Teaching Through the Student Lens: Qualitative Exploration of Student Evaluations of Teaching

OBJECTIVE

The purpose of this study is to use feedback from student evaluations of teaching (SETs) to define and describe themes associated with perceived teaching effectiveness.

METHODS

We retrospectively analyzed SETs for instructors in required didactic courses from one academic year using qualitative content analysis. The analysis included student responses to the following questions: "Describe the strongest aspect of the instructor's teaching." and "What could the instructor do to improve his/her teaching effectiveness?"

RESULTS

Five themes were developed from 4683 coded segments and are described with example quotations. These themes included clarity of instruction and learning activities, alignment of learning and assessment activities, examples that offer practice or demonstrate relevance, engaging learning environment, and concern for student learning and success. Aspects of each theme are described with example coded segments.

CONCLUSION

These themes and supportive quotes offer a deeper understanding of the student perspective on similar ideas that are present throughout the teaching and learning literature and represent broad aspects of teaching, such as material design, in-class practices, and interpersonal characteristics. These themes can provide guidance for specific domains of faculty development in teaching.

Qualitative Analysis of Pre and Postpromotion/Tenure Review Processes Employed by US Pharmacy Schools

OBJECTIVE

Policies related to prepromotion/tenure reviews and postpromotion/tenure reviews are critical to faculty advancement and retention. The objective of this study is to describe the utilization, timing, and application of such policies as described within promotion and/or tenure documents from US colleges/schools of pharmacy.

METHODS

PT documents were collected from internet searches and/or contact with administrators at each institution. Qualitative content analysis was used to systematically review policies related to pre and postpromotion/tenure reviews. Policies were reviewed for required vs optional status, timing, possible outcomes, and other characteristics.

RESULTS

PT documents were analyzed from 121 (85%) colleges/schools. Of these, 26% included policies for prepromotion review of nontenure-track faculty, while 45% included pretenure reviews for tenure-track faculty. The majority of prereviews were required (65% and 91%, respectively) and conducted after 3 years in rank on average. Only 22 (18%) included postpromotion/tenure reviews, with most (17, 77%) conducting reviews after a prespecified time in advanced rank (mean 3.9 years). Potential negative consequences of postpromotion/tenure reviews were more frequently described than potential rewards.

CONCLUSION

This analysis of promotion and/or tenure documents revealed that pre/posttenure reviews were more commonly employed than pre/postpromotion reviews. Documents most frequently described potential negative consequences that may result from unsatisfactory postpromotion/tenure reviews. Academic leaders should consider the implications of these trends within their own institutions and how their own policies may be improved to create clearly articulated, fair, and parallel processes for both tenure-track and nontenure-track faculty.

Analysis of Teaching-Related Criteria Within Promotion and Tenure Documents from US Pharmacy Schools

OBJECTIVE

To describe teaching-related criteria within promotion and tenure (PT) guidance documents from US-based colleges/schools of pharmacy.

METHODS

PT guidance documents were retrieved from college/school websites or via electronic mail. Institutional characteristics were compiled using available online data. Using qualitative content analysis, a systematic review of PT guidance documents was conducted to identify how teaching and teaching excellence were considered in decision of promotion and/or tenure at each institution.

RESULTS

PT guidance documents were analyzed from 121 (85%) colleges/schools of pharmacy. Of these, 40% included a requirement that faculty must achieve excellence in teaching for promotion and/or tenure, though excellence was infrequently defined (14% of colleges/schools). Criteria specific to didactic teaching were most frequently included (94% of institutions). Criteria specific to experiential (50%), graduate student (48%), postgraduate (41%), and interprofessional (13%) teaching were less frequently included. Institutions frequently required student (58%) and peer (50%) evaluations of teaching to be considered in PT decisions. Most institutions acknowledged many teaching accomplishments as examples indicating teaching success rather than strictly requiring specific criteria to be fulfilled.

CONCLUSION

Teaching-related criteria within PT criteria of colleges/schools of pharmacy often lack clear guidance regarding quantitative or qualitative requirements for advancement. This lack of clearly specified requirements may result in faculty members' inability to self-assess for readiness for promotion and inconsistent application of criteria in PT decisions by review committees and administrators.

Guidance for Qualitative Research Manuscripts in Pharmacy Education

The goal of this Best Practice Review is to support researchers in successfully preparing and publishing qualitative research in pharmacy education. Standard practice from the literature and journals' guidance from related fields were reviewed, and recommendations and resources applicable to qualitative research in pharmacy education were compiled for researchers planning to conduct and publish qualitative research. This review provides recommendations, not requirements, for publication in the Journal and is intended to be a guide, especially for authors and reviewers relatively new to the field of qualitative research. Additionally, researchers planning to publish their qualitative research are advised to review available best practices and standards, such as the Consolidated Criteria for Reporting Qualitative Research checklist and the Standards for Reporting Qualitative Research. Given the diverse methodology of qualitative research, it is important for authors to provide sufficient details and justifications of selected methods for transparency and to report collected results in a manner that allows reviewers and readers to adequately assess the validity of their study and the applicability of the findings.

Changes in Arkansans' attitudes toward pharmacist involvement and regulation of medical cannabis following its availability in Arkansas

BACKGROUND

Pharmacists are likely to encounter questions from patients regarding medical cannabis (MC). This serves as an opportunity for pharmacists to provide reliable medical information about MC dosing, drug interactions, and impact on preexisting health conditions.

OBJECTIVES

This study examined changes in perceptions of the Arkansan community toward MC regulation and pharmacist involvement in MC dispensing after MC products became available in Arkansas.

METHODS

A longitudinal, self-administered online survey was conducted in February 2018 (baseline) and September 2019 (follow-up). Baseline participants were recruited through Facebook posts, emails, and printed flyers. Participants from the baseline survey (N = 1526) were invited to participate in the follow-up survey. Paired t tests were used to determine changes in responses, and multivariable regression analysis was used to identify factors associated with follow-up perceptions.

RESULTS

Participants (n = 607, response rate 39.8%) started the follow-up survey, resulting in 555 usable surveys. The largest group of participants was 40-64 year old (40.9%). The majority were female (67.9%), white (90.6%), and reported past 30-day cannabis use (83.1%). Compared to baseline, participants preferred less regulatory control of MC. They were also less likely to agree that pharmacists helped improve MC-related patient safety. Participants favoring less MC regulation were more likely to report 30-day cannabis use and perceived cannabis to have low health risk. Past 30-day cannabis use was also significantly associated with disagreement that pharmacists improve patient safety and are well-trained to provide MC counseling.

CONCLUSION

After MC product availability, Arkansans' attitudes changed toward less MC regulation and less agreement with the pharmacist's role in improving MC safety. These findings call for pharmacists to better promote their role in public health safety and demonstrate their knowledge concerning MC. Pharmacists should advocate for an expanded, active consultant role in dispensaries to improve safety of MC use.

Strengthen Academic Pharmacy by Protecting Self-Expression

Pharmacy, including academic pharmacy, is affected by several important issues. Additionally, we deal with these issues in a society that is increasingly polarized in beliefs and siloed in interactions. Within this important juncture, pharmacy faculty may be prone to employ restrictions on freedom of expression, particularly around viewpoints they do not endorse. This tendency will likely have unintended effects and inhibit the ability of the profession to find solutions to its current challenges. We implore the Academy to actively work to increase viewpoint diversity, open inquiry, and academic freedom.

Unpacking the Use of Therapy-Speak in Scholarly Writing

Pharmacy faculty have begun to adopt therapy-speak, which are common words and phrases derived from mental health services, more frequently in both informal modes of communication as well as in scholarly and creative efforts. In this Commentary, we consider the use of this trendy, idiomatic language in scholarly writing and characterize potential problems with its clear and lasting interpretation. Conversely, we also examine how contemporary language can be used to enhance scholarly writing by engaging members of the Academy with an interesting writing style. Finally, we challenge pharmacy faculty to carefully consider how and when such language can be used to communicate in a clear and straightforward style that creates interest among readers.

Advancing Pharmacy Education and Workforce Development Amid the COVID-19 Pandemic: Report of the 2020-2021 AACP Academic Affairs Committee

EXECUTIVE SUMMARY The 2020-2021 Academic Affairs Committee was charged to (1) Read all six reports from the 2019-20 AACP standing committees to identify elements of these reports that are relevant to your committee's work this year; (2) Determine what changes made in colleges and schools of pharmacy during the COVID-19 pandemic should be continued to advance pharmacy education; (3) Develop a realistic model for colleges and schools of pharmacy to share resources to meet the curricular needs of member schools; (4) Create strategies by which colleges and schools of pharmacy can meet current and future workforce development needs particularly in light of the changes in healthcare delivery as a result of the COVID-19 pandemic; (5) Identify salient activities for the Center To Accelerate Pharmacy Practice Transformation and Academic Innovation (CTAP) for consideration by the AACP Strategic Planning Committee and AACP staff. This report provides an overview of changes made in schools and colleges of pharmacy implemented in response to the COVID-19 pandemic that may be continued to advance pharmacy education; a realistic model for colleges and schools of pharmacy to share resources to meet the curricular needs of member schools; and strategies by which schools and colleges of pharmacy can meet current and future workforce development needs, particularly in light of the changes in healthcare delivery as a result of the COVID-19 pandemic. The committee is proposing one policy statement for consideration by the 2021 AACP House of Delegates, four suggestions for consideration by schools and colleges of pharmacy (including two endorsements for suggestions from the 2020-21 Argus Commission), and one recommendation for consideration by AACP for CTAP to implement and oversee.

Analysis of Research and Scholarship Criteria Within Promotion and Tenure Documents of US Pharmacy Schools

Objective. To describe criteria for evaluating faculty scholarship within the promotion and tenure guidance documents of US schools and colleges of pharmacy.Methods. Promotion and tenure documents were obtained from the websites of US pharmacy schools or requested via electronic mail, and institutional characteristics were collected from publicly available online data. A qualitative content analysis was conducted to systematically catalogue document characteristics and criteria for promotion and tenure.Results. Promotion and tenure guidance documents from 121 (85%) of 142 pharmacy schools were analyzed. Institutions were 55% public and equally distributed across Carnegie institutional classifications as well as geographic and extramural funding stratifications. Publications (94%) and grants and contracts (87%) were the most frequently included criteria for faculty advancement. More than 50% of schools recognized the criteria within promotion and tenure guidance documents but did not explicitly require faculty to achieve them before receiving promotion and/or tenure. For institutions that required publications for advancement, the most frequently required criterion was publication in peer-reviewed journals (47%). Few schools (22%) documented a specific number of required publications.Conclusion. This analysis provides a comprehensive review of scholarship criteria in academic pharmacy promotion and tenure guidance documents. There was wide variability among scholarship criteria, and documents often lacked specific language defining scholarship requirements. As a result, faculty may find the documents less helpful for self-assessment and preparation toward promotion and/or tenure. These benchmark data can assist pharmacy faculty and administrators in developing and revising promotion and tenure guidance documents to include clear criteria and better align with peer institutions.

The Power of Peer Mentoring to Support Women Pharmacy Faculty Personally and Professionally

Regardless of a faculty member's career stage, effective mentoring is critical for successful professional development and a thriving academic career. Traditional mentor-mentee relationships can be effective but may present challenges for some faculty depending on their individual needs and institutional resources. The use of peer mentoring circles, where group members serve as both mentor and mentee, may provide additional resources and benefits to faculty at all career stages and appear especially beneficial for women faculty because of their focus on interconnectedness and collaboration. However, literature is scarce regarding effective mentoring strategies for women pharmacy faculty. As members of one women faculty-only peer mentoring circle, we describe our experiences using this mentoring strategy and offer recommendations for other faculty members considering this approach.

Positioning the Scholarship of Teaching and Learning Squarely on the Center of the Desk

The scholarship of teaching and learning (SOTL) is one of four traditionally defined domains of research. Yet faculty members who pursue the SOTL may feel disadvantaged because of its relatively low perceived value by many institutions. Thus, interested faculty members may relegate the SOTL to a limited, secondary line of research and instead pursue other types of research that appear to be more highly valued by the institution. This commentary explores the benefits to the institution when the SOTL is expressly valued and purposefully supported. We advocate for a multifaceted approach by which pharmacy education leaders can examine how the SOTL is valued, encouraged, and supported through organizational structure and policy. Approaches to solidify and communicate the institutional value of the SOTL are discussed. Specific attention to ensure the SOTL is represented in rewards and incentive systems, such as the college or school's promotion and tenure policies, may empower faculty members to pursue success in this area of research.

A cross-sectional analysis of self-reported scholarly publications among United States pharmacy practice faculty

INTRODUCTION

The objectives of this study were to provide an estimate of self-reported peer-reviewed publications and evaluate characteristics associated with publication rates among pharmacy practice faculty within United States (US)-based colleges and schools of pharmacy.

METHODS

An online survey instrument was distributed to pharmacy practice faculty via email listserv. Information regarding faculty members' publication histories, faculty position, institutional characteristics, and faculty demographic characteristics was gathered. Descriptive statistics were used to characterize participants, and t-tests and analysis of variance were used for comparisons among groups.

RESULTS

Two hundred and nine pharmacy practice faculty were included. The majority were female (67%), white (81%), and from public institutions (66%). Academic ranks were well-represented. Reporting higher percent time spent in research, employment at public institutions, and having earned a doctor of philosophy (PhD) degree were all significantly associated with higher total number of publications and a higher annualized publication rate. Tenure track faculty who were not yet tenured had higher annual publication rates than faculty who were tenured or in non-tenure track positions. The overall annual publication rate was 2.0 ± 2.1 publications per year.

CONCLUSIONS

Characteristics such as being in a tenure track position, holding a PhD, spending more time in research, and employment within a public institution were all associated with a higher publication rate. These self-reported data from pharmacy practice faculty also indicate an increase in the average number of scholarly publications per year from previously reported estimates.

Exploring factors associated with scholarly writing among US pharmacy practice faculty

OBJECTIVES

This study explored intrinsic facilitators (i.e., grit, self-efficacy, and writing motivation) and barriers associated with scholarly output as measured by self-reported publications among US pharmacy practice faculty.

METHODS

A cross-sectional study design was used to gather information regarding scholarly writing output and intrinsic facilitators and barriers among US pharmacy practice faculty using an online self-reported survey. The survey link was distributed via email between October and November 2017. The Grit-S, New Generalized Self-Efficacy Scale (NGSE), and Scholarly Writing Motivation Scale (SWMS) were used to measure grit, self-efficacy, and writing motivation, respectively. Perceived barriers, self-reported quantity of publications, and demographics were also collected. A structural equation modeling (SEM) approach was used to determine effects of perceived barriers and each intrinsic factor on self-reported total publications.

RESULTS

N = 208 participants were included in the analyses. The average number of self-reported annual publications was 1.88. Participants who reported having higher than average numbers of annual publications (n = 85, 40.9%) more frequently held a PhD degree and were more frequently in the tenure track, compared to those with annual publications less than the average (n = 123, 59.1%). The majority of both groups reported being employed in public institutions. Lack of time for scholarly writing was the highest perceived barrier and lack of knowledge about technical writing/English mastery was the lowest. All three SEM models consistently showed that perceived barriers were negatively associated with numbers of self-reported publications. However, only scholarly writing motivation according to SWMS was positively associated with the numbers of self-reported publications.

CONCLUSIONS

Writing motivation and barriers to scholarly writing are shown to have a significant impact on scholarly output. These factors can be identified and should be appropriately addressed by colleges/schools of pharmacy to enhance scholarly activities among pharmacy practice faculty.

Arkansas community's attitudes toward the regulation of medical cannabis and the pharmacist's involvement in Arkansas medical cannabis

OBJECTIVES

This study explored the attitudes of the Arkansas community toward medical cannabis (MC) regulation and the role of pharmacists in dispensing MC before the product became available and examined whether participants' demographics (e.g., age, gender) and characteristics (e.g., history of cannabis use) were associated with these attitudes.

DESIGN

Cross-sectional survey.

SETTING AND PARTICIPANTS

Using social media, a university research registry, and posted flyers, we invited residents of Arkansas to participate in the self-administered online survey study during a 3-month period, February to April, in 2018.

OUTCOME MEASURES

Five questions that inquired about participants' attitudes toward MC regulation and pharmacists' roles regarding MC use.

RESULTS

Participants (n = 1343) who completed at least 1 of the 5 questions were included. The majority were aged 40-64 years (52.2%), female (69.1%), and white (88.7%). Most participants reported a history of cannabis use (81.8%) and possession or intention to apply for an MC card (52.9%). Among the conditions approved for MC use, pain (20.3%), arthritis (15.4%), and posttraumatic stress disorder (14.5%) were reported frequently. Likewise, prescription use for mood disorders (46.1%) and pain (37.4%) were also reported. In multivariable regression analyses, participants' history of cannabis use was associated with a preference for lesser oversight of MC, disagreement with MC being available through a pharmacy only, and disagreement on whether MC should be regulated before it is legalized for recreational use (all P < 0.001). It was also associated with a decrease in agreement that pharmacists are well-trained to improve patient safety (P < 0.001) and counsel patients regarding appropriate MC use (P = 0.032).

CONCLUSION

Participants who had previously used cannabis were in favor of fewer restrictions and negatively perceived pharmacists' involvement in ensuring appropriate dispensing and MC use. The findings may highlight the need for Arkansas pharmacists to explore alternative ways to promote the safe and proper MC use.

A communications module to reinforce motivational interviewing concepts

BACKGROUND AND PURPOSE

Motivational interviewing (MI) is a patient-centered method of communicating that can be used to improve medication adherence. However, it can be difficult to teach and learn. This paper describes the creation of a stand-alone introductory MI module for second-year pharmacy students and its transformation to a module intended to reinforce content after the addition of a new MI-based course in the first year. It compares student competence in MI skills between the two modules (introductory versus reinforcement).

EDUCATIONAL ACTIVITY AND SETTING

In 2012 and 2013, an introductory MI module was delivered to second year pharmacy students. In 2014, a course grounded in MI principles was introduced in the first year of the curriculum, with the module in the second year modified to reinforce those principles. All second-year students' MI skills were assessed with an objective structured clinical examination (OSCE) case. Overall case scores and individual item scores were compared before and after the addition of the course using assessment data from two years before and after the change.

FINDINGS

Overall case scores (81.9% vs. 86.9%, p = 0.001) significantly improved after the introduction of the new course. Items related to MI skills also improved significantly. Scores for general communication items were not different.

SUMMARY

After the introduction of the new MI-based first-year course, students performed better on items specifically related to MI in an OSCE case. This model can serve as a useful example of how to introduce MI skills and reinforce these skills later in the curriculum.

Design and Evaluation of a Longitudinal Faculty Development Program to Advance Scholarly Writing Among Pharmacy Practice Faculty

Objective. To describe the design and evaluation of a six-month longitudinal faculty development program designed to promote experience and skills in scholarly writing among pharmacy practice faculty. Methods. Writer's Block uses a scheduled weekly writing time, peer support, and multiple accountability measures to promote progress in manuscript writing. Faculty participation, satisfaction, and manuscript writing progress were used to evaluate the program's success. Demographic data describing faculty participation in at least one of three cohorts of Writer's Block were collected. Satisfaction was determined using an anonymous online survey. Writing progress was determined through reporting of weekly manuscript word counts and submission to a peer-reviewed journal. Results. Twelve assistant professors participated in one or more program cohorts to develop 20 manuscripts. Twelve (60%) manuscripts were submitted to a peer-reviewed journal. Of these, 10 (83%) have been published or accepted for publication, and one (8%) is undergoing peer review. The majority of participants agreed or strongly agreed that the program was helpful in starting and advancing manuscript writing. Specific program components meant to encourage writing accountability, such as monthly meetings, reporting word counts, and setting a weekly writing schedule, were highly valued. Conclusion. This program is the first described writing-focused faculty development program among pharmacy practice faculty. It successfully engaged pharmacy practice faculty members in the scholarly writing process, evidenced by participation in the program, participant satisfaction, and documented progress in manuscript development.

Establishment of a patient-centered communication course to address curricular gaps

BACKGROUND AND PURPOSE

Patient-centered communication (PCC) skills are critical to the practice of pharmacy. A gap analysis of the communication content of our curriculum revealed inadequate coverage of several competencies recommended by a National Association of Chain Drug Stores Foundation - National Community Pharmacy Association - Accreditation Council for Pharmacy Education joint task force report: "support patient behavior change through skills such as motivational interviewing", "demonstrate compassion and empathy for patients", and "solve adherence challenges created by low health literacy".

EDUCATIONAL ACTIVITY AND SETTING

A required PCC course, heavily grounded in motivational interviewing principles, was introduced into the spring of the first professional year to address the identified curricular gaps. Activities and assessments in additional semesters were added to further develop these skills and provide accountability.

FINDINGS

The course addressed the curricular gaps and was well-received by students. Students demonstrated competency in a role-play setting including improved proficiency between role-play activities. Reflections from a community pharmacy introductory pharmacy practice experience (IPPE) demonstrate that students perceived an ability to use the skills in practice.

DISCUSSION AND SUMMARY

This course has been successfully established as an introduction to PCC concepts and skills for first professional year pharmacy students. Use of the skills during a community pharmacy IPPE illustrates that the class functions as a foundation on which to further develop these skills throughout the remaining didactic and experiential curricula.

Use and Risk Perception of Electronic Nicotine Delivery Systems and Tobacco in Pregnancy

INTRODUCTION

Given the rapid rise in availability and use, understanding the perception of electronic nicotine delivery systems (ENDS) products in pregnant women is vital. As more women of reproductive age use these products, it is likely that their use during pregnancy is also increasing. This study investigated the use of ENDS and tobacco cigarettes, along with knowledge and perceptions of associated health risks in pregnant women.

METHODS

A cross-sectional survey was conducted at a university-based obstetrical clinic. A 32-item self-administered survey was used to collect participants' knowledge, use, and risk perceptions of ENDS and tobacco smoking. Bivariate associations of demographics and ENDS user status were explored using Chi-square or Fisher's exact tests. Average differences in agreement with perception statements across ENDS user status were tested using ANOVA with Tukey's tests for multiple comparisons.

RESULTS

Of 382 participants, 57.9% were 21-29 years old and 60.1% had some college or higher education. 30.3% reported using both ENDS and tobacco cigarettes and 11.9% were current ENDS users. The majority of participants had adequate knowledge about the facts and safety of ENDS and there was no difference across three ENDS user status groups. ENDS users perceived significantly lower risk of ENDS and higher benefit of using ENDS to aid quitting tobacco smoking, compared to non-ENDS users. The majority of participants reported that their healthcare providers less frequently assessed ENDS use during their prenatal visits, compared to tobacco cigarette use.

CONCLUSIONS

There is critical need for healthcare providers to increase the screening for ENDS use during pregnancy and promote awareness of risks and benefits of ENDS in pregnant women.

Electronic cigarette use, knowledge, and perceptions among health professional students

INTRODUCTION

Our study evaluated the electronic cigarette (e-cigarette) use, knowledge, and perceptions of health professional students enrolled in one of five colleges at a single academic health center.

METHODS

A 56-item survey was conducted to examine the use, knowledge, and perceptions of e-cigarettes among health professional students. An e-cigarette knowledge score was calculated according to correct responses to eight true-false survey items, with possible scores ranging from zero to eight points. Regressions were used to determine associations between students' enrolled college/discipline and e-cigarette knowledge scores and to identify associations between three perception domains (smoking cessation, harm reduction, and enhanced regulation) and e-cigarette use.

RESULTS

Of the 853 students responding, 24.2% reported e-cigarette ever-use. Of e-cigarette ever users, 85.5% had used within the past year, and 23.1% used e-cigarettes for smoking cessation. Participants from the colleges of public health, pharmacy, and nursing had significantly higher knowledge scores, compared to those in allied health. Knowledge scores from college of medicine participants did not differ significantly compared to scores from allied health. Perceptions of using e-cigarettes for smoking cessation, reduced harm compared to tobacco, and reduced e-cigarette regulation were significantly associated with using e-cigarettes.

DISCUSSION AND CONCLUSIONS

Self-reported ever-use of e-cigarettes among health professional students in this sample was 3.5-6 times higher than previously reported among medical and nursing students. Substantial gaps in e-cigarette knowledge exist. Enhancing health professionals' preparedness to effectively advise patients about the benefits and harms of e-cigarettes is crucial.

Measurement of Grit and Correlation to Student Pharmacist Academic Performance

Objective. To describe grittiness of students from three pharmacy schools and determine if grit is associated with academic performance measures. Methods. Pharmacy students completed an electronic questionnaire that included the Short Grit Scale (Grit-S). Associations were determined using logistic regression. Results. Grit-S total score was a significant and independent predictor for participants who reported a GPA ≥3.5, and Consistency of Interest (COI) and Perseverance of Effort (POE) domain scores were significantly higher compared to participants with a GPA of 3.0-3.49. Participants reporting a D or F had slightly lower average total Grit-S scores and COI domain scores compared to participants who did not. In addition, the group who reported a GPA <3.0 had lower scores in the POE domain compared to those with a GPA of 3.0-3.4. Conclusion. Grittiness may be associated with student pharmacist academic performance and the Grit-S Scale may have substantive implications for use in pharmacy programs.

Qualitative Analysis of Written Reflections during a Teaching Certificate Program

OBJECTIVE

To evaluate the success of a teaching certificate program by qualitatively evaluating the content and extent of participants' reflections.

METHODS

Two investigators independently identified themes within midpoint and final reflection essays across six program years. Each essay was evaluated to determine the extent of reflection in prompted teaching-related topic areas (strengths, weaknesses, assessment, feedback).

RESULTS

Twenty-eight themes were identified within 132 essays. Common themes encompassed content delivery, student assessment, personal successes, and challenges encountered. Deep reflection was exhibited, with 48% of essays achieving the highest level of critical reflection. Extent of reflection trended higher from midpoint to final essays, with significant increases in the strengths and feedback areas.

CONCLUSION

The teaching certificate program fostered critical reflection and self-reported positive behavior change in teaching, thus providing a high-quality professional development opportunity. Such programs should strongly consider emphasizing critical reflection through required reflective exercises at multiple points within program curricula.

Effect of the clopidogrel-proton pump inhibitor drug interaction on adverse cardiovascular events in patients with acute coronary syndrome

STUDY OBJECTIVE

To examine the effect of the drug interaction between clopidogrel and proton pump inhibitors (PPIs) on the risk of an adverse cardiovascular event.

DESIGN

Population-based, retrospective cohort study.

DATA SOURCE

IMS LifeLink Health Plan administrative claims database.

PATIENTS

A total of 10,101 patients aged 18 years or older with a diagnosis of acute coronary syndrome (ACS) made during a hospitalization or emergency department visit between 2001 and 2008 and who had their first clopidogrel prescription within 90 days after their ACS diagnosis were included in the study. Patients were stratified according to concurrent use (clopidogrel plus PPI group) or no use (clopidogrel alone group) of the following PPIs: esomeprazole, lansoprazole, omeprazole, pantoprazole, or rabeprazole.

MEASUREMENTS AND MAIN RESULTS

Data were collected on baseline patient demographic and clinical characteristics. Patients were followed from their first clopidogrel prescription until they experienced an adverse cardiovascular event, defined as inpatient hospitalization or emergency department visits for myocardial infarction, percutaneous coronary intervention, or intermediate coronary syndrome; were disenrolled; discontinued clopidogrel; or reached the end of the study period. Using a propensity scoring method, the clopidogrel plus PPI group was matched in a 1:1 ratio with the clopidogrel alone group. Exposure to overlapping clopidogrel-PPI prescriptions was modeled as a time-dependent covariate. The Cox hazards regression model was used to estimate the risk of an adverse cardiovascular event in the clopidogrel plus PPI group versus the clopidogrel alone group. Propensity score matching resulted in 2674 patient pairs. In the propensity score-matched sample, the mean age was 61.30 years, with a mean follow-up of 268 days, and 70.04% were male. Concurrent use of clopidogrel with a PPI was associated with a significantly increased risk of a cardiovascular adverse event (hazard ratio 1.438, 95% confidence interval 1.237-1.671) compared with clopidogrel alone.

CONCLUSION

Concurrent use of clopidogrel plus a PPI was associated with a significant increase in risk of an adverse cardiovascular event in patients with ACS. Large randomized studies are needed to confirm this finding. Until then, clinicians should prescribe the concurrent use of these two drugs cautiously.

Effect of the clopidogrel-proton pump inhibitor drug interaction on adverse cardiovascular events in patients with acute coronary syndrome

STUDY OBJECTIVE

To examine the effect of the drug interaction between clopidogrel and proton pump inhibitors (PPIs) on the risk of an adverse cardiovascular event.

DESIGN

Population-based, retrospective cohort study.

DATA SOURCE

IMS LifeLink Health Plan administrative claims database.

PATIENTS

A total of 10,101 patients aged 18 years or older with a diagnosis of acute coronary syndrome (ACS) made during a hospitalization or emergency department visit between 2001 and 2008 and who had their first clopidogrel prescription within 90 days after their ACS diagnosis were included in the study. Patients were stratified according to concurrent use (clopidogrel plus PPI group) or no use (clopidogrel alone group) of the following PPIs: esomeprazole, lansoprazole, omeprazole, pantoprazole, or rabeprazole.

MEASUREMENTS AND MAIN RESULTS

Data were collected on baseline patient demographic and clinical characteristics. Patients were followed from their first clopidogrel prescription until they experienced an adverse cardiovascular event, defined as inpatient hospitalization or emergency department visits for myocardial infarction, percutaneous coronary intervention, or intermediate coronary syndrome; were disenrolled; discontinued clopidogrel; or reached the end of the study period. Using a propensity scoring method, the clopidogrel plus PPI group was matched in a 1:1 ratio with the clopidogrel alone group. Exposure to overlapping clopidogrel-PPI prescriptions was modeled as a time-dependent covariate. The Cox hazards regression model was used to estimate the risk of an adverse cardiovascular event in the clopidogrel plus PPI group versus the clopidogrel alone group. Propensity score matching resulted in 2674 patient pairs. In the propensity score-matched sample, the mean age was 61.30 years, with a mean follow-up of 268 days, and 70.04% were male. Concurrent use of clopidogrel with a PPI was associated with a significantly increased risk of a cardiovascular adverse event (hazard ratio 1.438, 95% confidence interval 1.237-1.671) compared with clopidogrel alone.

CONCLUSION

Concurrent use of clopidogrel plus a PPI was associated with a significant increase in risk of an adverse cardiovascular event in patients with ACS. Large randomized studies are needed to confirm this finding. Until then, clinicians should prescribe the concurrent use of these two drugs cautiously.

Impact of health screening and education on knowledge of coronary heart disease risk factors

OBJECTIVES

To evaluate the effects of a community health screening and education intervention on knowledge of coronary heart disease (CHD) risk factors and participation in health-promoting behaviors.

DESIGN

Descriptive, exploratory, nonexperimental study.

SETTING

Little Rock, AR, from July 2007 to December 2007.

PARTICIPANTS

56 participants recruited from two community health screenings.

INTERVENTION

Prescreening written questionnaire to determine baseline knowledge of CHD risk factors. Participants underwent risk factor screening (lipid profile, blood glucose, body mass index [BMI], and blood pressure) and received tailored education. A postscreening telephone questionnaire was administered 4 to 8 weeks later.

MAIN OUTCOME MEASURES

Participant knowledge of CHD risk factors and participation in health-promoting behaviors pre- and postscreening.

RESULTS

Of the 56 participants enrolled, 45 (80.4%) completed the postscreening telephone survey. Compared with prescreening responses, participants showed significantly greater postscreening knowledge of healthy values for CHD risk factors, including blood pressure (P = 0.02), fasting blood glucose (P = 0.03), fasting total cholesterol (P < 0.01), and BMI (P < 0.01). Following the screening, 20 (44.4%) participants had consulted their primary care provider and 31 (68.8%) made at least one healthy behavior change. Approximately one-half of participants reported changing eating habits, and 5 (11.1%) reported increased exercise.

CONCLUSION

These results demonstrate that community-based health screening and education interventions can effectively promote public health knowledge and empower participants to engage in health-promoting behaviors.

Comparison of the effects of energy drink versus caffeine supplementation on indices of 24-hour ambulatory blood pressure

BACKGROUND

Cardiovascular events associated with energy drink consumption have been reported, but few data exist to delineate the hemodynamic effects of energy drinks.

OBJECTIVE

To compare the effects of an energy drink versus caffeine supplementation on blood pressure (BP) indices as measured by 24-hour ambulatory BP monitoring (ABPM).

METHODS

Healthy, nonsmoking, normotensive volunteers (aged 18-45 years) taking no medications were enrolled in a single-center, open-label, 2-period crossover pilot study. During each study period, subjects received either an energy drink (Red Bull Energy Drink, each dose containing 80 mg of caffeine and 1000 mg of taurine in an 8.3-oz serving) or a control (compounded caffeine solution, each dose containing 80 mg of caffeine solution in 8 oz of bottled water) at 0800, 1100, 1500, and 1900 hours and underwent 24-hour ABPM. The study periods were separated by a washout period (4-30 days). Mean 24-hour, daytime, and nighttime systolic (SBP), diastolic (DBP), and mean arterial (MAP) BP; BP load; and percent nocturnal dipping were compared between study periods.

RESULTS

Nine subjects (5 females, mean [SD] age 27.7 [5.0] years) completed the study. Mean 24-hour SBP (123.2 vs 117.4 mm Hg, p = 0.04), DBP (73.6 vs 68.2 mm Hg, p = 0.02), and MAP (90.1 vs 84.8 mm Hg, p = 0.03) were significantly higher during energy drink supplementation versus caffeine supplementation. Daytime DBP (77.0 vs 72.0 mm Hg, p = 0.04) also was significantly higher with the energy drink versus caffeine supplementation. Trends in higher daytime SBP (127.0 vs 121.9 mm Hg, p = 0.05) and MAP (93.6 vs 88.6 mm Hg, p = 0.05) were recorded with energy drink supplementation versus caffeine supplementation. Nighttime SBP and DBP loads were significantly higher with the energy drink, but nocturnal dipping did not differ significantly between study periods.

CONCLUSIONS

Single-day energy drink supplementation increased mean 24-hour and daytime BP compared to caffeine control in this pilot study. Additional research is warranted to better understand the hemodynamic effects of energy drink consumption.

β-Adrenergic Antagonists in Hypertension: A Review of the Evidence

Objective:

To evaluate the effects of β-adrenergic antagonist therapy on cardiovascular and cerebrovascular outcomes in the treatment of hypertension.

Data Sources:

Literature searches were conducted using MEDLINE (1966–August 2009), International Pharmaceutical Abstracts (1970–August 2009), and Cochrane Database of Systematic Reviews (until third quarter 2009) to locate clinical trials and meta-analyses comparing β-blocker therapy with placebo or other antihypertensive agents in patients with hypertension. Bibliographies from relevant research and review articles were reviewed for additional references.

Study Selection and Data Extraction:

All English-language articles identified from the data sources were reviewed. Articles describing original research with cardiovascular or cerebrovascular outcomes and/or death as either primary or secondary endpoints were included. Articles describing the use of β-blocker therapy for conditions other than hypertension were not included,

Data Synthesis:

Five placebo-controlled studies and 10 active-controlled studies were reviewed. In addition, 11 meta-analyses were evaluated. Placebo-controlled trials of β-blockers in hypertension provide evidence of reduced risk for stroke, cardiovascular events, and heart failure. Only 2 studies comparing β-blockers with other antihypertensives found significant benefit with β-blockers. However, the majority of meta-analyses comparing β-blockers with other antihypertensive agents show increased risk for stroke with β-blockers, and some data suggest increased risk for cardiovascular events and all-cause mortality. The majority of data results from studies of atenolol, and many studies employed combination antihypertensive therapies, which often included thiazide diuretics.

Conclusions:

Overall, data supporting β-blockers as preferred therapy in hypertension are inadequate. Although most negative cardiovascular and cerebrovascular outcomes of β-blockers were associated with atenolol therapy, data supporting other β-blockers in hypertension are lacking.

Candesartan Cilexetil Effectively Reduces Blood Pressure in Hypertensive Children

Background:

The angiotensin-receptor blocker candesartan cilexetil is a well-toleraled antihypertensive agent with demonstrated benefits in adults with hypertension. However, there are few data supporting its use in children with hypertension.

Objective:

To determine the efficacy and tolerability of candesartan cilexetil in the treatment of pediatric hypertension.

Methods:

In an open-label, uncontrolled pilot study, hypertensive pediatric patients were eligible tor participation if untreated systolic and/or diastolic blood pressure (BP) exceeded the 95th percentile for sex, age, and height. Patients underwent a 7-day washout period prior to initiation of weight-based dosing of candesartan cilexetil (2-8 mg daily). The dose was doubled after 7 days of therapy if inadequate antihypertensive response was determined by clinic-measured casual BP monitoring (CBPM) and home BP monitoring (HBPM). Three methods of BP measurement were compared before and after 2 weeks of treatment with the final dose of candesartan cilexetil: CBPM, HBPM, and 24-hour continuous ambulatory BP monitoring (ABPM). Self-reported adverse effects and clinical laboratory analyses were used to determine tolerability.

Results:

Eleven patients (mean age 14.2 y) received a final candesartan cilexetil median daily dose of 8 mg (0.13 mg/kg, range 2-16 mg). Study treatment resulted in significant reductions in systolic and diastolic BP as measured by CBPM (-7.4%, p = 0,03 and -5.9%, p = 0.01, respectively) and by ABPM (-6.0%, p = 0.03 and -10.8%, p = 0.006, respectively), but no significant reductions as measured by HBPM. No clinically significant changes in laboratory measures were observed, and patients reported nonspecific mild adverse effects.

Conclusions:

Candesartan cilexetil effectively reduced BP as demonstrated by CBPM and ABPM measurements and was well tolerated in this group of hypertensive children.

Multiple rubric-based assessments of student case presentations

OBJECTIVES

To evaluate a rubric-based method of assessing pharmacy students' case presentations in the recitation component of a therapeutics course.

METHODS

A rubric was developed to assess knowledge, skills, and professional behavior. The rubric was used for instructor, student peer, and student self-assessment of case presentations. Rubric-based composite scores were compared to the previous dichotomous checklist-based scores.

RESULTS

Rubric-based instructor scores were significantly lower and had a broader score distribution than those resulting from the checklist method. Spring 2007 rubric-based composite scores from instructors and peers were significantly lower than those from the pilot study results, but self-assessment composite scores were not significantly different.

CONCLUSIONS

Successful development and implementation of a grading rubric facilitated evaluation of knowledge, skills, and professional behavior from the viewpoints of instructor, peer, and self in a didactic course.

Severe anaphylactic reaction after repeated intermittent exposure to lepirudin

Lepirudin, a recombinant DNA derivative of hirudin, is used to prevent thromboembolic complications caused by heparin-induced thrombocytopenia type II. Anaphylactic and anaphylactoid reactions have been reported with its use in patients both with and without known previous exposure to lepirudin. We describe the case of a 57-year-old woman who received five uneventful courses of lepirudin therapy before having a severe anaphylactic reaction during administration of the intravenous bolus dose that began her sixth course. The patient experienced cardiorespiratory arrest but recovered from the reaction. The decision to administer lepirudin to a patient who has previously received it should be reached with due consideration of the risk:benefit ratio and strategies to manage risk resulting from readministration. Risk factors for an anaphylactic reaction to lepirudin may include use of an initial bolus dose, intravenous rather than subcutaneous administration, length of any single course of therapy beyond 3 days, and repeat administration of lepirudin within 100 days.

Thiazolidinediones in patients with type 2 diabetes mellitus and heart failure

PURPOSE

A review of the significant findings related to the use of the thiazolidinediones (TZDs) in the treatment of patients with type 2 diabetes mellitus and heart failure was conducted.

SUMMARY

TZDs are antihyperglycemic medications that increase insulin sensitivity and improve the underlying defect of insulin resistance and type 2 diabetes mellitus, and they have the potential to slow or decrease the cardiovascular damage that results from these conditions. TZDs are also implicated in weight gain; however, this is accompanied by an improvement in insulin sensitivity and, therefore, its clinical significance is unclear. Edema has been well characterized in patients treated with TZDs. Edema is more common in patients treated with a TZD in combination with insulin and higher doses of TZDs. Because of the potential for fluid retention and worsening edema, clinical studies have excluded patients with New York Heart Association (NYHA) functional class III or IV heart failure. In patients at risk for heart failure or those who have NYHA functional class I or II symptoms, initiation of therapy should be at the lower dose for TZDs with close monitoring of weight gain, edema, and other signs of worsening heart failure.

CONCLUSION

Current data suggest that TZDs may be used cautiously in patients with type 2 diabetes mellitus who are at risk for heart failure or who have NYHA functional class I or II heart failure. Patients with NYHA functional class III or IV heart failure should not receive TZDs.

AGI-1067: a novel vascular protectant for prevention of restenosis

OBJECTIVE

To review the synthesis, pharmacology, clinical trials, and adverse effects of AGI-1067, a novel agent for preventing restenosis.

DATA SOURCES

Literature searches were conducted using MEDLINE (1966-July 2005) and International Pharmaceutical Abstracts (1970-July 2005) for English-language articles containing the search terms AGI-1067, AGI 1067, and probucol. In addition, bibliographies from relevant articles were reviewed for additional references.

STUDY SELECTION AND DATA EXTRACTION

All articles identified from data sources were reviewed for relevant information. Applicable information was included in this review.

DATA SYNTHESIS

AGI-1067, a derivative of the lipid-lowering agent probucol, is the first of a new class of drugs termed vascular protectants. It has antioxidant and lipid-lowering effects. In addition, it inhibits inflammatory processes without resultant immunosuppression through its selective inhibition of vascular cell adhesion molecule-1 expression. AGI-1067 also exhibited anti-atherosclerotic effects in preclinical studies. Relatively short-term treatment with AGI-1067 showed positive results compared with probucol in preventing restenosis in patients undergoing percutaneous coronary intervention. AGI-1067 appears to be well tolerated and holds important advantages over probucol in that it has fewer adverse effects on high-density lipoprotein cholesterol and the QT interval.

CONCLUSIONS

The favorable safety profile of AGI-1067 offers potential advantages over its precursor, probucol. Preclinical and clinical studies indicate that it possesses antioxidant, antiinflammatory, and lipid-lowering properties. Ongoing Phase II and III studies will determine AGI-1067's place in therapy for the prevention of restenosis and reduction in cardiovascular events in patients undergoing percutaneous intervention for coronary atherosclerosis.

Influence of grapefruit juice on the systemic availability of itraconazole oral solution in healthy adult volunteers

STUDY OBJECTIVE

To evaluate the effect of repeated ingestion of grapefruit juice on the systemic availability of itraconazole (ITZ) and hydroxyitraconazole (OHITZ) serum concentrations in subjects administered hydroxypropyl-beta-cyclodextrin-ITZ (HP-beta-CD ITZ) oral solution.

DESIGN

Randomized, two-period, crossover study.

SETTING

College of pharmacy research unit.

SUBJECTS

Twenty healthy, adult volunteers (10 men, 10 women).

INTERVENTION

Subjects received 240 ml of regular-strength grapefruit juice from frozen concentrate or bottled purified water 3 times/day for 2 days. On the third day they received a single dose of HP-beta-CD ITZ oral solution 200 mg (20 ml) with 240 ml of the beverage. Two hours after dosing they received another 240 ml of the beverage.

MEASUREMENTS AND MAIN RESULTS

Repeated blood samples were drawn for 72 hours after dosing. After a 14-day washout period, subjects were crossed over to the beverage they had not received previously and the above procedure was repeated. There was no difference in peak ITZ concentration (Cmax) or time to Cmax (Tmax). Coadministration of grapefruit juice reduced OHITZ Cmax nearly 10%, but this difference was not statistically significant. It produced a statistically significant increase in ITZ area under the concentration-time curves from 0-48 hours (AUC(0-48)) (17%) and from time zero extrapolated to infinity (AUC(0-infinity)) (19.5%). Apparent oral clearance of ITZ was significantly reduced (14%). Significant changes in OHITZ exposure were not observed; however, grapefruit juice coadministration produced statistically significant decreased mean OHITZ:ITZ AUC(0-48) and AUC(0-infinity) ratios. Grapefruit juice also decreased the mean OHITZ:ITZ Cmax ratio, but the difference was not statistically significant.

CONCLUSION

Repeated grapefruit juice consumption moderately affects ITZ systemic availability in subjects administered HP-beta-CD ITZ oral solution. Unlike previous findings with ITZ capsules, changes in the disposition of ITZ and OHITZ after repeated grapefruit juice consumption are consistent with grapefruit juice inhibition of intestinal cytochrome P450 3A4.

Effect of interleukin 6 on the hepatic metabolism of itraconazole and its metabolite hydroxyitraconazole using primary human hepatocytes

A potential cytokine-drug interaction between interleukin 6 (IL-6) and itraconazole (ITZ) was studied using human hepatocytes in primary culture. Cultures from 5 adult males (mean age 42 +/- 15 years) who had not received any medicines known to interact with CYP3A4 were studied. Cultures were exposed to ITZ 500 ng/ml, and the effects of 120 microg/ml cimetidine, 50 ng/ml human IL-6, or IL-6 plus IL-6 receptor antagonist were analyzed for 2, 4, 8, and 12 h. Intracellular ITZ and hydroxyitraconazole concentrations were measured using HPLC and normalized to total cellular protein. Mean intracellular concentrations between groups were compared using one-way Anova (f test; p < 0.10) and corresponding Bonferroni versus control test for multiple comparisons (p < 0.02). Mean intracellular ITZ concentrations between the groups were similar at all time points. Human hepatocytes in primary culture can metabolize ITZ. However, IL-6 did not inhibit hydroxyitraconazole formation, but it may inhibit its subsequent metabolism.

Olmesartan medoxomil: the seventh angiotensin receptor antagonist

OBJECTIVE

To review the pharmacology, pharmacokinetics, efficacy, and adverse effects of olmesartan medoxomil, an angiotensin II receptor antagonist for the treatment of hypertension.

DATA SOURCES

Information was obtained from MEDLINE searches (1996-April 2002) of English-language medical literature. Search terms included CS-866, olmesartan, olmesartan medoxomil, RNH-6270 (active metabolite of olmesartan), Benicar, angiotensin receptors, and antihypertensive agents. In addition, references from relevant articles were reviewed for additional citations. The authors independently reviewed literature identified in the searches. Studies evaluating olmesartan (i.e., abstracts, clinical trials, data on file with manufacturer) were considered for inclusion.

STUDY SELECTION

All articles identified from data sources with pertinent information regarding olmesartan medoxomil were evaluated, and all information deemed relevant was included in this review.

DATA SYNTHESIS

Olmesartan medoxomil is a competitively priced addition to the class of angiotensin II receptor antagonists. Monotherapy with olmesartan medoxomil in once-daily doses of 20-40 mg has produced significant reductions in systolic and diastolic blood pressure in hypertensive patients. Adverse effects have been minimal with olmesartan medoxomil, with dizziness being the only adverse effect occurring more often than with placebo in clinical trials. Additionally, animal studies indicate that olmesartan medoxomil may prove to be useful treatment for diabetic nephropathy, as well as atherosclerosis.

CONCLUSIONS

Olmesartan medoxomil has a favorable safety and efficacy profile, with blood pressure-lowering effects comparable to those of other angiotensin receptor blockers (i.e., losartan, valsartan, irbesartan). At this time, formulary decisions will be driven primarily by economic issues. Theoretical benefits of olmesartan medoxomil in reducing atherogenesis and lowering angiotensin II concentrations better than the alternative agents will be determined only with more extensive research.