Development of a Competency Assessment Framework for Pharmacy Residents Participating in High-Fidelity Simulation and Creation of the SIMPHARM Assessment Tool.

Background: Simulations are used to improve professional practice across multiple health professions; however, the application of simulations in pharmacy curricula has been limited by a lack of evidence. Objectives: To delineate the competencies of pharmacy residents needed to assess their progress while participating in a high-fidelity simulation training program and to create a reliable assessment tool based on these competencies. Methods: A literature review was conducted, followed by application of a modified Delphi method. An assessment tool based on the results of these activities was drafted (in French). A second modified Delphi process was carried out to assess the reliability of the tool, and the tool was modified accordingly. Results: The literature search yielded a total of 2670 articles, of which 289 were included for analysis. The first modified Delphi process involved 19 experts in the first round and 10 experts in the second round. The Cronbach α was 0.866 (95% confidence interval [CI] 0.713-0.960), indicating good reliability. A total of 7 competencies were retained for inclusion in the SIMPHARM assessment tool: professionalism, leadership, teamwork, communication, critical thinking, preparation and packaging of medications, and pharmaceutical calculations. The second modified Delphi process involved 9 experts in the first round and 11 experts in the second round. The final Cronbach α was 0.877 (95% CI 0.741-0.960). Conclusions: To the authors' knowledge, this was one of the largest studies exploring pharmacy competencies in the context of simulations. This work yielded a reliable framework for the assessment of pharmacy residents' competencies. This assessment tool may help evaluators in assessing the competencies of pharmacy trainees after simulation training.

Contexte: Les simulations sont utilisées dans le but d'améliorer la pratique professionnelle de plusieurs professions de la santé; cependant, le manque de données probantes limite leur application dans les programmes d'enseignement en pharmacie. Objectifs: Décrire les compétences nécessaires pour évaluer le progrès des résidents en pharmacie qui participent à une formation basée sur un programme de simulation haute-fidélité; et mettre au point un outil d'évaluation fiable qui se base sur ces compétences. Méthodologie: Une revue de littérature a été effectuée, avant d'appliquer une méthode Delphi modifiée et de faire l'ébauche d'un outil d'évaluation (en français) basé sur les résultats de ces activités. Une deuxième méthode Delphi modifiée a été appliquée pour évaluer la fiabilité de l'outil et celui-ci a fait l'objet de modifications en conséquence. Résultats: La revue de littérature a donné un total de 2670 articles, parmi lesquels 289 ont été inclus à des fins d'analyse. La première méthode Delphi modifiée a impliqué 19 experts pour la première phase, et 10 pour la seconde. Le coefficient alpha de Cronbach était de 0,866 (intervalle de confiance [IC] à 95 % 0,713­0,960), indiquant une bonne fiabilité. Au total, 7 compétences à inclure dans l'outil d'évaluation ont été retenues: professionnalisme, leadership, travail d'équipe, communication, pensée critique, préparation et conditionnement des médicaments, et calculs pharmaceutiques. La deuxième méthode Delphi modifiée impliquait quant à elle 9 experts pour la première phase et 11 pour la seconde. Le coefficient alpha de Cronbach final était de 0,877 (IC à 95 % 0,741­0,960). Conclusions: À la connaissance des auteurs, cette étude était l'une des plus importantes se penchant sur les compétences en pharmacie dans le contexte des simulations. Ce travail a donné lieu à un cadre de référence fiable pour évaluer les compétences des résidents en pharmacie. Cet outil d'évaluation pourrait aider les évaluateurs à évaluer les compétences des stagiaires à la suite d'une formation par simulation.

Melatonin and Ramelteon for the treatment of delirium: A systematic review and meta-analysis.

OBJECTIVE: To assess the efficacy of melatonin and melatonergic agonist for the treatment of delirium in hospitalized patients. METHODS: Embase, MEDLINE, PsycINFO, PubMed, CENTRAL, Cochrane Database of Systematic Reviews, TRIP Medical Database, ClinicalTrials.gov and Google were searched from inception to October 2022. Randomized controlled trials (RCT) and observational studies with any type of comparator evaluating melatonin or melatonergic agonist (ramelteon) enrolling any populations (ICU, surgery, geriatric) were included. Two reviewers independently selected and extracted data using the Cochrane risk of bias tools (RoB2 and ROBINSI). RESULTS: Out of the 650 screened publications, three RCTs and six observational studies were included (n = 1211). All three RCTs compared melatonin to placebo, as the majority of observational studies compared melatonin or ramelteon to antipsychotics. Two RCTs reported the duration of delirium and a meta-analysis provided a statistical difference between melatonin and placebo (-1.72 days, 95% CI -2.66 to -0.77, p = 0.0004). Five observational studies reported the duration of delirium but only one reported a statistical reduction in the duration of delirium. CONCLUSION: Although melatonin and ramelteon may be effective treatments for delirium, particularly to shorten the duration of delirium and to limit the use of rescue medication, current data is limited in number and in its quality. Clinicians should wait until higher quality data from ongoing RCTs are available before prescribing melatonin to delirious patients.

Successful Management of Natalizumab-Associated Primary Central Nervous System Lymphoma through Autologous Stem Cell Transplant.

Natalizumab is used as a second-line treatment for multiple sclerosis (MS). Some reports have linked natalizumab to primary central nervous system lymphoma (PCNSL), although few have described its management. A 45-year-old woman with Balo's Concentric Sclerosis presented dizziness, vertigo accompanied by dysarthria, weakness on the left side and blurred vision to the right eye after the fourth dose of natalizumab. Magnetic resonance imaging (MRI) and a brain biopsy confirmed the diagnosis of PCNSL. The patient received modified PCNSL chemotherapy (MATRix protocol) followed by high-dose chemotherapy (HDC) supported by an autologous hematopoietic stem cell transplant (ASCT) as a consolidation therapy. Thirty months later, she is still in complete remission of her PCNSL and MS. In this case, whole brain radiotherapy was excluded because it may be associated with an increased risk of neurotoxicity in MS. ASCT was preferred because it has been shown to prevent disability progression in less advanced MS stages. Our patient is the second to receive an ASCT in this context and this option of treatment should be the preferred if the patient is eligible.