A Survey of Pandemic Impacts on Pharmacy Residency Applications, Interviews, and Selection Factors.

Objective. To assess the impact of the COVID-19 pandemic on pharmacy residency application/interview processes, match rate, and factors influencing match rankings at a single college of pharmacyMethods. In spring of 2020 and 2021, an anonymous survey of fourth-year pharmacy school (P4) residency applicants at one college of pharmacy was administered. Survey responses were compared to explore trends in showcase participation, number/type/geographic dispersion of applications submitted, interview invitations, grade point average (GPA), research experience, and match rate. A thematic analysis evaluated common factors influencing match rankings.Results. Responses were collected from 75 of 99 (75.8% response rate) residency-seeking students in 2020 and 79 of 94 (84.0% response rate) in 2021. Students in 2021 reported applying to a higher median number of programs, with no significant differences in mean reported number of interview invitations or match rate. The virtual American Society of Health-System Pharmacists (ASHP) Midyear Showcase led to a median reported savings of $1000 with no significant impact on perceived value. Virtual interviews led to a median reported savings of $430. Thematic analysis revealed feel/culture, location, and learning experience options as the most prevalent deciding factors for match rankings in both years.Conclusion. The pandemic led to an increase in the number of residency applications per student and yielded a net cost savings. There were no differences in number of interviews offered, match rate, or in deciding factors influencing match rankings. As the pandemic evolves, schools should maintain a flexible and dynamic approach to support students.

Improving Developmental Screening and Supporting Families with Paid Parent Partners.

OBJECTIVE: The primary goals of the project were to improve rates of developmental screening and appropriate referral for atypical screens for children from birth to 3 years in participating practices and to integrate parent partners (PPs) into primary care. METHOD: Parents' Place of Maryland, in collaboration with the Maryland Department of Health, developed a quality improvement project to improve rates of developmental screening, referral, and follow-up. Nine practices from across the state completed the project. Participating practices received training and technical assistance for screening, referral, and data collection as well as a paid part-time PP to assist with care coordination. Families of children with atypical developmental screening results were offered a referral to receive support in following through with referrals, including needed social services to address health care barriers. RESULTS: Developmental screening rates across practices increased from 65% to 95% during the 9-month project, and autism-specific screening increased from 75% to 94%. Appropriate referral rates tripled from 6% to 20% of children. After an initial learning curve, practices gradually increased referrals to PPs, and they served 292 individual families (total of 544 contacts) over 9 months. PPs helped families identify a variety of community services to meet their needs. CONCLUSION: While developmental screening rates can be improved using quality improvement processes, supporting families to connect to services requires additional resources. Integrating trained PPs into pediatric practices improves access to community-based services in a cost-efficient manner. More research is needed to identify the most efficient models for providing this service on a broader scale.

Inpatient Perioperative Formulary Restriction of Intravenous Acetaminophen at Vizient Partner Hospitals: A National Survey of Pharmacists.

Purpose: Despite potential benefits of intravenous (i.v.) administration of acetaminophen (APAP), consistent outcome data are lacking. This, combined with the higher acquisition cost of the drug, has led to variation in i.v. APAP management strategies. This project evaluated the contemporary formulary status and restrictions of i.v. APAP in the perioperative setting. Methods: A survey focusing on i.v. APAP formulary restriction in the perioperative setting was developed by the Vizient Pharmacy Research Committee and distributed to Vizient Pharmacy Program participant listservs for Pharmacy Directors or Drug Information Pharmacists. The four survey domains included hospital characteristics, perioperative i.v. APAP formulary status and prescribing restrictions, perioperative i.v. APAP use, and perioperative i.v. APAP medication use evaluation (MUE) results. Responses were collected and summarized, and primary outcomes were evaluated using Fisher's exact test. Results: A total of 1195 surveys were distributed with a response rate of 19%. Respondents were equally distributed between academic medical centers (AMC) and non-academic medical centers (non-AMC). Two cohorts were examined: those with i.v. APAP on formulary and those without. The non-AMCs showed a larger proportion of hospitals with the medication on formulary (P = .041). Regarding formulary decision-making, the AMCs were more considerate of value. Several different practices were employed to limit or restrict i.v. APAP. Conclusion: A survey of directors of pharmacy and drug information specialists revealed that the majority of hospitals have i.v. APAP on formulary for perioperative use, but use is restricted. Differences in i.v. APAP formulary practices between AMCs and non-AMCs warrant further consideration.

Impact of early direct patient care introductory pharmacy practice experiences on student pharmacists' career exploration.

BACKGROUND AND PURPOSE: The University of Kentucky College of Pharmacy piloted a novel longitudinal introductory experiential program to provide second (P2) and third (P3) year professional students early exposure to pharmacist-provided direct patient care, opportunity to develop professionally expected behaviors, and ability to explore contemporary pharmacy career options. This paper describes the influence of the pilot on pre-advanced pharmacy practice experiences (APPEs) career interests and professional development. EDUCATIONAL ACTIVITY AND SETTING: Forty P2 and P3 students participated in the longitudinal experiential pilot course. Students were assigned to 32 pharmacist preceptors in a variety of direct patient care practices. Students completed 16 onsite hours over the fall semester. Influence of the pilot experience on APPE plans and future career interests was assessed by an end of experience reflective assignment and survey. FINDINGS: The pilot course served as the initial exposure for the majority of students to both direct patient care and specialized areas of pharmacy practice. Nearly half of students indicated the experience advanced their knowledge of pharmacists' scope of practice and potential career opportunities. Most students (85%) reported the experience influenced future career plans, with half indicating increased interest in their specific practice specialty. Over 75% planned to pursue an APPE in that practice area. Nearly all students reported making professional contacts through this experience. SUMMARY: Early exposure to direct patient care and specialized pharmacy practice areas through this IPPE provided students opportunity to inform career interest and develop professional contacts with preceptors in specialized practice areas.

Pharmacy Students' Ability to Identify the Steps of the Pharmacists' Patient Care Process During IPPE.

Objective. To determine the ability of first-year Doctor of Pharmacy (PharmD) students to describe patient care activities performed by pharmacists and accurately associate those activities with the five core steps of the Pharmacists' Patient Care Process (PPCP). Methods. First-year student pharmacists completed introductory practice experiences at ambulatory and institutional pharmacies. Students' ability to describe activities that occurred in these settings and align them with the five core steps (collect, assess, plan, implement, and follow-up) of the PPCP were assessed. Results. The students were more adept in describing patient care activities and aligning them to the appropriate PPCP steps in an ambulatory pharmacy setting than in an institutional pharmacy setting. Students achieved higher scores when describing and aligning patient care activities associated with the collect and implement steps in an ambulatory pharmacy setting and for the assess step in an institutional pharmacy setting. Conclusion. As institutions strive to adopt the PPCP in all areas of the curriculum, this application serves as an example of successful PPCP integration early in the introductory experiential curriculum. Our results challenge faculty to provide early opportunities for students to apply the PPCP in a variety of practice settings, including settings focused on the medication distribution system.

Whole Person Health: Using Experiential Learning and the ICF Model as a Tool for Introductory Interprofessional Collaborative Practice.

BACKGROUND: The International Classification of Func¬tioning (ICF) model is recommended for interprofessional use to define, measure, and create health and disability policy. Our goal was to expand a uniprofessional student learning experience into an interprofessional experiential clinical learning experience focused on the ICF model. METHODS: An experiential interprofessional education program was developed for Physical Therapy (PT), Physician Assistant (PA), and Pharmacy students. Student teams interviewed a community mentor from a senior living community outside of class to explore their mentor's health journey, assess quality of life, and perform an environmental safety assessment. In this pilot study, students completed an anonymous, unique-identifier electronic survey with open response items pre- and post-experience. Data were coded using inductive thematic analysis. RESULTS: Four themes emerged: learning about other professions (scope of practice), mentor's experiences with health care, treating the whole person, and improving team effectiveness. All four Interprofessional Education Collaborative (IPEC) competencies mapped to the data broadly indicating this learning experience meets interprofessional educational requirements. CONCLUSIONS: Student teams deepened their understanding of their community mentor's health and valued the interprofessional knowledge gained. Using the common lens of the ICF, students' understanding and appreciation of other disciplines emerged and students began to see their mentors from a more holistic perspective.

Successes, challenges, and impact of a large-cohort preclinical interprofessional curriculum: A four-year reflection.

BACKGROUND: Accreditation Council for Pharmacy Education (ACPE) Standards 2016 established a new standard on interprofessional education (IPE) to place specific emphasis on developing interprofessional competence among pharmacy graduates. INTERPROFESSIONAL EDUCATION ACTIVITY: Interprofessional Collaboration And Team Skills (iCATS) serves as the core interprofessional curriculum for nearly 700 first-year students in seven participating health professional programs. The curriculum was developed around the four Interprofessional Education Collaborative (IPEC) Competencies to develop foundational interprofessional knowledge, skills, and attitudes. Pharmacy students build preliminary competence in interprofessional roles and responsibilities, team dynamics, values and ethics, communication, and conflict resolution (ACPE Standard 11.1) and have an opportunity to learn about, from, and with other interprofessional students (ACPE Standard 11.2). DISCUSSION: Refinement of the iCATS curriculum has been an iterative process over the past four years. For iCATS 2016-2017, all Interprofessional Collaborative Competency Attainment Scale (ICCAS) evaluation items indicated significant changes in pre- and posttest indicating targeted IPEC Competencies were addressed through the iCATS curriculum. IMPLICATIONS: The 2016-2017 revision of iCATS resulted in the most effective iteration of this core interprofessional curriculum to date. Clearer course objectives, a compressed schedule, employment of a variety of teaching/learning methods, and greater schedule cooperation among the colleges have contributed to the success and delivery of an IPE curriculum. Additionally, iCATS provides a unique opportunity for pharmacy students to interact with health professions students from six other programs while making significant progress toward competence in ACPE Standards 11.1 and 11.2 on interprofessional education (IPE).

Evaluating the Use of Automated Feedback on Student Motivation.

OBJECTIVE: Autonomy-support and quality feedback have been shown to significantly impact student learning. Unfortunately, quality feedback is often very time consuming. The goal of this study was to examine the autonomy-supportive potential from feedback provided via technology, specifically the ExamSoft Strength and Opportunities report. METHODS: Students were divided into two groups: one received enhanced performance feedback via the ExamSoft Strength and Opportunities report, the other received traditional grade-only feedback in the form of grades and course averages, via ExamSoft. The Learning Self-Regulation Survey (SRQ-L) was administered to 139 third-year doctor of pharmacy students. The survey contained 14 statements asking students to rate their reasons (relative autonomy) for reviewing ExamSoft feedback, three items related to use of the ExamSoft technology, and five demographic items. RESULTS: A statistical difference, t(52) = -2.07, p =0.043; d = .577, was reported between the two groups indicating enhanced feedback via ExamSoft had a moderate impact on students' autonomy. CONCLUSIONS: Students who received enhanced ExamSoft feedback reported significantly higher relative autonomy index (RAI) for feedback review than students who did not receive the feedback. This suggests that the enhanced ExamSoft feedback was autonomy-supportive.

Factors influencing professional state association membership decisions among recent pharmacy graduates.

INTRODUCTION: State pharmacy association membership levels have remained stagnant in recent years despite active student organization involvement among student pharmacists and an increased number of pharmacy schools producing new pharmacy graduates in the United States. The objective of this project was to examine factors considered by recent pharmacy graduates when deciding to join state pharmacy associations. METHODS: A 16-item cross sectional survey of recent pharmacy graduates collected respondents' demographic profile, professional student organization involvement, association memberships, and membership decision factors. RESULTS: The most influential factors in membership decisions included continuing education (62.8%), opportunity to advance pharmacy practice (51.1%), email updates (39.4%), and networking opportunities (37.2%). State pharmacy association meeting attendance (p = 0.004 and p = 0.028 for the Kentucky Society of Health-System Pharmacists and the Kentucky Pharmacists Association respectively), student organization membership (p = 0.038), committee service (p = 0.025), and state association board participation (p = 0.021) during pharmacy education increases the likelihood of membership in state associations. CONCLUSIONS: Early engagement in state pharmacy associations during pharmacy school improves the likelihood of new practitioner membership. Pharmacy schools should engage with state association leaders to promote student committee participation, association board participation, and attendance at state meetings to ensure the continued success of state pharmacy associations.

Student Perception of Improvement in Communication and Value in 2 Interprofessional Education Delivery Formats.

A preferred format to deliver interprofessional education (IPE) has not been described. The aim of this study was to compare students' (N = 150) perceived value and improvement in communication between an IPE activity delivered using a comprehensive versus an abbreviated format. Although both formats were perceived by students to improve their communication skills and add value to their education, students indicated the abbreviated format was more effective than the comprehensive format.

Teaching educational assistants to facilitate the multisymbol message productions of young students who require augmentative and alternative communication.

PURPOSE: Many classroom educational assistants (EAs) have a significant amount of responsibility in carrying out educational plans for children who use augmentative and alternative communication (AAC), but they receive little instruction on how to do so (Kent-Walsh & Light, 2003). This study investigates the impact of using a communication partner instructional program to teach EAs how to teach their students to produce symbol combinations on their speech-generating devices. METHOD: A single-subject multiple-probe-across-participants design was used to evaluate the effectiveness of the instructional program on (a) the EAs' implementation of an interaction strategy with their students who used AAC and (b) the rates of multisymbol message productions for the students who used AAC. RESULTS: All 3 participating EAs learned to use the interaction strategy appropriately, and all 3 participating students who used AAC increased their multisymbol message production rates. CONCLUSIONS: Results provide further evidence (a) of the viability of using a communication partner instructional program for teaching partners how to facilitate the communication skills of children who use AAC and (b) that the interaction strategy can be an effective tool for increasing expressive multisymbol message rates for children who use AAC.

Wnt signaling is regulated by endoplasmic reticulum retention.

Precise regulation of Wnt signaling is important in many contexts, as in development of the vertebrate forebrain, where excessive or ectopic Wnt signaling leads to severe brain defects. Mutation of the widely expressed oto gene causes loss of the anterior forebrain during mouse embryogenesis. Here we report that oto is the mouse ortholog of the gpi deacylase gene pgap1, and that the endoplasmic reticulum (ER)-resident Oto protein has a novel and deacylase-independent function during Wnt maturation. Oto increases the hydrophobicities of Wnt3a and Wnt1 by promoting the addition of glycophosphatidylinositol (gpi)-like anchors to these Wnts, which results in their retention in the ER. We also report that oto-deficient embryos exhibit prematurely robust Wnt activity in the Wnt1 domain of the early neural plate. We examine the effect of low oto expression on Wnt1 in vitro by knocking down endogenous oto expression in 293 and M14 melanoma cells using shRNA. Knockdown of oto results in increased Wnt1 secretion which is correlated with greatly enhanced canonical Wnt activity. These data indicate that oto deficiency increases Wnt signaling in vivo and in vitro. Finally, we address the mechanism of Oto-mediated Wnt retention under oto-abundant conditions, by cotransfecting Wnt1 with gpi-specific phospholipase D (GPI-PLD). The presence of GPI-PLD in the secretory pathway results in increased secretion of soluble Wnt1, suggesting that the gpi-like anchor lipids on Wnt1 mediate its retention in the ER. These data now provide a mechanistic framework for understanding the forebrain defects in oto mice, and support a role for Oto-mediated Wnt regulation during early brain development. Our work highlights a critical role for ER retention in regulating Wnt signaling in the mouse embryo, and gives insight into the notoriously inefficient secretion of Wnts.

Beetle and plant density as cues initiating dispersal in two species of adult predaceous diving beetles.

Dispersal can influence population dynamics, species distributions, and community assembly, but few studies have attempted to determine the factors that affect dispersal of insects in natural populations. Consequently, little is known about how proximate factors affect the dispersal behavior of individuals or populations, or how an organism's behavior may change in light of such factors. Adult predaceous diving beetles are active dispersers and are important predators in isolated aquatic habitats. We conducted interrelated studies to determine how several factors affected dispersal in two common pond-inhabiting species in southern Alberta, Canada: Graphoderus occidentalis and Rhantus sericans. Specifically, we (1) experimentally tested the effect of plant and beetle densities on dispersal probabilities in ponds; (2) surveyed ponds and determined the relationships among beetle densities and plant densities and water depth; and (3) conducted laboratory trials to determine how beetle behavior changed in response to variation in plant densities, conspecific densities, food, and water depth. Our field experiment determined that both species exhibited density dependence, with higher beetle densities leading to higher dispersal probabilities. Low plant density also appeared to increase beetle dispersal. Consistent with our experimental results, densities of R. sericans in ponds were significantly related to plant density and varied also with water depth; G. occidentalis densities did not vary with either factor. In the laboratory, behavior varied with plant density only for R. sericans, which swam at low density but were sedentary at high density. Both species responded to depth, with high beetle densities eliciting beetles to spend more time in deeper water. The presence of food caused opposite responses for G. occidentalis between experiments. Behavioral changes in response to patch-level heterogeneity likely influence dispersal in natural populations and are expected to be important for observed patterns of individuals in nature.

The effects of aided AAC interventions on AAC use, speech, and symbolic gestures.

Augmentative and alternative communication (AAC) service provision can be time-consuming, and it is important to ensure that the time invested in aided AAC interventions is worth the costs. As children who use AAC are multimodal communicators, it is important to understand the effects that aided AAC interventions may have not only on AAC use but also on other communication modes, including speech and symbolic gestures. Toward these ends, this article contains a review of commonly used AAC intervention techniques, a discussion of how use of these techniques affects aided AAC use, and an examination of the effect that AAC interventions have on other communication modes, including speech and various types of gestures. Overall, current research findings indicate that aided AAC interventions can be highly effective for teaching students who use AAC to become more effective communicators and that such interventions do not have a negative effect on speech-and may, in some cases, have a positive effect on speech.

Morphine-induced receptor endocytosis in a novel knockin mouse reduces tolerance and dependence.

Opioid drugs, such as morphine, are among the most effective analgesics available. However, their utility for the treatment of chronic pain is limited by side effects including tolerance and dependence. Morphine acts primarily through the mu-opioid receptor (MOP-R) , which is also a target of endogenous opioids. However, unlike endogenous ligands, morphine fails to promote substantial receptor endocytosis both in vitro, and in vivo. Receptor endocytosis serves at least two important functions in signal transduction. First, desensitization and endocytosis act as an "off" switch by uncoupling receptors from G protein. Second, endocytosis functions as an "on" switch, resensitizing receptors by recycling them to the plasma membrane. Thus, both the off and on function of the MOP-R are altered in response to morphine compared to endogenous ligands. To examine whether the low degree of endocytosis induced by morphine contributes to tolerance and dependence, we generated a knockin mouse that expresses a mutant MOP-R that undergoes morphine-induced endocytosis. Morphine remains an excellent antinociceptive agent in these mice. Importantly, these mice display substantially reduced antinociceptive tolerance and physical dependence. These data suggest that opioid drugs with a pharmacological profile similar to morphine but the ability to promote endocytosis could provide analgesia while having a reduced liability for promoting tolerance and dependence.

Multifocal and recurrent subarachnoid hemorrhage due to an herbal supplement containing natural coumarins.

INTRODUCTION: Over-the-counter herbal and alternative medicines are classified as dietary supplements and, unlike drugs, are not rigorously regulated by the United States Food and Drug Administration. Their potential adverse effects are often poorly characterized. METHOD: Red clover, dong quai, and Siberian ginseng are herbal compounds used for treatment of perimenopausal symptoms such as hot flashes. These compounds are known to contain coumarins, and thus carry the potential for hemorrhagic complications; however, no cases of intracranial hemorrhage have been reported. DISCUSSION: We report a 53-year-old woman with spontaneous subarachnoid hemorrhage due to the use of an herbal supplement containing red clover, dong quai, and Siberian ginseng.

Within and between population variation for zinc and nickel accumulation in two species of Thlaspi (Brassicaceae).

In this study, the differences in zinc (Zn) and nickel (Ni) hyperaccumulation were investigated between three populations of Thlaspi pindicum together with genetic variation within populations of T. pindicum and Thlaspi alpinum var. sylvium, both serpentine endemics. Three experiments were conducted under standard conditions in hydroponic assay. Each experiment contained three treatments of metal: 100 microm Zn, 100 microm Ni, and combined 100/100 microm Zn/Ni. Genetic variation within populations was determined using maternal families. No genetic variation within populations was found for either Zn or Ni hyperaccumulation for both T. pindicum and T. alpinum var. sylvium, but differences were observed for both Zn and Ni hyperaccumulation between populations of T. pindicum. In combined Zn/Ni treatments, Zn inhibited Ni translocation in both species, which is unexpected considering that these species are serpentine endemics and well known Ni hyperaccumulators. The lack of genetic variation for metal hyperaccumulation is possibly due to inbreeding. Since Zn hyperaccumulation is not manifested in the field, inadvertent uptake of Zn is a plausible hypothesis for its preferential uptake.