A pilot school-based health center intervention to improve asthma chronic care in high-poverty schools.

OBJECTIVE: To test the feasibility and effectiveness of a multifaceted intervention administered through school-based health centers (SBHCs) to improve asthma control for children in high-poverty schools with not well controlled asthma. METHODS: Students 4-14 years old with persistent asthma were enrolled from three SBHCs. The centers' advanced practice providers received training on evidence-based asthma guidelines. Students randomized to the intervention received directly observed therapy of their asthma controller medication, medication adjustments as needed by the centers' providers, and daily self-management support. Students randomized to usual care were referred back to their primary care provider (PCP) for routine asthma care. RESULTS: We enrolled 29 students. Students in the intervention group received their controller medication 92% of days they were in school. Ninety-four percent of follow-up assessments were completed. During the study, 11 of 12 intervention students had a step-up in medication; 2 of 15 usual care students were stepped up by their PCP. Asthma Control Test scores did not differ between groups, although there were significant improvements from baseline to the 7 month follow-up within each group (both p < .01). Both FEV1% predicted and FEV1/FVC ratio significantly worsened in the usual care group (both p = .001), but did not change in the intervention group (p = .76 and .28 respectively). CONCLUSIONS: Our pilot data suggest that a multifaceted intervention can be feasibly administered through SBHCs in communities with health disparities. Despite the small sample size, spirometry detected advantages in the intervention group. Further study is needed to optimize the intervention and evaluate outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03032744.

Mixed-Method Study of Utilizing Portfolios to Document and Assess Co-Curricular Activities: Student and Advisor Perceptions.

Background: Development of professional behaviors must occur in tandem with clinical skills to ensure graduates provide quality care. Portfolios have been widely utilized as a medium to document and reflect on experiences related to professional skills. Methods: Students were required to complete a series of co-curricular activities and document them via paper or electronic portfolios, which were shared with their advisors for feedback and review. To gather perception data, student surveys were administered twice: once for the electronic cohort and once for the paper cohort after their first-year experience with the platform, and focus groups were conducted a year later. Faculty advisors were also asked to complete surveys. Results: Both students and advisors felt that electronic portfolios resulted in a greater understanding of the educational outcomes and was the preferred method for recording co-curricular requirements. Several technical challenges arose with the use of the electronic portfolio and many students and advisors felt they needed more education regarding mapping of activities. Conclusions: The electronic portfolio was found to be more sustainable as compared with paper portfolios, as it helped students adhere to the criteria and self-assessment process. Further research is needed to evaluate long-term benefit of documenting and assessing co-curricular experiences within an electronic platform.

Students' perceptions of biostatistics following integration into an evidence-based medicine course series.

BACKGROUND AND PURPOSE: Student pharmacists are expected to demonstrate an understanding of commonly employed statistical tests. This study describes the integration of biostatistics in an evidence-based medicine course series using a learner-centered model tailored to students' needs and interests. EDUCATIONAL ACTIVITY AND SETTING: This course series included thirteen two-hour biostatistics sessions focused on interpreting results and critiquing statistical methods. Three lab sessions were also included, which focused on producing summary reports from clinical data. Journal club presentations were the key method of assessing knowledge. A survey to evaluate students' perceptions of the course and their level of confidence in applying biostatistical concepts was administered twice to measure change over time within two student cohorts. FINDINGS: Results of the survey showed that a significantly higher proportion of students agreed they understood the analyses covered in class (97% vs. 44%, p < 0.001) and felt more confident interpreting results (82% vs. 41%, p < 0.001) in their third year compared to the second year. Students who agreed that they learned important skills for future practice had a significantly higher mean exam score (82.5% vs. 76.2%, p = 0.001). SUMMARY: The results indicate an improvement in the students' perceptions over time with regards to knowledge and usefulness of the course content. Although, integrating biostatistics in a literature-evaluation course is common, this is the first study that evaluated teaching it in more than one semester beyond inclusion in assessment rubrics.

Pharmacists' Attitudes and Practices Regarding Tetanus, Diphtheria and Pertussis (Tdap) Vaccination in Pregnancy and Surrounding Newborns.

BACKGROUND: Bordetella pertussis or whooping cough is a serious and vaccine-preventable illness. Despite widespread vaccination in the pediatric population, pertussis still infects approximately 100,000 infants each year in the United States. The purpose of this study was to determine gaps in pharmacists’ understanding, attitudes, practices, and barriers surrounding the tetanus, diphtheria, and pertussis (Tdap) vaccination recommendation for patients who are pregnant or planning to come in close contact with infants. METHODS: This study was a descriptive, exploratory electronic survey. The survey assessed three major areas; the role of the pharmacist in Tdap vaccination, perceived barriers to vaccination, and understanding the recommendations. RESULTS: A total of 225 pharmacists responded to the survey. Pharmacists who responded to this survey agreed that pharmacists should have a role vaccinating the public and individuals expecting to come into contact with a newborn, (88.5% and 86.9%) respectively, but fewer agreed that pharmacists should have a role vaccinating pregnant women against tetanus, diphtheria, and pertussis (77%, p < 0.001). Based on the responses to case scenarios, only 22.5% and 30.6% of respondents understood the recommendations. Numerous barriers to vaccinating pregnant women were identified. CONCLUSION: While most pharmacists surveyed felt they should have a role in vaccinating pregnant women and those expecting to come in contact with a newborn, there are barriers to implementing this practice. Future efforts should focus on further evaluating identified gaps and developing programs for pharmacists that emphasize the significance of vaccinating these patients to reduce the burden of pertussis in infants.

Considerations for Providing Ambulatory Pharmacy Services for Pediatric Patients.

Pediatric clinical pharmacists are an integral part of the health care team. By practicing in an ambulatory care clinic, they can reduce the risk of medication errors, improve health outcomes, and enhance patient care. Unfortunately, because of limited data, misconceptions surrounding the role of pharmacists, and reimbursement challenges, there may be difficulty in establishing or expanding pediatric clinical pharmacy services to an ambulatory care setting. The purpose of this paper is to provide an overview of considerations for establishing or expanding pharmacy services in a pediatric ambulatory care clinic. The primer will discuss general and pediatric-specific pharmacy practice information, as well as potential barriers, and recommendations for identifying a practice site, creating a business plan, and integrating these services into a clinic setting.

The impact of pharmacy monitoring and intervention in patients receiving intravenous heparin.

Background Intravenous unfractionated heparin (IV UFH) has a narrow therapeutic index and poses a high risk of bleeding. Objective To determine the impact of pharmacy monitoring and intervention on adherence to and appropriate implementation of IV UFH protocol. Setting A 438 bed hospital specializing in cardiac services. Methods This is a retrospective chart review study. Pre-pharmacy intervention data were collected from November 2013 to January 2014 and compared to post-pharmacy intervention data obtained between August 2014 and October 2014. Patients were included if they received IV UFH for at least 24 hours. The first three daytime laboratory draws were collected for each patient and analyzed using generalized estimating equations to quantify the association between pharmacy monitoring and adherence to the institution's protocol. Main outcome measures Designation of appropriate protocol, accurate selection of initial infusion rate, timing of anti-Xa levels within 60 min of anticipated due time, change of infusion rate within 120 min of laboratory result, and appropriate adjustment of infusion rates. Results A total of 195 data points were included. The initial selection of infusion rate and subsequent adjustments were more appropriate in the post-intervention period with an odds ratio of 8.36 (95% CI 2.41-29.01, p value = 0.0008), and 4.66 (95% CI 1.41-15.43, p value = 0.0118), respectively. Conclusion The results of this study indicate that pharmacy monitoring of IV UFH therapy has improved adherence to an institution's protocol and is associated with more accurate selection of initial infusion rates and adjustment of infusions based upon laboratory results.

Asthma Review for Pharmacists Providing Asthma Education.

Asthma is the most common pediatric illness affecting more than 6 million children in the United States. Children with asthma have more frequent office visits and hospitalizations compared with adults. Despite advances in therapies, asthma still has a significant effect on the health care system. Regardless of the setting, pharmacists are uniquely equipped with an intimate knowledge of medications. With this knowledge, they can provide education to patients at various points throughout the health care system, from hospitalization to office visits to point of pick up at the pharmacy. The goal of this article is to equip the pharmacist with the necessary knowledge to provide education to these patients in a variety of practice settings, including community pharmacies, ambulatory care settings, and during transitions in care.

Active learning through a debate series in a first-year pharmacy self-care course.

OBJECTIVE: To evaluate the usefulness of formal debates in the pharmacy classroom as a way to learn course material and as a tool for developing competency in essential skills including critical thinking, communication, public speaking, research methods, and teamwork. DESIGN: Debates were incorporated into a self-care course, where students were assigned different debate topics focused on controversial issues. Quantitative analysis was completed to assess debate style learning, knowledge about the subjects presented, and the impact on necessary skills. ASSESSMENT: Quizzes given before and after debates showed up to a 36% improvement in grades and up to a 31% change in opinions on the topic. Students assessed themselves as more competent in the skill sets at the completion of the debate series. CONCLUSION: Incorporation of debates into didactic style courses offers students an opportunity to improve upon skills that will help them succeed as pharmacists.

Association between caffeine citrate exposure and necrotizing enterocolitis in preterm infants.

PURPOSE: The results of a case-control study of the potential role of caffeine citrate therapy in the development of necrotizing enterocolitis (NEC) are presented. METHODS: Patient records for a 10-year period were reviewed to collect sufficient data to test the hypothesis that newborns treated in a hospital's perinatal intensive care unit for NEC might have had a higher cumulative exposure to caffeine citrate relative to that of neonates of similar postconceptional and postnatal age who did not develop NEC. Ninety-five cases of NEC were identified; each case was matched to a control case by gestational age and birth weight. To enable comparative analyses, each control was assigned an index date according to the number of days from birth to NEC diagnosis in the paired case. Data collected for analysis included patient demographics, information on caffeine citrate and concomitant medication use, and potential confounding factors. RESULTS: Analysis of aggregated data for the entire seven-day NEC event timeframe indicated no significant differences between cases and controls with regard to average caffeine citrate loading doses (p = 0.5), cumulative exposure (p = 0.2), and trough serum concentrations (p = 0.5); mean cumulative exposure values differed significantly at one time point (four days prior to NEC diagnosis (p = 0.04). CONCLUSION: Cumulative exposure to caffeine citrate among infants who developed NEC and infants who did not develop NEC differed significantly at only one of six evaluated time points during the seven days before NEC development or the index date. There was no significant difference between groups in the proportions of patients who received caffeine citrate or in mean serum caffeine concentrations.