Implementation and evaluation of a practice transformation advanced pharmacy practice experience.

BACKGROUND AND PURPOSE: Advanced entrepreneurship opportunities are important to consider as entrepreneurial skills become increasingly important to develop in pharmacy students. This institution implemented a new practice transformation advanced pharmacy practice experience (APPE), pairing students with community partners to implement and/or evaluate pharmacy services, network with pharmacists, and receive mentorship. The purpose of this article is to describe the APPE and students' outcomes during this first pilot year. EDUCATIONAL ACTIVITY AND SETTING: A faculty preceptor mentored and oversaw all APPE activities. Students were selected through an application process, and community partners were recruited based on alignment with students' goals and need for student assistance. Community partners prepared a list of practice transformation activities needed at their sites, and progress was tracked during weekly virtual meetings. APPE students completed a pre-APPE questionnaire, collecting background information and predictors of entrepreneurship: proactive personality, entrepreneurial self-efficacy, and individual entrepreneurial orientation (IEO). At the end of the APPE, IEO was measured again, and students reflected on what skills were developed. FINDINGS: Three students participated in the first year and were paired with various community partners. IEO baseline scores ranged from 24 to 28 (mean = 25.3, SD = 2.3), and follow-up scores increased to 28 to 30 (mean = 29.0, SD = 1.0). Students reported development in both soft and technical skills. SUMMARY: The practice transformation APPE offered students a unique opportunity to develop a diverse set of skills during a focused five-week experience. Based on positive feedback from students, this institution plans to continue to expand this APPE.

Comparison of manual therapy techniques on ankle dorsiflexion range of motion and dynamic single leg balance in collegiate athletes.

INTRODUCTION/PURPOSE: Literature consistently identifies two key examination components when managing ankle/foot pathologies: 1) dorsiflexion range of motion (DFROM) and 2) single limb balance. Mobilizations with movement (MWM) and Instrument-Assisted Soft Tissue (IASTM) are two emerging manual therapy (MT) options in the management of ankle/foot conditions. METHODOLOGY/SAMPLE: In this observational cohort study, 147 subjects were randomized in a block fashion as follows: 1) Control, 2) IASTM, 3) MWM, and 4) Combination of both MT interventions. Descriptive statistics of the sample were conducted with integrity checks followed by comparative analysis for mean change between the variables or DFROM and YBTLQ ™ performance. RESULTS: ANOVA Welch's F indicated significant differences between the treatment conditions (Welch's F (3,75.669) = 4.533, p = .006). Games-Howell post hoc tests indicated significantly more change in DFROM in the IASTM (p = .043) and CKCMOB (p = .026) conditions when they were administered as single treatments, than in the Control Condition or when the treatments were combined. Dynamic balance, as measured by the YBT-LQ™, did not yield a significant response based on the intervention arm. DISCUSSION/CLINICAL RELEVANCE: Specifically, IASTM or closed kinetic chain (CKC) MWM MT techniques used in isolation can be considered a cost-effective intervention that can be administered by a skilled MT practitioner in a "low risk-high reward" clinical scenario with potential biomechanical and neurophysiological benefits for improving CKCDFROM.

Some People are Different from You: A Case Study of a Cultural and Ethical Problem in Global Health.

Pharmacists, student pharmacists, and other healthcare providers are frequent participants on short-term medical service trips (MSTs) to medically underserved areas. Many such MSTs take place in areas like sub-Saharan Africa where cultural beliefs about healthcare and society may be very different from what volunteers from the Global North believe. These cultural divergences may then give rise to ethical problems MST volunteers need to navigate. This case study provides an example of such an ethical problem developing from a difference in cultures - the case of female genital cutting. Often, the ethical training that most MST volunteers receive during their clinical education is inadequate to help them address these kinds of cultural differences and the problems that result. A six-step process to provide MST volunteers with the tools to address such cultural-ethical problems is included. Medical, Public Health, and Microfinance Teams with local interpreters in Nana Kenieba, Cercle of Kati, Koulikoro Region, Southwest Mali.

Decreasing the stigma surrounding alcohol use disorder.

INTRODUCTION: There is a paucity of data on educational interventions that prepare students to mitigate the stigma or burden of alcohol use disorder. The objectives of this study were to (1) assess the impact of an interprofessional symposium on personal knowledge and stigma of alcohol use disorder and (2) inform future educational models. METHODS: The symposium highlighted the impact of alcohol at one private Midwestern university and reviewed the pharmacology of alcohol, diagnostic criteria for alcohol use disorder, and treatment for alcohol use disorder. Prior to and after the symposium, participants were given nine statements (two knowledge-based and seven stigma-based) about alcohol use disorder. Agreement with each statement was measuring on a five-point rating scale, and responses were collapsed into three categories: 1 = low stigma/high understanding, 2 = neutral, and 3 = high stigma/low understanding. Change between response categories before and after the symposium were analyzed using a Wilcoxon signed-ranked test (W). RESULTS: A total of 87 responses were collected pre-symposium and 45 responses were collected post-symposium. Both knowledge-based statements showed an increase in individual respondent understanding of alcohol use disorder as a disease. All stigma-based statements conveyed a decrease in individual respondent stigma of alcohol use disorder as a disease. Test statistics (Z) for significant items raged between Z = 3 to 5, P < .05. CONCLUSIONS: The symposium was successful at conveying positive changes in attitudes toward alcohol use disorder.

Financial Incentive Required for Pharmacy Students to Accept a Post-Graduation Position in Rural and Undesirable Pharmacy Settings.

Background: It has been estimated that in 2018, 20% of pharmacy students were unemployed following graduation. However, many pharmacy positions go vacant each year, with the majority of these positions existing in rural areas. Methods: Pharmacy students completed a one-time, anonymous, online questionnaire. Measures of interest included: subject characteristics and preference in a variety job offers. Discrete Choice Experiment methodology of questionnaire design was used and Conditional Logit models were conducted to analyze the data to determine the financial incentive required for pharmacy students to take a post-graduate job with particular traits. Conclusions: A total of 283 students completed questionnaires from Iowa, North Dakota, South Dakota, Saskatchewan, and Manitoba. The majority of subjects were female, P3 students, and from a non-rural hometown. American students would need to be paid an additional $18,738 in salary to practice in a rural area, while Canadian students would require an additional $17,156. Canadian respondents would require an additional $7125 in salary to work in a community pharmacy with a low level of patient interaction compared to a community position with a large amount of patient interaction. Overall, pharmacy student preferences in post-graduation job attributes vary significantly between states and provinces.

Pharmacy Student Knowledge, Confidence and Attitudes Toward Medical Cannabis and Curricular Coverage.

Objective. To assess pharmacy student confidence in their knowledge of qualifying conditions for medical cannabis use in the US and their attitudes toward curricular coverage of medical cannabis. Methods. Students were asked to complete an electronic survey to measure knowledge and confidence in various domains of medical cannabis treatment, including qualifying conditions, adverse effects, and other patient care skills. Results. There were 238 students who completed the survey. Responses to all domains and their corresponding confidence levels displayed a lack in confidence. The only domain wherein students had confidence in was their ability to retrieve related drug information. Nearly 80% of students felt that the topic of medical cannabis should be added to existing curricula within the next five years. Conclusion. With the prevalence of cannabis programs and knowledge gap, pharmacy schools should consider coverage of medical cannabis in the curricula.

Proposed model for translational research at a teaching-intensive college of pharmacy.

BACKGROUND: Many American colleges of pharmacy are small, private, teaching institutions. Faculty are required to maintain a research agenda, although the publication quota is less compared with their publicly funded college of pharmacy peers. Faculty at these smaller schools conduct research with very little internal or external funding. This tends to lead to smaller, less impactful research findings. Translational research is becoming popular for research faculty as it bridges theory to practice. The Knowledge-to-Action (KTA) framework presents the steps to conduct translational research. PURPOSE: To apply and determine if the KTA framework would be able to produce practice-impactful research at an institution that does not depend on grant funding as part of faculty research agendas. PROCEDURES: An interdisciplinary team was formed with providers at the clinical faculty's practice site. As the team moved through the KTA steps, authors documented the roles of each team member. It was clear that many different types of teams were formed throughout the KTA process. These teams were then categorized according to the Interdisciplinary Teamwork System. The final result is a proposed model of types of teams and required member roles that are necessary within each KTA step for faculty to conduct practice-impactful research at a small, private, teaching institution without substantial grant funding awards. MAIN FINDINGS: Applying the KTA framework, two impactful original research manuscripts were developed over two academic years. Furthermore, the practitioners at the clinical faculty member's site were very pleased with the ease of conducting research, as they were never required to take a lead role. In addition, both faculty members alternated lead and support role allowing for a decreased burden of workload while producing theory-driven research. CONCLUSION: The KTA framework can create a model for translational research and may be particularly beneficial to small teaching institutions to conduct impactful research.

Characteristics of Older Adults Who Consume Alcohol While on Antidepressants.

OBJECTIVES: Determine the characteristics of older Americans who self-report consuming alcohol and taking at least one antidepressant. DESIGN: This study utilized cross-sectional analyses. SETTING: The University of Michigan Health and Retirement Study and its subsurvey Prescription Drug Study (PDS). PATIENTS, PARTICIPANTS: Those who reported taking at least one antidepressant prescription medication, were 65 years of age or older, and were enrolled in Medicare or Medicaid between 2002 and 2004. INTERVENTIONS: Chi-square tests were conducted between demographic groups and alcohol consumption variables. Relationships between antidepressant quantity and behaviors of those consuming alcohol while taking antidepressants were also addressed. MAIN OUTCOME MEASURES: Demographics, alcohol consumption, number of antidepressants, psychiatric problem status, and alcohol behaviors. RESULTS: There were 412 subjects from the 2007 PDS (N = 3,536) who self-reported taking at least one antidepressant prescription medication. A total of 102 (24.8%) of the 412 subjects taking antidepressants reported using alcohol. Ethnicity, education level attained, and geographic region all showed a statistical difference between alcohol drinkers and nondrinkers. Most subjects were only on one antidepressant medication. Also, none of the subjects felt they needed to cut down on their drinking though they also did not feel annoyed by criticism from others about their drinking habits. CONCLUSION: This study showed that 24.8% of older Americans in the community were consuming some amount of alcohol while on antidepressants. These results show that there is an opportunity for consultant pharmacists to educate older American adults about the safety concerns with alcohol consumption and antidepressant use.

Quantifying the relationship between patient characteristics and involvement in developing and implementing a treatment plan.

OBJECTIVE: Improving the patient-physician relationship through patient involvement in the care may lead to improved patient safety and better health outcomes. There exists a gap in knowledge in identifying factors that affect self-reported patient involvement in individualized treatment plans. The objectives of this study were to 1) describe patients' perceptions of their involvement in the creation and implementation of their treatment plans and 2) determine if patient involvement varied by medical condition or demographic characteristics. METHODS: This study was a cross-sectional analysis of data from the "Quality of Care" module of the 2008 Health and Retirement Study (HRS). The individuals of HRS surveys were older than 50 years. One-way analyses of variance were conducted to determine differences between patient characteristics and involvement in creating a treatment plan. A linear regression was conducted to determine predictors of the summed involvement score. RESULTS: Average summed scores for each domain (shared decision-making, counseling, and follow-up) and overall involvement scores were ~50%. Linear regression showed that being non-White, older age, and diagnosed with a psychiatric condition or diabetes were predictors of increased self-reported involvement in the development and communication of a patient's treatment plan. CONCLUSION: Age, race, and having diabetes or a psychiatric condition were the major predictors affecting patient involvement in care, although overall involvement in care was low for all groups. PRACTICE IMPLICATIONS: Patient involvement in care was lower than expected and should be further studied to determine the effects of involvement on health outcomes.

Apparent homology of expressed genes from wood-forming tissues of loblolly pine (Pinus taeda L.) with Arabidopsis thaliana.

Pinus taeda L. (loblolly pine) and Arabidopsis thaliana differ greatly in form, ecological niche, evolutionary history, and genome size. Arabidopsis is a small, herbaceous, annual dicotyledon, whereas pines are large, long-lived, coniferous forest trees. Such diverse plants might be expected to differ in a large number of functional genes. We have obtained and analyzed 59,797 expressed sequence tags (ESTs) from wood-forming tissues of loblolly pine and compared them to the gene sequences inferred from the complete sequence of the Arabidopsis genome. Approximately 50% of pine ESTs have no apparent homologs in Arabidopsis or any other angiosperm in public databases. When evaluated by using contigs containing long, high-quality sequences, we find a higher level of apparent homology between the inferred genes of these two species. For those contigs 1,100 bp or longer, approximately 90% have an apparent Arabidopsis homolog (E value < 10-10). Pines and Arabidopsis last shared a common ancestor approximately 300 million years ago. Few genes would be expected to retain high sequence similarity for this time if they did not have essential functions. These observations suggest substantial conservation of gene sequence in seed plants.