Impact of a Film on Student Pharmacists' Views on Quality of Life and Aging.

Objective. To assess the effectiveness of film in providing health and quality-of-life experiences of aging to student pharmacists. Methods. Third professional year student pharmacists enrolled in an elective course in geriatric pharmacy were shown a made-for-television movie, To Dance With the White Dog, which portrays elderly people experiencing health and quality-of-life issues. The student pharmacists were surveyed before and after viewing. The survey contained Likert-scale items as well as open-ended directed reflection questions. Responses to pre- and post-intervention surveys were compared using descriptive statistics and the Student t test for paired data. Qualitative content analysis was used to evaluate the directed reflection data. Results. Of the 69 students surveyed, 97% completed the pre- and post-intervention survey instruments. Comparison of pre- and post-survey data revealed non-significant increases in the strength of student pharmacists' agreement with statements on film as a useful resource. Students' self-reported understanding of geriatric health and quality-of-life experiences improved significantly from pre- to post-intervention. Agreement that film was a valid alternative to a lecture decreased slightly on the post-intervention survey. Through qualitative analysis of student reflections on the film activity, the themes of meaningful experience, opportunity to consider an approach to practice, and opportunity to experience the patient perspectives of autonomy, death, self-image of aging, and medication burden were identified. Conclusion. In pharmacy education, the combination of viewing a film followed by class discussion and written reflection was perceived by student pharmacists as a valuable method of learning about age-related health and quality-of-life experiences.

Student pharmacists' preparedness to evaluate primary literature pre- and post-Advanced Pharmacy Practice Experiences.

BACKGROUND AND PURPOSE: The primary objective of this study was to assess the effect of formal primary literature evaluation (PLE) during advanced pharmacy practice experiences (APPEs) on student pharmacists' preparedness and knowledge related to literature evaluation. EDUCATIONAL ACTIVITY AND SETTING: A perception of preparedness survey and knowledge assessment was given to student pharmacists pre- and post-APPEs. Student pharmacists were also asked to characterize their opportunities for formal PLE during APPEs. Literature evaluation experiences, knowledge base and preparedness data were compared between student pharmacists who completed two or more PLE on APPE and those who did not. FINDINGS: A total of 211 student pharmacists completed 529 formal PLE during their APPE experiences. Quiz grades and average perception of preparedness increased significantly from pre- to post-APPE regardless of whether student pharmacists had the opportunity for formal PLE on APPE. Student pharmacists who completed two or more PLE on APPE stated they felt more confident in evaluating primary literature after APPE, had greater post-APPE preparedness scores and a trend towards higher post-APPE quiz scores. DISCUSSION AND CONCLUSION: APPEs provide an important opportunity for student pharmacists to improve their PLE knowledge.

Efficacy and safety of tofacitinib for treatment of rheumatoid arthritis.

Tofacitinib is the first in a new class of nonbiologic disease-modifying antirheumatic drugs (DMARDs), a targeted, synthetic DMARD, approved for the treatment of rheumatoid arthritis (RA) as monotherapy or in combination with methotrexate or other non-biologic DMARD. Tofacitinib, an orally administered Janus kinase (JAK) inhibitor, decreases T-cell activation, pro-inflammatory cytokine production, and cytokine signaling by inhibiting binding of type I cytokine receptors family and γ-chain cytokines to paired JAK1/JAK3 receptors. The net effect of tofacitinb's mechanism of action is decreased synovial inflammation and structural joint damage in RA patients. To date, six phase 3 trials have been conducted to evaluate the safety and efficacy of tofacitinib under the oral rheumatoid arthritis triaLs (ORAL) series. This review describes the pharmacology of the novel agent, tofacitinib, and details the safety and efficacy data of the ORAL trials.

Student pharmacists' clinical interventions in advanced pharmacy practice experiences at a community nonteaching hospital.

OBJECTIVE: To assess student pharmacists' clinical interventions in advanced pharmacy practice experiences (APPEs) at a community nonteaching hospital and evaluate completed interventions based on the type of documentation method used. METHODS: Clinical interventions of 120 fourth-year (P4) student pharmacists in advanced institutional, medication safety, or internal medicine APPEs were collected over a 3½-year period. Clinical interventions were analyzed for cost savings, intervention type, and acceptance rates. A secondary analysis of paper-based vs electronic-based documentation of completed interventions was performed. RESULTS: There were 2,170 clinical interventions attempted with an acceptance rate of 97%. The estimated cost savings was $280,297. A comparable number of interventions and cost savings per student was observed between paper-based and electronic-based documentation methods. CONCLUSION: Student pharmacists at a community nonteaching hospital have many opportunities for participation in patient-centered activities, and for interaction and collaboration with other healthcare professionals. They can significantly benefit patient care through clinical interventions, while also contributing to cost savings for the institution.

A comparison of students' self-assessments with faculty evaluations of their communication skills.

OBJECTIVE: To compare students' self-assessment of their communication skills with faculty members' formal evaluation of their skills in a therapeutics course. METHODS: Over a 3-year period, faculty members evaluated second-year pharmacy students' communication skills as part of a requirement in a therapeutics course. Immediately following an individual oral assessment and again following a group oral assessment, students self-assessed their communication skills using the same rubric the faculty members had used. Students' self-assessments were then compared with faculty members' evaluation of students' communication skills. RESULTS: Four hundred one (97.3%) students consented to participate in this study. Faculty evaluation scores of students for both the individual and group oral assessments were significantly higher than students' self-assessment scores. Students' self-assessment scores of their communication skills increased from the individual to the group oral assessment. CONCLUSION: Students' self-assessments of communication skills were consistently lower than faculty members' evaluations. Greater use of oral assessments throughout the pharmacy curriculum may help to improve students' confidence in and self-assessment of their communication skills.

Icatibant for the treatment of hereditary angioedema.

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical trials, and safety of icatibant, a recently approved bradykinin B(2) receptor antagonist for treatment of acute attacks of hereditary angioedema (HAE). DATA SOURCES: Articles indexed in MEDLINE (1948-June 2012), International Pharmaceutical Abstracts (1970-May 2012), and Cumulative Index to Nursing and Allied Health Literature (1981-June 2012) were identified using the search terms icatibant, bradykinin B(2) receptor antagonist, and hereditary angioedema. Additional references were identified from the reference lists of the articles identified. STUDY SELECTION AND DATA EXTRACTION: English-language articles were reviewed. DATA SYNTHESIS: Icatibant was evaluated in 3 Phase 3 clinical trials and found to be a safe and effective option for treatment of acute HAE. Icatibant was compared to placebo in 2 clinical trials (FAST-1 and FAST-3) and to tranexamic acid in the FAST-2 trial. Patients receiving icatibant in FAST-1 did not experience a significant improvement in median time to clinically significant relief of the index symptom (p = 0.14), whereas patients receiving icatibant in FAST-3 experienced a significant improvement in median time to at least 50% reduction in symptom severity (p < 0.001). When icatibant was compared to tranexamic acid in FAST-2, the median time to clinically significant relief of the index symptom was shorter for patients receiving icatibant (p < 0.001). The most common adverse events associated with the administration of icatibant were injection-site reactions, which were mild to moderate and transient. These data suggest that icatibant is a safe and effective treatment for acute attacks of HAE. Although direct comparisons of recently approved alternatives for treatment of acute attacks are lacking, there are administration advantages of icatibant over other agents. Additionally, the cost of icatibant is comparable to that of the C1 esterase inhibitor Berinert and less expensive than ecallantide. CONCLUSIONS: Available efficacy data support that icatibant should be considered a safe and effective treatment for acute attacks of HAE. Additionally, limited treatment options for this rare condition, ease of administration, and comparable cost profile support its consideration for formulary inclusion.

A review of the advances in chronic obstructive pulmonary disease treatment.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality across the globe and within the United States. Although several medication classes are used for COPD treatment, none of these medications have been shown to significantly improve long-term lung function or mitigate overall disease progression. This review describes the pharmacologic treatment options for COPD and highlights recent studies evaluating the impact of bronchodilators and combination therapy on lung function, mortality, quality of life, and exacerbations. Additionally, indacaterol and roflumilast, 2 new COPD treatment agents approved by the Food and Drug Administration in 2011, are discussed. Pharmacists play an important role in managing and educating patients with COPD and should utilize new evidence to make recommendations.

Critical appraisal of efficacy and safety of abatacept in the treatment of refractory rheumatoid arthritis.

Rheumatoid arthritis is a chronic, progressive, autoimmune disease that leads to significant disability and premature mortality. Various treatment options are available, but the foundation of treatment includes nonbiologic and biologic disease-modifying antirheumatic drugs. The incidence of patients with rheumatoid arthritis refractory to first-line agents is estimated to be at least 20%. Abatacept, a T cell costimulation modulator, is the first agent to interfere with full T cell activation by competing with CD28 for binding of CD80 and CD86, which results in decreased secretion of proinflammatory cytokines and autoantibody production. Current American College of Rheumatology treatment guidelines recommend abatacept for patients with at least moderate disease activity and a poor prognosis demonstrating an inadequate response to other agents. Several key Phase III trials have been conducted to evaluate the efficacy and safety of abatacept in patients with an inadequate response to methotrexate or anti-tumor necrosis factor alpha therapy. Response rates in all trials showed statistically significant improvements compared with placebo according to American College of Rheumatology criteria for disease improvement. The most common adverse event report in patients receiving abatacept was infection; however, the frequency of adverse events was similar to placebo. Abatacept is a safe and effective rheumatoid arthritis treatment for patients with an inadequate response to methotrexate or anti-tumor necrosis factor alpha therapy.

Spinosad for treatment of head lice infestation.

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical trials, and safety profile of spinosad 0.9% topical lotion, a recently approved pediculicide for treatment of head lice infestation. DATA SOURCES: English-language articles indexed in MEDLINE (1948-May 2011), Toxline, Google Scholar, International Pharmaceutical Abstracts (1970-May 2011), and Cumulative Index to Nursing and Allied Health Literature (1981-May 2011) were identified, using the search terms spinosad, head lice, and pediculosis capitis. STUDY SELECTION AND DATA EXTRACTION: Available English-language articles were reviewed. DATA SYNTHESIS: In the studies that were reviewed, the percentage of patients who were lice free 14 days after the last treatment was significantly higher in the spinosad groups compared to the permethrin groups (84.6% vs 44.9% and 86.7% vs 42.9%, respectively; p < 0.001 for both studies). Additionally, the proportion of all primary and nonprimary participants determined to be lice free following only 1 treatment with the study medication was higher among patients in the spinosad groups compared with those in the permethrin groups. Application-site erythema was observed in patients in both treatment groups; however, it was more common in patients in the permethrin groups compared with those receiving spinosad (6.8% vs 3.1%, respectively; p = 0.007). No serious adverse effects were reported by patients receiving spinosad. Adherence was higher in the spinosad groups compared with the permethrin groups, although adherence overall was high in both studies. These data suggest that spinosad is a safe and effective treatment for the eradication of head lice, and the ease of administration and improved adherence with spinosad could offer an advantage over currently available treatment options. CONCLUSIONS: Because of its established efficacy, favorable safety profile, and ease of application, spinosad can be considered a convenient and effective treatment for head lice in patients aged 4 years and older.

Professional technical standards in colleges and schools of pharmacy.

OBJECTIVE: To determine the prevalence, characteristics, and use of professional technical standards among colleges and schools of pharmacy accredited by the Accreditation Council for Pharmacy Education (ACPE). METHODS: The Web site of every college and school of pharmacy accredited by ACPE was searched to identify information regarding the availability, content, and use of technical standards and to obtain demographic information. RESULTS: Information was obtained from all of the 114 colleges and schools of pharmacy and 67 (59%) had technical standards in place. Common themes for technical standards were: observation; communication; motor; intellectual, conceptual, integrative and quantitative abilities; and behavioral and social attributes. Of those colleges and schools with technical standards, 61 (91%) had standards that addressed all 5 of these themes and 34 (51%) specified that the technical standards were used in their admission, progression, and graduation procedures. CONCLUSION: More than half of the colleges and schools of pharmacy examined in this study have technical standards; however, 41% have yet to develop and implement them. Colleges and schools of pharmacy looking for guidance in technical standards development could use the technical standards themes identified in this study.

Resident physicians' acceptance of pharmacy students' pharmacotherapy recommendations during an ambulatory care advanced pharmacy practice experience.

OBJECTIVE: To compare the acceptance rates of written versus verbal pharmacotherapy recommendations made by pharmacy students on an ambulatory care advanced pharmacy practice experience (APPE). METHODS: Fourth-year pharmacy students made written and verbal pharmacotherapy recommendations to resident physicians in an internal medicine clinic at an urban, teaching hospital over a 10-month period. The types of recommendations and outcomes of the interventions were recorded using a data collection form to determine differences in acceptance rates for written versus verbal recommendations. The recommendation types and corresponding acceptance rates were also compared. RESULTS: Of 542 pharmacotherapy recommendations made by 14 APPE students during the 10-month study period, 65.1% were written and 34.9% were verbal. Of the 189 verbal recommendations, 97.9% were accepted, compared with 83.6% of written recommendations (p < 0.0001). The most frequent types of recommendations and overall rates of acceptance were dosage change (87.0%), laboratory monitoring (85.8%), and medication initiation based on evidence-based medicine guidelines (79.3%). CONCLUSION: Verbal pharmacotherapy recommendations made by pharmacy students were accepted by resident physicians at a significantly higher rate than written recommendations in an outpatient internal medicine clinic.

Abatacept: a novel treatment for rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic, autoimmune disease that has traditionally been treated with non-biologic and biologic disease-modifying antirheumatic drugs (DMARDs). Although these agents have become firmly established as effective RA treatments, some patients do not have an adequate response. The recent approval of abatacept, a first-in-class agent that selectively modulates the activation of T cells, offers an alternative therapeutic option. As reflected in pharmacokinetic analyses, abatacept 10 mg/kg has been shown to be effective in treating patients with established RA. Demonstrating safety, efficacy and quality of life improvements in a wide range of RA patients, including those with inadequate response to methotrexate or tumor necrosis factor antagonists, abatacept is seen as a valuable addition to the RA treatment armamentarium.

The impact of problem-based learning on students' perceptions of preparedness for advanced pharmacy practice experiences.

OBJECTIVES: To evaluate graduating pharmacy students' perceptions of their preparedness for advanced pharmacy practice experiences and the effectiveness of problem-based learning in their preparation. METHODS: A survey instrument was administered anonymously in May 2004 and May 2005 to graduating pharmacy students of the University of Mississippi School of Pharmacy. RESULTS: Students reported that the areas in which problem-based learning prepared them most effectively for advanced pharmacy practice experiences were retrieval of medical information (80%), discussion of disease states and drug therapies at the basic science level (56%), and evaluation of the appropriateness of a medication regimen based on patient specific information (50%). Areas in which students reported being inadequately prepared included identifying and utilizing drug assistance programs (42%) and processing prescriptions/hospital orders (40%). CONCLUSION: Data from 2 consecutive graduating classes supports that problem-based learning is an effective format for preparing pharmacy students for advanced pharmacy practice experiences in a variety of areas.