A Process for Curricular Improvement Based on Evaluation of Student Performance on Milestone Examinations.

Objective. To identify and address areas for curricular improvement by evaluating student achievement of expected learning outcomes and competencies on annual milestone examinations. Design. Students were tested each professional year with a comprehensive milestone examination designed to evaluate student achievement of learning outcomes and professional competencies using a combination of multiple-choice questions, standardized patient assessments (SPAs), and objective structured clinical examination (OSCE) questions. Assessment. Based on student performance on milestone examinations, curricular changes were instituted, including an increased emphasis on graded comprehensive cases, OSCE skills days, and use of patient simulation in lecture and laboratory courses. After making these changes, significant improvements were observed in second and third-year pharmacy students' grades for the therapeutic case and physician interaction/errors and omissions components of the milestone examinations. Conclusion. Results from milestone examinations can be used to identify specific areas in which curricular improvements are needed to foster student achievement of learning outcomes and professional competencies.

Assessment and revision of clinical pharmacy practice internet web sites.

BACKGROUND: Health care professionals, trainees, and patients use the Internet extensively. Editable Web sites may contain inaccurate, incomplete, and/or outdated information that may mislead the public's perception of the topic. OBJECTIVE: To evaluate the editable, online descriptions of clinical pharmacy and pharmacist and attempt to improve their accuracy. METHODS: The authors identified key areas within clinical pharmacy to evaluate for accuracy and appropriateness on the Internet. Current descriptions that were reviewed on public domain Web sites included: (1) clinical pharmacy and the clinical pharmacist, (2) pharmacy education, (3) clinical pharmacy and development and provision for reimbursement, (4) clinical pharmacists and advanced specialty certifications/training opportunities, (5) pharmacists and advocacy, and (6) clinical pharmacists and interdisciplinary/interprofessional content. The authors assessed each content area to determine accuracy and prioritized the need for updating, when applicable, to achieve consistency in descriptions and relevancy. The authors found that Wikipedia, a public domain that allows users to update, was consistently the most common Web site produced in search results. RESULTS: The authors' evaluation resulted in the creation or revision of 14 Wikipedia Web pages. However, rejection of 3 proposed newly created Web pages affected the authors' ability to address identified content areas with deficiencies and/or inaccuracies. CONCLUSIONS: Through assessing and updating editable Web sites, the authors strengthened the online representation of clinical pharmacy in a clear, cohesive, and accurate manner. However, ongoing assessments of the Internet are continually needed to ensure accuracy and appropriateness.

Rhabdomyolysis in a patient receiving ranolazine and simvastatin.

PURPOSE: A case of rhabdomyolysis occurring shortly after the addition of ranolazine to a stable simvastatin regimen is reported. SUMMARY: A 63-year-old Caucasian man with a history of hyperlipidemia and coronary artery disease arrived at an urgent care center with complaints of worsening bilateral lower-extremity weakness over three days. He was admitted to a hospital within 24 hours. His other underlying medical conditions included congestive heart failure, chronic kidney disease, degenerative joint disease, and a history of stroke. Oral medications at the time of admission included furosemide 40 mg daily, clopidogrel 75 mg daily, hydralazine 50 mg three times daily, metoprolol 50 mg twice daily, isosorbide mononitrate 120 mg daily, omeprazole 20 mg daily, nitroglycerin tablets as needed for chest pain, simvastatin 80 mg daily, and the recent addition of ranolazine 500 mg daily. Laboratory tests revealed that the patient's serum creatinine (SCr) concentration was 3.9 mg/dL and his creatine kinase (CK) concentration was 31,989 units/L. Ranolazine and simvastatin were discontinued, and metoprolol, hydralazine, isosorbide mono-nitrate, and furosemide were continued via nasogastric tube, along with amlodipine 10 mg daily and omeprazole 40 mg daily. The patient's serum CK concentration remained above 10,400 units/L for four days. By day 7 of hospitalization, the patient's serum CK concentration was 715 units/L, and it was almost undetectable by hospital day 18 (24 units/L). The patient's SCr concentration remained at his baseline value of 2.2 mg/dL. CONCLUSION: A 63-year-old man with a history of chronic renal impairment on a stable dosage of simvastatin developed rhabdomyolysis after the addition of ranolazine to his medication regimen.