and persuade learners, facilitation of the learning environment supporting a portfolio may be the most important variable determining its success or failure. The authors review the components necessary to successfully build and maintain a robust portfolio learning environment in a graduate medical education setting. These include gaining staff acceptance, staging implementation, enhancing learner participation, training mentors, choosing paper versus electronic formats, and selecting assessment methods. Their blueprint for implementing a portfolio is informed by their five-year experience with a portfolio rollout in one internal medicine residency, from 2006 to 2011.


Subject(s)
Competency-Based Education/methods , Education, Medical, Graduate/methods , Educational Measurement/methods , Educational Measurement/standards , Internal Medicine/education , Internship and Residency/standards , Academic Medical Centers , Accreditation , Clinical Competence/standards , Competency-Based Education/standards , Education, Medical, Graduate/standards , Humans , Mentors/education , Pennsylvania
10.
Nat Rev Rheumatol ; 5(9): 505-12, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19652649

ABSTRACT

Acute or progressive sensorineural hearing loss, with or without vertigo and tinnitus, has a considerable impact upon an individual's quality of life. Sensorineural hearing disorders are more commonly observed in patients with rheumatic disease than in the general population, are more likely to be accompanied by the presence of serum autoantibodies, and might respond to steroid therapy. A subgroup of these disorders seem to be immune mediated, but audiologic presentation and serologic testing do not enable this subgroup to be further defined. Rheumatologists should be prepared to manage patients with known rheumatic disease who develop acute hearing loss and to evaluate referred patients without known rheumatic illness experiencing progressive or refractory sensorineural hearing loss. In this article, we summarize the literature and outline a rational approach for the evaluation and treatment of such patients.


Subject(s)
Hearing Loss, Sensorineural/immunology , Meniere Disease/immunology , Rheumatic Diseases/immunology , Acute Disease , Adult , Anti-Inflammatory Agents/therapeutic use , Autoantibodies/blood , Comorbidity , Disease Progression , Hearing Loss, Sensorineural/drug therapy , Hearing Loss, Sensorineural/epidemiology , Humans , Meniere Disease/epidemiology , Prednisone/therapeutic use , Remission, Spontaneous , Rheumatic Diseases/epidemiology
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