A National Survey Exploring Practices and Perceptions of Sharing Experiential Evaluations With Future Preceptors.

OBJECTIVE: This study aimed to understand pharmacy programs' policies and processes of sharing Advanced Pharmacy Practice Experience (APPE) assessment information among preceptors and to determine the types of grading scales currently being used nationally. METHODS: A 14-question survey was utilized to collect information on Experiential Education policies and practices regarding APPE evaluations and assessment data sharing. The survey was administered electronically to Experiential Education Administrators at accredited schools of pharmacy nationally and gathered information on approach to APPE assessment, information sharing with future preceptors and open-ended responses on how struggling student learners are supported. Descriptive statistics were used to analyze quantitative responses, while qualitative open-ended comments were analyzed using thematic analysis. RESULTS: A total of 95 responses were included in the analysis (67.9% response rate). The majority of programs (83.2%) reported not sharing student performance assessments with future preceptors. Themes that emerged from the analysis of open-ended comments included concerns about bias and privacy violations, and the benefits of sharing evaluations for preceptor preparation and longitudinal student growth. The grading approach varied, with 53.7% of programs using traditional tiered letter grades and 45.3% using a pass/fail grading system. CONCLUSION: Most pharmacy programs do not share APPE assessment information with future preceptors due to concerns about bias and protecting student privacy. However, programs may be looking for alternative processes that address the need to facilitate student growth and to support struggling learners. Examples shared may provide stimulus and insight for Experiential Education Offices to engage in programmatic discussions about the approach to assessment sharing practices.

A Mixed-Methods Analysis of the Promotion and Tenure Process for Experiential Education Faculty.

OBJECTIVE: To understand the process of the promotion and tenure (P&T) as experienced by faculty members in experiential education (EE). METHODS: A quantitative survey of EE faculty at any academic rank investigated the general landscape of experiences in P&T. Phenomenological qualitative interviews with faculty who currently work in EE and who achieved promotion to full professor while working within EE provided additional context. Analysis was completed using a mixed-methods approach. Incomplete survey responses were excluded. RESULTS: Survey respondents indicated feeling different from other clinical faculty, particularly in the need to justify their work to the P&T committee (26/38; 68%). Respondents noted how challenging the P&T process was and perceived a lack of understanding of EE work among P&T committee members, chairs, and/or colleagues. In qualitative interviews, 3 themes emerged, which were characterizing a misunderstood role; navigating an unclear process with creativity and courage; and seeking outside-of-the-box mentoring. CONCLUSION: Experiential education faculty may require specific guidance and a thoughtful approach in tailoring their dossier for the P&T process, especially in accounting for administrative work and other unique aspects of the role. To promote inclusivity and retention of EE faculty, greater understanding of the EE role is needed as it applies to guidelines for P&T. Furthermore, EE faculty and others with unique roles should receive guidance to meaningfully apply P&T guidelines in a manner that best represents their role.

Assessing student reflections of significant professional identity experiences.

INTRODUCTION: Professional identity formation (PIF) is an essential component of pharmacy education. A student-focused holistic approach can be introduced through exposure to a variety of curricular and co-curricular activities. It is essential for students to not only participate in these activities but also to reflect on their actions and thoughts about those activities. The objective of this study was to better understand the experiences students identify as significant in their PIF. METHODS: A mixed methods approach with qualitative thematic analysis was conducted for first-year (P1) and second-year (P2) student pharmacist end-of-year reflections to understand the types and impact of various experiences on PIF. Students identified which experience was most impactful; additional analysis based on this identification was conducted. RESULTS: A review of 151 student reflections led to coding and analysis of 453 experiences. Co-curricular experiences were identified most frequently in both P1 and P2 groups (59.8% and 56.4%, respectively). Curricular experiences were more likely to be mentioned by P1 students than P2 students (28.8% vs. 9.8%, P < .001). P2 students were more likely to identify experiential rotations (17.9% vs. 6.4%, P < .001) or work (13.7% vs. 9.1, P < .001). Other experiences were cited less frequently but were ranked as most impactful by students. Students often identified experiences that allowed them to apply skills and knowledge and opportunities to attend seminars and lectures. CONCLUSIONS: When reflecting on experiences and their impact on PIF, student pharmacists discussed a variety of experiences but identified co-curricular opportunities most frequently as impactful.

Electronic cigarette use among adults with asthma: 2014-2017 National Health Interview Survey.

BACKGROUND: Electronic cigarette (e-cigarette) use has increased dramatically in the United States among adults and adolescents. Patients with asthma may be most vulnerable to the chemical components of e-cigarettes as they may be a potential asthma trigger. OBJECTIVE: To assess the prevalence of e-cigarette use among adult asthmatics and to evaluate the factors associated with e-cigarette use. METHODS: This was a retrospective, cross-sectional study that used data from the 2014-2017 National Health Interview Survey (NHIS) database. The study sample included current asthmatics who were 18-85 years old. The outcome variable was ever use of an e-cigarette (Yes/No). The Andersen Behavioral Model of Health Services Utilization was used to identify independent variables with the potential to influence the patient's decision to try e-cigarettes. Descriptive statistics were used to describe the sample. Factors associated with e-cigarette use were assessed using logistic regression. All analyses were stratified by age group. Appropriate survey weights were used to account for the complex survey design. RESULTS: The study sample included 10,578 adults with current asthma and about 18% of the sample had ever tried an e-cigarette. About 20% of males and 20% of non-Hispanic Whites reported ever trying an e-cigarette. From 2014 to 2017, the e-cigarette use among the 18-24 year old age group increased the most from 20.3% to 29.1%. Current smokers were more likely to have tried e-cigarettes than former/never smokers (18-24 years OR: 11.5 CI: 7.4-18.0). This trend was significant among all age groups. Non-Hispanic Blacks were less likely to have tried e-cigarettes than non-Hispanic Whites (50-64 years OR: 0.34 CI: 0.22-0.52). CONCLUSION: The prevalence of e-cigarette use among adult asthmatics has continued to increase over time. Smoking status was the most consistent predictor of e-cigarette use among all age groups in this asthmatic population.

Asthma and health related quality of life in late midlife adults.

BACKGROUND: Health related quality of life (HRQoL) reflects the impact of a chronic disease, such as asthma, from a patient perspective. Late midlife adults (50-64 years) have been identified by the Centers for Disease Control & Prevention as an important population for healthy aging. OBJECTIVES: To evaluate the factors associated with HRQoL among late midlife adults with asthma. METHODS: This study utilized data from 2012 to 2013 Behavioral Risk Factor Surveillance System Asthma Call Back Survey. Adults with current asthma and 50-64 years of age were included in the study. Independent variables were identified using the Andersen Behavioral Model of Health Services Utilization. HRQoL was defined using 4 domains including self-rated health, physical health, mental health and activity limitation. Descriptive statistics were used to assess sample characteristics. Bivariate and multivariate logistic regression models were used to examine factors associated with the four HRQoL domains. All analyses were stratified by asthma control status. Appropriate survey weights were used to account for the complex survey design. RESULTS: The final sample consisted of 5857 (Weighted: 4 million) late midlife asthmatics, mostly female (66%) and White (72%). About 42% had fair/poor self-rated health, 33% had impaired physical health, 23% had impaired mental health, and 24% experienced activity limitation. Multivariate analyses found that Non-Hispanic African American adults were significantly more likely to report fair/poor self-rated health compared to Whites (Well-controlled asthma OR: 2.2, 95% CI: 1.2-4.1). Adults who experienced any cost barrier were significantly more likely to have activity limitations (Poorly controlled asthma OR: 1.6, 95% CI: 1.1-2.3). Adults with a respiratory comorbidity were more likely to report impaired physical health compared to adults without (Well controlled asthma OR: 1.7, 95% CI: 1.01-2.7). CONCLUSION: Reducing respiratory comorbidities and cost barriers may improve HRQoL in asthmatic late midlife adults.

Interprofessional education involving medical and pharmacy students during transitions of care.

The transition of care from hospital to home is susceptible to clinical errors and adverse drug events. Despite this risk and the benefits of an interprofessional approach to patient care, medicine and pharmacy do not often collaborate during transitions of care. The purpose of this study was to evaluate the impact of an interprofessional education experience consisting of medical and pharmacy students performing transitions of care. A total of 88 students (13 pharmacy students and 75 medical students) participated and were surveyed before and after the experience, to evaluate their confidence in performing aspects of the transition of care process as well as their attitudes towards interprofessional care. Pharmacy students had higher baseline levels of confidence compared with the medical students, and both student groups revealed a significantly greater level of confidence in their abilities after the experience. The impact of the experience on students' attitudes towards interprofessional care varied, with medical students showing very little change from baseline and pharmacy students showing improved attitudes in several areas. The results of this study have positive implications for an interprofessional approach to transitions of care while highlighting potential future areas of study.

Treatment Patterns in Asthma- Chronic Obstructive Pulmonary Disease Overlap Syndrome.

BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is a complex disease entity with limited guidance surrounding medication therapy. OBJECTIVE: To evaluate a patient population with possible ACOS and their medication regimen based on the Global Initiative for Asthma and Global Initiative for COPD joint statement for ACOS. METHODS: This was a retrospective study based at a large clinical practice within a school of medicine. The sample included adults 40 to 85 years old who had an active concurrent diagnosis of asthma and COPD. Patients were considered to have likely inconsistent therapy (only preventive, no rescue medication), inconsistent therapy (neither preventive nor rescue medication), and likely consistent therapy (both preventive and rescue medication or rescue medication alone). RESULTS: A total of 513 patients were included the study. The majority of the sample were female (75%) and white (87.1%), with an average age of 61 years. About 7% of patients had likely inconsistent therapy, whereas 7.7% had inconsistent therapy to control their airway disease. Never smokers were more likely than former smokers to have inconsistent therapy (adjusted odds ratio [OR] = 4.54; CI = 1.86-11.04). Adults 65 years and older were more likely than those aged 40 to 49 years to be in the likely inconsistent therapy group (adjusted OR = 4.01; CI = 1.04-15.34). Patients without any comorbid conditions were more likely than those with 2 or more comorbid conditions to be in the likely inconsistent group (adjusted OR = 3.50; CI = 1.39-8.77). CONCLUSION: As the disease definition and treatment recommendations evolve, future studies should continue to monitor ACOS treatment patterns and outcomes.

Atrioventricular dissociation after electroconvulsive therapy.

Electroconvulsive therapy (ECT) is increasingly used as a treatment for psychiatric disorders. Cardiac effects are the principal cause of medical complications in these patients. We report a case of atrioventricular (AV) dissociation that occurred after ECT that was treated with pacemaker implantation. The mechanisms contributing to the onset of AV dissociation in this patient, and the management and rationale for device therapy, in light of the most recent guidelines, are reviewed.

Olanzapine-induced parkinsonism associated with smoking cessation.

PURPOSE: The case of a patient taking high-dosage olanzapine who experienced parkinsonism after smoking cessation is reported. SUMMARY: A 73-year-old Caucasian woman with a recent diagnosis of Parkinson disease and a history of chronic obstructive pulmonary disease, hyperlipidemia, chronic osteoarthritis, and hypothyroidism was hospitalized for altered mental status, weakness, and ambulatory dysfunction. The diagnosis of Parkinson disease was made approximately four months prior. Despite initiation of carbidopa-levodopa, the patient's symptoms did not improve, and her mental and physical status declined. The patient was taking olanzapine 30 mg daily for bipolar disorder and had a 40-pack-year history of smoking, but she quit smoking approximately four months before this hospitalization. The results of a neurologic evaluation suggested that the patient did not have Parkinson disease but was possibly experiencing olanzapine toxicity secondary to smoking cessation. Carbidopa-levodopa was discontinued. Psychiatry was consulted, and a monthlong cross-taper to discontinue olanzapine and initiate aripiprazole with a target dosage of 20 mg daily was recommended. During the course of therapy, the patient's level of alertness and bradykinesia improved. Overall, it was noted that her extrapyramidal symptoms were gradually improving; two days before hospital discharge, she was noted to have no definite remaining evidence of parkinsonism. In this case, use of the Naranjo et al. adverse-drug-reaction probability scale and the drug interaction probability scale indicated that the adverse effects were probably related to the interaction between smoking and olanzapine. CONCLUSION: A 73-year-old woman receiving high-dosage olanzapine for bipolar disorder developed parkinsonism after smoking cessation.