Incorporation of a mock pharmacy and therapeutics committee as an entrustable professional activity supporting task.

INTRODUCTION: Entrustable professional activities (EPAs) denote activities and tasks students should be able to perform by graduation irrespective of their practice setting. Formulary decision-making includes several core EPA related skills, such as utilization of drug information, written, and verbal skills. The objective of this study was to describe an EPA supporting task aimed at improving utilization of evidence-based medicine skills and its impact on student self-perceived confidence, rating of skills needed, and competence. METHODS: Teams comprised of six to seven students were assigned a drug and instructed to complete the following activities: (1) background literature search, (2) drug monograph, (3) five-min presentation to simulate a live pharmacy and therapeutics (P&T) committee meeting, and (4) vote on a formulary drug in each drug class. Students completed a pre/post five-point Likert scale self-efficacy survey and a perceived importance survey. A scoring rubric assessed monograph and presentation elements (max points 30). Survey items were analyzed using Wilcoxon signed-rank test. Descriptive statistics were used for assignment grades. RESULTS: One hundred ninety students completed the pre/post self-efficacy and perceived importance survey. Confidence showed statistically significant improvement (P < .001) in nine target skill areas. In ranking importance, all 12 assessed skills exhibited a statistically significant increase following the activity. CONCLUSIONS: A mock P&T activity represents an innovative way to evaluate an EPA supporting task that allows students to improve their evidence-based analysis, written, and verbal communication skills.

Use of virtual patient software to assess student confidence and ability in communication skills and virtual patient impression: A mixed-methods approach.

BACKGROUND AND PURPOSE: Knowledge related to the use of virtual patients (VP) in pharmacy education is limited in relation to student satisfaction with this learning technique. This project aimed to assess students' confidence and impressions in using their communication skills with a VP and to evaluate their skills using this technology. EDUCATIONAL ACTIVITY AND SETTING: This explanatory mixed-methods study was conducted with first-year doctor of pharmacy students. Fourteen survey items that addressed confidence in student abilities and VP impressions were analyzed. Mann-Whitney U tests were conducted to compare pre- and post- scores. Student reflections were reviewed to obtain primary themes and concerns. Descriptive statistics were used for student grades. FINDINGS: Out of 205 students, 203 completed the pre-survey and 163 completed the post-survey. Responses regarding pre-post confidence indicated statistically significant improvement (p < 0.001) for 8 of 10 survey items as follows: understand history taking, conduct an organized interview, elicit subjective information, ask follow-up questions, ask questions related to severity, document subjective data, document objective data, and organize an interview. Regarding their impressions toward VPs, student responses were improved and statistically significant (p < 0.001) for 1 of 4 survey items (tools are easy to use). Forty-two students stressed the need to improve their written communication skills in the self-reflection. The average grade for subjective data was 31.48% and for objective data was 93.66%. SUMMARY: This VP program improved student confidence in their verbal and written communication skills despite low subjective data scores.

Management of hypertension with fixed-dose triple-combination treatments.

The objective of this review is to evaluate the role of fixed-dose triple-combination therapy for the management of hypertension. An assessment of clinical trials showed that half the patients with hypertension have uncontrolled blood pressure (BP), with underlying factors including therapeutic inertia and poor patient adherence. Many patients will require three antihypertensive agents to achieve BP goals, and current guidelines recommend combining drugs with complementary mechanisms of action. Three single-pill triple-combination treatments are available and each includes an agent affecting the renin-angiotensin-aldosterone pathway (either a direct renin inhibitor or an angiotensin II receptor blocker) in combination with a calcium channel blocker and diuretic. These triple-combination therapies consistently demonstrated significantly greater BP reduction relative to the component dual combinations, with BP reductions documented across a range of patient populations. Triple-combination treatments were well tolerated in all clinical trials reviewed. The use of single-pill, triple-combination antihypertensive therapy has been shown to be an effective, well-tolerated, and convenient treatment strategy that can help patients achieve BP control.

A novel endocrinology-based wellness program to reduce medication expenditures and improve glycemic outcomes.

AIMS: The purpose of this study was to determine the difference in diabetes-related medication expenditures as a result of a 16-week lifestyle intervention program. Medical expenditures for patients with diabetes are twice as high compared to patients without this condition. Secondary objectives were changes in HbA1C, BMI, weight, body fat, and program satisfaction. METHODS: The Wellness Life! Program includes educational sessions focused on nutrition, fitness, and behavioral therapy. Medication costs were based on Average Wholesale Prices, tabulated from the 2010 Red Book. RESULTS: A total of 36 patients (49-80 years old) enrolled, of which 27 patients have diabetes mellitus (Type 2=26, Type 1=1). Mean 30-day anti-diabetic medication costs decreased by $142.92. Clinical mean parameters improved in both the overall group and the diabetic subgroup, respectively: HbA1C (%) -0.69, -0.82; weight (lbs) -16.94, -17.11; BMI -2.73, -2.88; and body fat (%) -1.71, -1.79. Participants were generally satisfied with the program. CONCLUSIONS: Employing a multidisciplinary wellness program within an endocrinology practice can reduce anti-diabetic medication expenses; however, long term follow-up is needed to determine if medication reductions and improved clinical parameters persist.

Development of a residency interviewing preparatory seminar.

PURPOSE: The development of a residency interviewing preparatory seminar (RIPS) is described. SUMMARY: The RIPS elective at Nova Southeastern University College of Pharmacy was designed to assist pharmacy students during their last professional year in preparing for the residency application process. The learning objectives of the course focused on improving students' interviewing and presentation skills, professionalism, and developing their curriculum vitae (CV) and personal statement. Course and instructor evaluations and demographic data collected via anonymous surveys were used to ascertain students' perspectives about the course. The class was purposely scheduled to begin in October and end in November, right before the ASHP Midyear Clinical Meeting in early December. Due to limited faculty availability on the scheduled evenings and the desire to provide tailored, in-depth feedback, enrollment was limited. The RIPS was an intensive eight-week elective completed by 10 fourth-year pharmacy students. The course began with an overview of the residency application process, and students submitted their CVs and personal statements to faculty mentors for critique. To simulate residency interview components, students completed several timed activities in class and participated in mock interviews. Students stated that the course improved their application materials, interview skills, and confidence in their ability to obtain a residency. Overall, 78% of RIPS participants matched with a residency program. CONCLUSION: The RIPS elective was successful in improving residency candidate confidence at the ASHP Midyear Clinical Meeting. Students reported that the course was helpful and improved their confidence and ability to interview.

Implementation and faculty assessment of an oral examination in a therapeutics course in a distance synchronous education pharmacy programme.

OBJECTIVES: To describe the process and implementation of an oral exam in a large class with distance synchronous education technology and to evaluate the faculty's perspective of the development, administration, and assessment of the oral exam. METHODS: The Department of Pharmacy Practice at Nova Southeastern University, USA, created two patient cases for the oral exam per course over two semesters within the Therapeutics and Pathophysiology course sequence to be distributed across three campus sites. The faculty's perspective was evaluated utilizing a questionnaire distributed via an online survey. KEY FINDINGS: The oral exam was administered simultaneously across three campuses to a total of 464 students over two semesters. A total of 42 faculty members assisted in the exam process. Four cases were developed for the two exams, with detailed answer keys to minimize subjectivity in grading. Twenty-eight faculty members (66%) completed the assessment questionnaire. Most faculty were in support of continuing to administer the oral exam in subsequent therapeutic courses. CONCLUSIONS: Implementation of an oral exam in a large class with synchronous education via distance campuses is feasible. However, exam coordinators must take into account logistics such as time commitment from faculty, adequate facilities and detailed case and key development.

Development of a comprehensive community pharmacy patient intake form compliant with OBRA'90 requirements.

OBJECTIVE: To identify whether community pharmacies are collecting the minimum patient information mandated by the Omnibus Budget Reconciliation Act of 1990 (OBRA'90), and to create an intake form that meets and exceeds these requirements. METHODS: Chain, mass merchandiser, supermarket, and wholesale pharmacies located within the state of Florida were eligible for selection. Only 1 pharmacy was selected from each company. The research assistant asked the pharmacy employee to describe all information requested from a patient who is bringing in a prescription for the first time and/ or provide a blank copy of their existing patient intake form. Patient intake information forms were collected between July 2008 and February 2009. RESULTS: Of the 10 pharmacies included in this study (3 supermarkets, 3 mass merchandisers, 2 wholesale pharmacies, and 2 chain pharmacies), 40% of the studied pharmacies collected information on patient medications. All pharmacies collected at least 6 information requirements. Only 1 pharmacy was compliant with OBRA'90 requirements evaluated. CONCLUSION: By obtaining this information providers are in a better position to assist with avoiding medication errors and to help with the medical reconciliation process in health systems.

Saxagliptin: a new dipeptidyl peptidase 4 inhibitor for type 2 diabetes.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of saxagliptin, a new dipeptidyl peptidase-4 (DPP-4) inhibitor for the treatment of type 2 diabetes. DATA SOURCES: Searches of PubMed (1966-March 2010) and International Pharmacy Abstracts (1970-March 2010) were conducted using the key words saxagliptin, Onglyza, and BMS-477118. A review of bibliographies of retrieved articles was also performed to identify additional references. STUDY SELECTION AND DATA EXTRACTION: All identified studies published in English and involving efficacy and safety of saxagliptin in the treatment of type 2 diabetes were reviewed. DATA SYNTHESIS: Saxagliptin is a competitive inhibitor of DPP-4 that slows the degradation of incretin hormones, thereby stimulating insulin secretion, reducing postprandial glucagon, and decreasing glucose levels. Saxagliptin is well absorbed after oral administration and demonstrates a pharmacokinetic profile that is compatible with once-daily dosing. Clinical trials with saxagliptin monotherapy for the treatment of type 2 diabetes showed a reduction in hemoglobin A(1c) (A1C) of 0.43-0.9%. Saxagliptin has demonstrated similar reductions in A1C when used as add-on therapy with metformin, sulfonylureas, and thiazolidinediones. The combination of saxagliptin and metformin for initial therapy in treatment-naïve patients was associated with greater improvements in A1C than either agent alone. In general, saxagliptin therapy is well tolerated. The most common adverse effects occurring in clinical trials were headache, nasopharyngitis, upper respiratory tract infections, and urinary tract infections. CONCLUSIONS: Saxagliptin is effective as monotherapy or add-on therapy for the management of type 2 diabetes. Because saxagliptin has a higher cost and reduces A1C and other surrogate markers of glucose control to a lesser extent than other well-validated therapies, such as metformin, saxagliptin should be reserved for patients who fail or are intolerant of conventional treatments for type 2 diabetes.

Role of omega-3 Fatty acids for prevention or treatment of perinatal depression.

Perinatal depression is a complex mental health disorder that can manifest during pregnancy or after childbirth. Women with perinatal depression may not receive proper medical treatment because of concerns over teratogenic effects related to drug therapy. Evidence suggests that low levels of omega-3 fatty acids are correlated with depressive symptoms during pregnancy and after delivery. Omega-3 fatty acids may produce antidepressant effects due to their role in serotonin functioning. A literature search identified seven clinical trials of omega-3 fatty acids for the prevention or treatment of perinatal depression. Depression rating scale scores used in the studies improved, but results were statistically significant in only three trials. Four studies were randomized and placebo controlled, and three were open label. One study evaluating the prevention of postpartum depression in women with a history of depression was discontinued early due to relapse of depressive symptoms. In the trials we evaluated, the most common adverse effects were foul breath and/or unpleasant taste, and gastrointestinal complaints; no serious adverse events were reported. The seven studies were limited by small sample sizes and variable dosing and study durations. In the studies that demonstrated statistical significance, improvement in depression rating scale scores for omega-3 fatty acids was comparable to placebo. Overall, results have been inconclusive, but further investigation of omega-3 fatty acids is warranted because they did improve depression scores and appeared to be safe during pregnancy.

Human papillomavirus vaccine safety in pediatric patients: an evaluation of the Vaccine Adverse Event Reporting System.

Recent news reports have linked the human papillomavirus (HPV) vaccine to serious adverse events (AEs) in children and adolescents. We used the Vaccine Adverse Event Reporting System (VAERS) database to extract postmarketing AEs reported in patients who received the vaccine. Since approval of the HPV vaccine in the US, 3174 AEs occurring in children and adolescents (aged 6-17 y) have been reported to the VAERS. Of these, 191 (6%) were deemed to be serious. Although these AEs are of significant concern, more research is required before they can be directly correlated with the vaccine.