Assessment of Longitudinal Advanced Pharmacy Practice Experience Programs in Preparing Pharmacy Students for Residency Training.

OBJECTIVE: This study aimed to determine whether postgraduate year 1 (PGY-1) pharmacy residents felt more prepared for residency training after having completed a Longitudinal Advanced Pharmacy Practice Experience (LAPPE) program during pharmacy school. METHODS: This was a multicenter, two-arm, cross-sectional study among PGY-1 pharmacy residents. The primary outcome was self-reported residency preparedness. Secondary outcomes included self-reported competency in key indicators for success during early residency and matching with a preferred residency program. A survey was developed to obtain these data and was sent via email to all residency program directors of qualifying programs, who then redistributed it to PGY-1 residents in their respective programs. RESULTS: A total of 960 PGY-1 residents were included in the study. Of these, 180 (19%) reported prior participation in a LAPPE program. Longitudinal Advanced Pharmacy Practice Experience participants reported increased preparedness for residency training as compared to nonparticipants (mean 6.18 vs 5.72 on a 7-point Likert scale; difference 0.46, 95% CI 0.309-0.618). Longitudinal Advanced Pharmacy Practice Experience participation was also associated with greater self-reported clinical knowledge and skills (mean 5.18 vs 4.95, difference 0.23, 95% CI 0.093-0.372). Self-reported matching with a preferred residency program was common and similar between cohorts. CONCLUSION: Postgraduate year 1 residents who had completed a LAPPE felt better prepared for residency than those who had not completed a LAPPE. Prior LAPPE participation was also associated with greater self-reported clinical knowledge and skills at the start of residency training.

It's a Hard Knock Life: How Kids With Mild Traumatic Brain Injuries Are Treated.

OBJECTIVES: The diagnosis and treatment of mild traumatic brain injuries (mTBIs) by emergency medicine providers is greatly varied. Because of the frequency and long-term consequences associated with pediatric head injuries, it is crucial that adequate counseling is provided in acute care settings. The purpose of our study is to evaluate existing practices at Loyola University Medical Center emergency department to address inconsistencies in diagnostic or discharge practices and determine future quality improvement measures. METHODS: A retrospective cohort study was conducted at an academic hospital emergency department of patient records from 2017 to 2020. Demographic, diagnostic, and discharge data were summarized, and Pearson χ2 tests and Fisher exact tests were performed to determine associations among patient characteristics and provider practices. RESULTS: A total of 1160 patients met inclusion criteria for analysis. In terms of diagnostic procedure, 31.6% of providers did not uniformly use existing screening criteria, such as PECARN, to determine if CT scans were needed for mTBI evaluation. Most discharge instructions were based on a generalized template on epic (91.9%). Only a minority of providers prepared patient-specific instructions through written, verbal, or other supplemental materials. The most common formats included epic only (46.1%), epic and personalized written instructions (20.2%), and epic and verbal instructions (12.4%). Follow-up care instructions were provided to 93% of patients who received discharged instructions, mainly for primary care (96.7%), sports medicine (1.58%), neurology (0.65%), or other providers (1.11%). CONCLUSIONS: There is a lack of consistency in the evaluation and education of mTBI in pediatric patients. There is a need for personalized discharge instructions to ensure adequate patient and parent understanding and compliance. Further studies looking at long-term outcomes in these patients would also be beneficial.

Spontaneous Retropharyngeal Emphysema: A Triage Twist.

Spontaneous retropharyngeal emphysema (SRE) is a rare condition, occurring in the absence of trauma. Symptoms usually include acute-onset odynophagia and dyspnea. This is an interesting case of a young, healthy woman who presented to an emergency department with benign upper respiratory symptoms but took a drastic turn while in the waiting room after being triaged. The features and implications of SRE are discussed in this case, including emergent thoracic surgery consultation and additional testing.

Factors Influencing Pediatric Emergency Department Visits for Low-Acuity Conditions.

OBJECTIVES: Emergency department (ED) overcrowding is a growing problem, and pediatric patients are contributing. In this study, we aimed to determine which factors influence parents or guardians to choose the ED over their primary care physician (PCP). METHODS: A cross-sectional, online survey was administered in an academic hospital pediatric ED from September to October 2017. The 21-question survey was offered to the parents or guardians of pediatric patients triaged as low acuity. The survey assessed establishment and availability of their PCP, perception of illness or injury severity, reasons for choosing the ED, and demographic information. RESULTS: A total of 101 surveys were collected, with a 95% completion rate. Most patients had an established PCP. More than two-thirds did not attempt to contact their PCP prior to their ED visit. Nearly half stated their PCP did not offer after-hours or weekend availability. Most did not feel their child's condition was serious. Almost half would have waited to see their PCP if they could be seen within 24 hours. CONCLUSIONS: There appears to be a common misperception that PCPs do not offer extended hours. In addition, the parent or guardian's perception of severity was oftentimes more serious than perceived by medical staff. These results suggest that improving health literacy among our patient population by educating them on PCP availability and capability, ancillary services offered by PCP, and appropriate usage of the ED could potentially reduce nonurgent ED visits.