Lessons from a cross-institutional online professional development pilot.

PURPOSE: To reflect on a collaborative approach used by a group of faculty and administrators from historically Black colleges and universities (HBCU) and predominantly Black institution (PBI) pharmacy programs to provide high quality, multiple institution, faculty development programming in online environments. DESCRIPTION: A pilot for a shared online professional development initiative between pharmacy programs at five HBCUs and one PBI was implemented as a two-hour combined video conference and webinar, with structured networking, instructional programming, and breakout group sessions. Learning outcomes focused on increasing knowledge and awareness of mindsets in faculty and students with additional project goals of beta-testing interactive web conference formats, developing cross-institutional networking, and identifying avenues for sharing resources and expertise. ANALYSIS/INTERPRETATION: Kolb's Cycle of Experiential Learning (Concrete Experience, Reflective Observation, Abstract Conceptualization, and Active Experimentation) was used to guide reflection on the joint workshop. The instructional design, delivery, and learning experiences of the program itself were analyzed using Garrison's Community of Inquiry Framework. CONCLUSIONS: Action research approaches can be applied to facilitate the continuous quality improvement cycle in multi-institution initiatives, such as joint faculty development programming. IMPLICATIONS: Lessons related to cross-institutional collaboration, communities of practice development, networking, and communication can be used for future joint faculty development sessions and other shared initiatives for institutions serving minoritized students as well as other multiple institution consortiums.

Bivalirudin: a direct thrombin inhibitor.

BACKGROUND: Studies of the anticoagulant effects of hirudin, which is derived from the saliva of the leech Hirudo medicinalis, led to the development of compounds that can directly inhibit thrombin activity without the need for additional cofactors. One of these is the direct thrombin inhibitor bivalirudin, which has recently been approved by the US Food and Drug Administration for use as an anticoagulant in patients with unstable angina undergoing percutaneous transluminal coronary angioplasty. OBJECTIVE: This is a review of the pharmacologic properties, efficacy, tolerability, and potential cost-effectiveness of bivalirudin in the treatment of ischemic coronary syndromes. METHODS: Articles were identified by searches of MEDLINE (1966-September 2001), International Pharmaceutical Abstracts (1970-September 2001), and the Iowa Drug Information Service (1966-September 2001) using the terms bivalirudin and Hirulog. The reference lists of retrieved articles were also reviewed for relevant articles. RESULTS: Bivalirudin is a synthetic polypeptide that directly inhibits thrombin by binding simultaneously to its active catalytic site and its substrate recognition site. After intravenous administration, peak plasma concentrations occur in 2 minutes. In patients given a 1.0-mg/kg bolus followed by a 2.5-mg/kg per hour infusion, a median activated clotting time of 346 seconds is achieved with little interpatient or intrapatient variability. Clearance of bivalirudin occurs through a combination of renal elimination and proteolytic cleavage, and doses may need to be decreased in the presence of renal dysfunction. In patients undergoing percutaneous coronary interventions, bivalirudin has been associated with equivalent efficacy but lower bleeding rates (P < 0.001) than unfractionated heparin (UFH). Data from the Hirulog Early Reperfusion/Occlusion-2 study suggest no reduction in mortality with bivalirudin compared with heparin when either is added to aspirin and streptokinase in patients with acute myocardial infarction, despite a lower reinfarction rate (P < 0.001). Experience with bivalirudin in patients with unstable angina and heparin-induced thrombocytopenia (HIT), as well as in patients receiving glycoprotein IIb/IIIla inhibitors, is limited. The differences in bleeding rates between bivalirudin and heparin in published clinical trials probably reflect differences in levels of anticoagulation achieved in comparator groups. CONCLUSIONS: Given its high cost, bivalirudin should be reserved for use as an alternative to UFH, primarily in patients with HIT, until clinical trials have more clearly demonstrated its benefits in terms of efficacy or safety.