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Grice GR, DiVall MV, Adams JL, Campbell JA. Letter to the Editor. Am J Pharm Educ 2024; 88:100679. [PMID: 38430986 DOI: 10.1016/j.ajpe.2024.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Gloria R Grice
- Department of Pharmacy Practice, St. Louis College of Pharmacy at University of Health Sciences and Pharmacy in St. Louis, St. Louis, MO, USA.
| | - Margarita V DiVall
- Bouve College of Health Sciences at Northeastern University, Boston, MA, USA
| | - Jennifer L Adams
- L.S. Skaggs College of Pharmacy at Idaho State University, Meridian, ID, USA
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Boyle CJ, Brown LM, Bzowyckyj AS, Cannon B, Chu A, Grice GR, Meyer SM, Robinson ET, Jackson A. Recommitting to AACP Engaged Governance for the Common Good: Report of the 50th Anniversary Commission to Reimagine the AACP House of Delegates. Am J Pharm Educ 2023; 87:100577. [PMID: 37544612 DOI: 10.1016/j.ajpe.2023.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
The 50th Anniversary Commission to Reimagine the American Association of Colleges of Pharmacy (AACP) House of Delegates (HOD Commission) was charged to consider and recommend changes to the AACP Board of Directors and AACP HOD regarding a broad range of issues related to the HOD. The 2021-2022 HOD Commission met virtually many times throughout the year as 2 sub-groups and a full commission, using Basecamp for shared documents and timelines, and it provided interim reports to the Board of Directors in November and February. A survey of 2022 delegates was developed and administered; responses from 163 delegates informed final recommendations as described in the report. The HOD Commission affirms the need for and purpose of AACP's HOD and urges that all schools/colleges of pharmacy recommit to engaged governance for the common good.
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Affiliation(s)
- Cynthia J Boyle
- University of Maryland, School of Pharmacy, Baltimore, MD, USA
| | | | | | - Bradley Cannon
- Rosalind Franklin University of Medicine & Science, College of Pharmacy, North Chicago, IL, USA
| | - Angela Chu
- Roseman University of Health Sciences, College of Pharmacy, Henderson, NV, USA
| | - Gloria R Grice
- University of Health Sciences and Pharmacy in St. Louis, St. Louis College of Pharmacy, St. Louis, MO, USA
| | - Susan M Meyer
- University of Pittsburgh, School of Pharmacy, Pittsburgh, PA, USA
| | - Evan T Robinson
- Creighton University, School of Pharmacy and Health Professions, Omaha, NE, USA
| | - Adam Jackson
- American Association of Colleges of Pharmacy, Arlington, VA, USA.
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Call WB, Grice GR, Tellor KB, Armbruster AL, Spurlock AM, Berry TM. Predictors of Student Failure or Poor Performance on Advanced Pharmacy Practice Experiences. Am J Pharm Educ 2020; 84:ajpe7890. [PMID: 33149328 PMCID: PMC7596595 DOI: 10.5688/ajpe7890] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/25/2020] [Indexed: 05/13/2023]
Abstract
Objective. To determine factors predictive of student failure or poor performance on advanced pharmacy practice experiences (APPEs) at a single pharmacy program. Methods. This retrospective cohort evaluated students entering the Doctor of Pharmacy (PharmD) program from 2012-2014 at St. Louis College of Pharmacy. Students who received a grade of F for one or more APPEs (failure group) were compared to all other students (non-failure group). A secondary evaluation compared students with a C or F on one or more APPEs (poor performers) to all other students (non-poor performers). Data were collected on didactic and experiential performance, identifiable professionalism issues from introductory pharmacy practice experiences (IPPEs), and academic honor code violations. Univariable and multivariable logistic regressions were performed to determine factors associated with APPE failure and poor performance. Results. A total of 669 students were analyzed. Twenty-eight students (4.2%) failed one or more APPEs and 81 students (12.1%) were identified as poor performers (grade of C or F). For the primary outcome, professional grade point average (GPA) of less than 2.7, practicum failure, IPPE professionalism issue(s), and pharmacotherapy course failure were identified for inclusion in the multivariable analysis. The IPPE professionalism issue(s) (HR 4.8 [95% CI 1.9-12.4]) and pharmacotherapy course failure (HR 4.2 [95% CI, 1.6-11.1]) were associated with APPE failure on multivariable regression. On the secondary analysis, the same variables were identified for multivariable regression, with professional GPA of less than 2.7 (HR 2.7 [95% CI 1.5-5]), IPPE professionalism issue(s) (HR 3.9 [95% CI 2.2-6.9]), and pharmacotherapy course failure (HR 2.0 [95% CI 1.1-3.7]) associated with poor performance. Conclusion. Poor academic performance and/or identified unprofessional behavior while completing IPPEs are associated with APPE failure and poor performance. Interventions should be aimed at identifying at-risk students and addressing risk factors prior to APPEs.
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Olson A, Rencic J, Cosby K, Rusz D, Papa F, Croskerry P, Zierler B, Harkless G, Giuliano MA, Schoenbaum S, Colford C, Cahill M, Gerstner L, Grice GR, Graber ML. Competencies for improving diagnosis: an interprofessional framework for education and training in health care. ACTA ACUST UNITED AC 2020; 6:335-341. [PMID: 31271549 DOI: 10.1515/dx-2018-0107] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/05/2019] [Indexed: 01/06/2023]
Abstract
Background Given an unacceptably high incidence of diagnostic errors, we sought to identify the key competencies that should be considered for inclusion in health professions education programs to improve the quality and safety of diagnosis in clinical practice. Methods An interprofessional group reviewed existing competency expectations for multiple health professions, and conducted a search that explored quality, safety, and competency in diagnosis. An iterative series of group discussions and concept prioritization was used to derive a final set of competencies. Results Twelve competencies were identified: Six of these are individual competencies: The first four (#1-#4) focus on acquiring the key information needed for diagnosis and formulating an appropriate, prioritized differential diagnosis; individual competency #5 is taking advantage of second opinions, decision support, and checklists; and #6 is using reflection and critical thinking to improve diagnostic performance. Three competencies focus on teamwork: Involving the patient and family (#1) and all relevant health professionals (#2) in the diagnostic process; and (#3) ensuring safe transitions of care and handoffs, and "closing the loop" on test result communication. The final three competencies emphasize system-related aspects of care: (#1) Understanding how human-factor elements influence the diagnostic process; (#2) developing a supportive culture; and (#3) reporting and disclosing diagnostic errors that are recognized, and learning from both successful diagnosis and from diagnostic errors. Conclusions These newly defined competencies are relevant to all health professions education programs and should be incorporated into educational programs.
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Affiliation(s)
- Andrew Olson
- Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Joseph Rencic
- Internal Medicine Residency Program, Tufts University School of Medicine, Boston, MA, USA
| | | | - Diana Rusz
- Society to Improve Diagnosis in Medicine, Chicago, IL, USA
| | - Frank Papa
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Pat Croskerry
- Department of Emergency Medicine, Dalhousie University Medical School, Halifax, Nova Scotia, Canada
| | - Brenda Zierler
- University of Washington School of Nursing, Seattle, WA, USA
| | | | - Michael A Giuliano
- Hackensack Meridian School of Medicine at Seton Hall, South Orange, NJ, USA
| | | | - Cristin Colford
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Maureen Cahill
- National Council State Boards of Nursing, Chicago, IL, USA
| | - Laura Gerstner
- Campbell University Physician Assistant Program, Buies Creek, NC, USA
| | | | - Mark L Graber
- Chief Medical Officer, Society to Improve Diagnosis in Medicine, New York, NY, USA
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Graber ML, Grice GR, Ling LJ, Conway JM, Olson A. Pharmacy Education Needs to Address Diagnostic Safety. Am J Pharm Educ 2019; 83:7442. [PMID: 31507297 PMCID: PMC6718490 DOI: 10.5688/ajpe7442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/14/2019] [Indexed: 06/10/2023]
Abstract
The American Association of Colleges of Pharmacy, the Accreditation Council for Pharmacy Education, and the Center for the Advancement of Pharmacy Education frame patient safety from the perspective of medication management, which is also the current focus of pharmacy education and training. With the growing appreciation that diagnostic errors represent an urgent and actionable patient safety concern, the National Academy of Medicine has recommended diagnostic safety training for all health care professions. The Society to Improve Diagnosis in Medicine has worked with an interprofessional consensus group to identify a set of 12 key competencies necessary to achieve diagnostic quality and safety that focuses on individual, team-based, and system-related competencies. Much of this already exists in pharmacy education, but pharmacy training programs need to give graduates more guidance on how they contribute to the diagnostic process and the prevention and detection of diagnostic errors. We describe the current state of progress in this regard, and what steps are needed by training programs to provide content and assessment so that graduates achieve the requisite competencies. Governing and advisory bodies need to expand the expectations around patient safety to include diagnostic safety.
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Affiliation(s)
- Mark L Graber
- The Society to Improve Diagnosis in Medicine, Plymouth, Massachusetts
| | | | - Louis J Ling
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Jeannine M Conway
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
| | - Andrew Olson
- University of Minnesota Medical School, Minneapolis, Minnesota
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Grice GR, Thomason AR, Meny LM, Pinelli NR, Martello JL, Zorek JA. Intentional Interprofessional Experiential Education. Am J Pharm Educ 2018; 82:6502. [PMID: 29692445 PMCID: PMC5909877 DOI: 10.5688/ajpe6502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/02/2017] [Indexed: 05/12/2023]
Abstract
The experiential component of a doctor of pharmacy curricula is an ideal, yet underutilized vehicle to advance interprofessional education (IPE) initiatives. To date, most experiential-based IPE initiatives occur in a naturally occurring, non-deliberate fashion. The American Association of Colleges of Pharmacy (AACP) Experiential Education Section formed the Task Force on Intentional Interprofessional Education in Experiential Education in academic year 2015-2016 to explore the issue. This commentary describes the work of the task force, including the following elements: defining intentional interprofessional experiential education as "the explicit effort by preceptors and practice sites to create/foster educational opportunities or activities designed specifically to achieve interprofessional educational competencies;" conducting a systematic literature review to identify examples of intentional interprofessional experiential education in the published literature; surveying faculty with oversight of experiential education programs and preceptors within those programs; and generating recommendations to stakeholders including AACP, pharmacy schools, and experiential education administrators.
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Affiliation(s)
| | | | - Lisa M. Meny
- Ferris State University College of Pharmacy, Big Rapids, Michigan
| | - Nicole R. Pinelli
- UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jay L. Martello
- West Virginia University School of Pharmacy, Morgantown, West Virginia
| | - Joseph A. Zorek
- University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin
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Grice GR, Gattas NM, Prosser T, Voorhees M, Kebodeaux C, Tiemeier A, Berry TM, Wilson AG, Mann J, Juang P. Design and Validation of Patient-Centered Communication Tools (PaCT) to Measure Students' Communication Skills. Am J Pharm Educ 2017; 81:5927. [PMID: 29200447 PMCID: PMC5701322 DOI: 10.5688/ajpe5927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 01/17/2017] [Indexed: 05/30/2023]
Abstract
Objective. To develop a comprehensive instrument specific to student pharmacist-patient communication skills, and to determine face, content, construct, concurrent, and predictive validity and reliability of the instrument. Methods. A multi-step approach was used to create and validate an instrument, including the use of external experts for face and content validity, students for construct validity, comparisons to other rubrics for concurrent validity, comparisons to other coursework for predictive validity, and extensive reliability and inter-rater reliability testing with trained faculty assessors. Results. Patient-centered Communication Tools (PaCT) achieved face and content validity and performed well with multiple correlation tests with significant findings for reliability testing and when compared to an alternate rubric. Conclusion. PaCT is a useful instrument for assessing student pharmacist communication skills with patients.
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Affiliation(s)
| | | | | | | | - Clark Kebodeaux
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Amy Tiemeier
- St. Louis College of Pharmacy, St. Louis, Missouri
| | | | | | - Janelle Mann
- Washington University Infusion Center Pharmacy, St. Louis, Missouri
| | - Paul Juang
- St. Louis College of Pharmacy, St. Louis, Missouri
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Perlmutter M, Tucker S, Harris D, Grice GR. Identifying Communication Behaviors That Promote Interprofessional Teamwork Among Health Care Profession Students. Am J Occup Ther 2017. [DOI: 10.5014/ajot.2017.71s1-po7050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/1/2017
The purpose of this study was to identify communication behaviors of students on an interprofessional team that impact patient and team satisfaction. Findings can be used to develop interprofessional educational experiences designed to foster team performance and quality of care.
Primary Author and Speaker: Monica Perlmutter
Additional Authors and Speakers: Susan Tucker
Contributing Authors: Dehra Harris, Gloria R. Grice
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Grice GR, Tiemeier A, Hurd P, Berry TM, Voorhees M, Prosser TR, Sailors J, Gattas NM, Duncan W. Student use of health literacy tools to improve patient understanding and medication adherence. ACTA ACUST UNITED AC 2014; 29:240-53. [PMID: 24704893 DOI: 10.4140/tcp.n.2014.240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Evaluate curricular changes related to health literacy and determine impact on independent-living senior residents as part of an introductory pharmacy practice experience for third-year student pharmacists. DESIGN Students were randomly assigned a resident whom they visited multiple times to conduct assessments and provide various services using three methods: Ask Me 3™ Four Habits Model, and Teach-back. SETTING The study was conducted at independent-living apartments within a 24-mile radius from the St. Louis College of Pharmacy, St. Louis, Missouri. PATIENTS, PARTICIPANTS Participants (n = 147 to 173, across all three years) were volunteer, elderly residents, living at a facility that collaborated with the research. INTERVENTIONS Within one academic year, students collected medical and medication histories, conducted household safety checks, performed screening assessments, assessed adherence, and provided general recommendations to a resident. MAIN OUTCOME MEASURE(S) Outcomes included resident satisfaction, student satisfaction, and correlations between student use of health literacy tools and resident satisfaction. RESULTS Exit surveys indicated resident overall satisfaction with the program, increased understanding of health-related information, increased confidence in asking health care professionals questions about their health, and greater commitment to medication adherence as a result of the experience. Students were highly satisfied with the program. Analyses reveal some correlations between a previously determined performance level of student communication and resident satisfaction. CONCLUSIONS Students' use of health literacy communication tools during encounters with independent-living senior residents can result in greater patient understanding and empowerment, which may in turn help improve medication adherence.
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Affiliation(s)
| | - Amy Tiemeier
- St. Louis College of Pharmacy, St. Louis, Missouri
| | - Peter Hurd
- St. Louis College of Pharmacy, St. Louis, Missouri
| | | | | | | | - Jill Sailors
- St. Louis College of Pharmacy, St. Louis, Missouri
| | | | - Wendy Duncan
- College of Pharmacy & Health Sciences, Drake University, Des Moines, Iowa
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Gleason BL, Gaebelein CJ, Grice GR, Crannage AJ, Weck MA, Hurd P, Walter B, Duncan W. Assessment of students' critical-thinking and problem-solving abilities across a 6-year doctor of pharmacy program. Am J Pharm Educ 2013; 77:166. [PMID: 24159207 PMCID: PMC3806950 DOI: 10.5688/ajpe778166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/17/2013] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To determine the feasibility of using a validated set of assessment rubrics to assess students' critical-thinking and problem-solving abilities across a doctor of pharmacy (PharmD) curriculum. METHODS Trained faculty assessors used validated rubrics to assess student work samples for critical-thinking and problem-solving abilities. Assessment scores were collected and analyzed to determine student achievement of these 2 ability outcomes across the curriculum. Feasibility of the process was evaluated in terms of time and resources used. RESULTS One hundred sixty-one samples were assessed for critical thinking, and 159 samples were assessed for problem-solving. Rubric scoring allowed assessors to evaluate four 5- to 7-page work samples per hour. The analysis indicated that overall critical-thinking scores improved over the curriculum. Although low yield for problem-solving samples precluded meaningful data analysis, it was informative for identifying potentially needed curricular improvements. CONCLUSIONS Use of assessment rubrics for program ability outcomes was deemed authentic and feasible. Problem-solving was identified as a curricular area that may need improving. This assessment method has great potential to inform continuous quality improvement of a PharmD program.
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Grice GR, Wenger P, Brooks N, Berry TM. Comparison of patient simulation methods used in a physical assessment course. Am J Pharm Educ 2013; 77:77. [PMID: 23716745 PMCID: PMC3663631 DOI: 10.5688/ajpe77477] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 12/15/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine whether there is a difference in student pharmacists' learning or satisfaction when standardized patients or manikins are used to teach physical assessment. DESIGN Third-year student pharmacists were randomized to learn physical assessment (cardiac and pulmonary examinations) using either a standardized patient or a manikin. ASSESSMENT Performance scores on the final examination and satisfaction with the learning method were compared between groups. Eighty and 74 student pharmacists completed the cardiac and pulmonary examinations, respectively. There was no difference in performance scores between student pharmacists who were trained using manikins vs standardized patients (93.8% vs. 93.5%, p=0.81). Student pharmacists who were trained using manikins indicated that they would have probably learned to perform cardiac and pulmonary examinations better had they been taught using standardized patients (p<0.001) and that they were less satisfied with their method of learning (p=0.04). CONCLUSIONS Training using standardized patients and manikins are equally effective methods of learning physical assessment, but student pharmacists preferred using standardized patients.
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Affiliation(s)
- Gloria R Grice
- St. Louis College of Pharmacy, St. Louis, MO 63110, USA.
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12
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Grice GR, Gattas NM, Sailors J, Murphy JA, Tiemeier A, Hurd P, Prosser T, Berry T, Duncan W. Health literacy: use of the Four Habits Model to improve student pharmacists' communication. Patient Educ Couns 2013; 90:23-28. [PMID: 22995596 DOI: 10.1016/j.pec.2012.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 07/30/2012] [Accepted: 08/31/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess whether student pharmacists' communication skills improved using the Four Habits Model (FHM) at the St. Louis College of Pharmacy. METHODS During the Fall of 2009 and 2010, student pharmacists in the third professional year learned and practiced the FHM. They were given feedback by faculty on three of the four Habits, used the FHM for self and peer assessment, and were formally evaluated on all four Habits during a standardized patient encounter. RESULTS Student pharmacist performance significantly improved from baseline during both Fall 2009 and Fall 2010 in the majority of the Habits assessed. CONCLUSION Use of the FHM in pharmacy education can improve a student pharmacists' ability to display the four Habits of communicating and developing relationships with patients. Tailoring of the FHM to pharmacy encounters will further enhance the utility of this communication framework. PRACTICE IMPLICATIONS Use of the FHM enhances the measurement and assessment of the relational aspects of student pharmacist-patient communication skills. Consistent use of the FHM over time is likely necessary to fully develop and retain communication skills. The overall goal is to improve patient's health literacy and appropriate medication use by improving communication and the pharmacist-patient relationship.
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Affiliation(s)
- Gloria R Grice
- Department of Pharmacy Practice, St Louis College of Pharmacy, St Louis, MO, USA.
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Grice GR, Monson K, Pitlick J, Chereson R, Duncan W, Geslani G, Kilgore K, Patel PB, Pautler H. Developing a Professionalism Plan. Innov Pharm 2013. [DOI: 10.24926/iip.v4i1.285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Professionalism is a way of being which underlies all the responsibilities of a pharmacist and associated general and professional abilities. The Student Affairs Committee was charged with developing a college-wide professionalism plan to meet the Accreditation Council for Pharmacy Education (ACPE) Standards 15.1 and 23. This plan was developed concurrently with a new curriculum. The plan was developed systematically with the following goals: 1) create a definition of professionalism, 2) determine outcomes of the plan, 3) identify existing components which should be continued and new components to be added, 4) ensure existing and new components are linked to outcomes and 5) develop a continuous assessment process for the plan. The proposed plan consists of curricular, co-curricular and extra-curricular activities designed to help students gain experience in three professionalism pillars: Competence, Connection and Character, as defined by Brown et al in "Taxonomy of Professionalism". While knowledge and skills will be enhanced, the focus of development will be on student virtues, values and attitudesäóîthat what they do defines who they are. The goal is to help students develop as people and professionals who value the high ideals expected of a pharmacist.
Type: Idea Paper
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Ogweno AW, Grice GR. Global management of chronic disease in sub-Saharan Africa: A call to action for pharmacists. J Am Pharm Assoc (2003) 2012; 52:e292-5. [DOI: 10.1331/japha.2012.12072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Horne BD, Lenzini PA, Wadelius M, Jorgensen AL, Kimmel SE, Ridker PM, Eriksson N, Anderson JL, Pirmohamed M, Limdi NA, Pendleton RC, McMillin GA, Burmester JK, Kurnik D, Stein CM, Caldwell MD, Eby CS, Rane A, Lindh JD, Shin JG, Kim HS, Angchaisuksiri P, Glynn RJ, Kronquist KE, Carlquist JF, Grice GR, Barrack RL, Li J, Gage BF. Pharmacogenetic warfarin dose refinements remain significantly influenced by genetic factors after one week of therapy. Thromb Haemost 2012; 107:232-40. [PMID: 22186998 PMCID: PMC3292349 DOI: 10.1160/th11-06-0388] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 11/04/2011] [Indexed: 01/06/2023]
Abstract
By guiding initial warfarin dose, pharmacogenetic (PGx) algorithms may improve the safety of warfarin initiation. However, once international normalised ratio (INR) response is known, the contribution of PGx to dose refinements is uncertain. This study sought to develop and validate clinical and PGx dosing algorithms for warfarin dose refinement on days 6-11 after therapy initiation. An international sample of 2,022 patients at 13 medical centres on three continents provided clinical, INR, and genetic data at treatment days 6-11 to predict therapeutic warfarin dose. Independent derivation and retrospective validation samples were composed by randomly dividing the population (80%/20%). Prior warfarin doses were weighted by their expected effect on S-warfarin concentrations using an exponential-decay pharmacokinetic model. The INR divided by that "effective" dose constituted a treatment response index . Treatment response index, age, amiodarone, body surface area, warfarin indication, and target INR were associated with dose in the derivation sample. A clinical algorithm based on these factors was remarkably accurate: in the retrospective validation cohort its R(2) was 61.2% and median absolute error (MAE) was 5.0 mg/week. Accuracy and safety was confirmed in a prospective cohort (N=43). CYP2C9 variants and VKORC1-1639 G→A were significant dose predictors in both the derivation and validation samples. In the retrospective validation cohort, the PGx algorithm had: R(2)= 69.1% (p<0.05 vs. clinical algorithm), MAE= 4.7 mg/week. In conclusion, a pharmacogenetic warfarin dose-refinement algorithm based on clinical, INR, and genetic factors can explain at least 69.1% of therapeutic warfarin dose variability after about one week of therapy.
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Affiliation(s)
- Benjamin D Horne
- Cardiovascular Department, Intermountain Medical Center, Salt Lake City, Utah 84107, USA.
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Voora D, Koboldt DC, King CR, Lenzini PA, Eby CS, Porche-Sorbet R, Deych E, Crankshaw M, Milligan PE, McLeod HL, Patel SR, Cavallari LH, Ridker PM, Grice GR, Miller RD, Gage BF. A polymorphism in the VKORC1 regulator calumenin predicts higher warfarin dose requirements in African Americans. Clin Pharmacol Ther 2010; 87:445-51. [PMID: 20200517 DOI: 10.1038/clpt.2009.291] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Warfarin demonstrates a wide interindividual variability in response that is mediated partly by variants in cytochrome P450 2C9 (CYP2C9) and vitamin K 2,3-epoxide reductase complex subunit 1 (VKORC1). It is not known whether variants in calumenin (CALU) (vitamin K reductase regulator) have an influence on warfarin dose requirements. We resequenced CALU regions in a discovery cohort of dose outliers: patients with high (>90th percentile, n = 55) or low (<10th percentile, n = 53) warfarin dose requirements (after accounting for known genetic and nongenetic variables). One CALU variant, rs339097, was associated with high doses (P = 0.01). We validated this variant as a predictor of higher warfarin doses in two replication cohorts: (i) 496 patients of mixed ethnicity and (ii) 194 African-American patients. The G allele of rs339097 (the allele frequency was 0.14 in African Americans and 0.002 in Caucasians) was associated with the requirement for a 14.5% (SD +/- 7%) higher therapeutic dose (P = 0.03) in the first replication cohort and a higher-than-predicted dose in the second replication cohort (allele frequency 0.14, one-sided P = 0.03). CALU rs339097 A>G is associated with higher warfarin dose requirements, independent of known genetic and nongenetic predictors of warfarin dose in African Americans.
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Affiliation(s)
- D Voora
- Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA
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Horne BD, Lenzini PA, Wadelius M, Jorgensen AL, Kimmel SE, Eriksson N, Anderson JL, Pirmohamed M, Limdi NA, Burmester JK, Kurnik D, Stein CM, Caldwell MD, Eby CS, Rane A, Lindh JD, Shin JG, Kim HS, Angchaisuksiri P, Chen J, Carlquist JF, Grice GR, Kronquist KE, Gage BF. WARFARIN DOSING ALGORITHM REFINEMENTS AFTER 7-9 DAYS OF THERAPY BASED ON PHARMACOGENETIC, PHARMACOKINETIC, CLINICAL, AND LABORATORY DATA. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61219-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Michael P. Gulseth
- Anticoagulation Services, Sanford–University of South Dakota Medical Center, Sioux Falls
| | - Gloria R. Grice
- St. Louis College of Pharmacy, and Manager, Barnes-Jewish Hospital Anticoagulation Service, Washington University, St. Louis, MO
| | - William E. Dager
- University of California Davis Medical Center, Davis, and Clinical Professor of Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco
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Lenzini PA, Grice GR, Milligan PE, Dowd MB, Subherwal S, Deych E, Eby CS, King CR, Porche-Sorbet RM, Murphy CV, Marchand R, Millican EA, Barrack RL, Clohisy JC, Kronquist K, Gatchel SK, Gage BF. Laboratory and clinical outcomes of pharmacogenetic vs. clinical protocols for warfarin initiation in orthopedic patients. J Thromb Haemost 2008; 6:1655-62. [PMID: 18662264 PMCID: PMC2920450 DOI: 10.1111/j.1538-7836.2008.03095.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Warfarin is commonly prescribed for prophylaxis and treatment of thromboembolism after orthopedic surgery. During warfarin initiation, out-of-range International Normalized Ratio (INR) values and adverse events are common. METHODS In orthopedic patients beginning warfarin therapy, we developed and prospectively validated pharmacogenetic and clinical dose refinement algorithms to revise the estimated therapeutic dose after 4 days of therapy. RESULTS The pharmacogenetic algorithm used the cytochrome P450 (CYP) 2C9 genotype, smoking status, peri-operative blood loss, liver disease, INR values and dose history to predict the therapeutic dose. The R(2) was 82% in a derivation cohort (n = 86) and 70% when used prospectively (n = 146). The R(2) of the clinical algorithm that used INR values and dose history to predict the therapeutic dose was 57% in a derivation cohort (n = 178) and 48% in a prospective validation cohort (n = 146). In 1 month of prospective follow-up, the percent time spent in the therapeutic range was 7% higher (95% CI: 2.7-11.7) in the pharmacogenetic cohort. The risk of a laboratory or clinical adverse event was also significantly reduced in the pharmacogenetic cohort (Hazard Ratio 0.54; 95% CI: 0.30-0.97). CONCLUSIONS Warfarin dose adjustments that incorporate genotype and clinical variables available after four warfarin doses are accurate. In this non-randomized, prospective study, pharmacogenetic dose refinements were associated with more time spent in the therapeutic range and fewer laboratory or clinical adverse events. To facilitate gene-guided warfarin dosing we created a non-profit website, http://www.WarfarinDosing.org.
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Affiliation(s)
- Petra A. Lenzini
- Washington University School of Medicine, Department of Internal Medicine
| | - Gloria R. Grice
- Washington University School of Medicine, Department of Internal Medicine
- St. Louis College of Pharmacy
| | - Paul E. Milligan
- Washington University School of Medicine, Department of Internal Medicine
- St. Louis College of Pharmacy
| | | | - Sumeet Subherwal
- Washington University School of Medicine, Department of Internal Medicine
| | - Elena Deych
- Washington University School of Medicine, Department of Internal Medicine
| | - Charles S. Eby
- Washington University School of Medicine, Department of Pathology
| | - Cristi R. King
- Washington University School of Medicine, Department of Internal Medicine
| | | | | | | | - Eric A. Millican
- Washington University School of Medicine, Department of Internal Medicine
| | - Robert L. Barrack
- Washington University School of Medicine, Department of Orthopedic Surgery
| | - John C. Clohisy
- Washington University School of Medicine, Department of Orthopedic Surgery
| | | | - Susan K. Gatchel
- Washington University School of Medicine, Department of Internal Medicine
| | - Brian F. Gage
- Washington University School of Medicine, Department of Internal Medicine
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Affiliation(s)
- S M Thacker
- St Louis College of Pharmacy, St Louis, MO, USA
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Grice GR, Milligan PE, Eby C, Gage BF. Pharmacogenetic dose refinement prevents warfarin overdose in a patient who is highly warfarin-sensitive. J Thromb Haemost 2008; 6:207-9. [PMID: 17944998 DOI: 10.1111/j.1538-7836.2007.02797.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lenzini PA, Grice GR, Milligan PE, Gatchel SK, Deych E, Eby CS, Burnett RSJ, Clohisy JC, Barrack RL, Gage BF. Optimal initial dose adjustment of warfarin in orthopedic patients. Ann Pharmacother 2007; 41:1798-804. [PMID: 17911206 DOI: 10.1345/aph.1k197] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Warfarin sodium is commonly prescribed for the prophylaxis and treatment of venous thromboembolism. Dosing algorithms have not been widely adopted because they require a fixed initial warfarin dose (eg, 5 mg) and are not tailored to other factors that may affect the international normalized ratio (INR). OBJECTIVE To develop an algorithm that could predict a therapeutic warfarin dose based on drug interactions, INR response after the initial warfarin doses, and other clinical factors. METHODS We used stepwise regression to quantify the relationship between these factors in patients beginning prophylactic warfarin therapy immediately prior to joint replacement. In the derivation cohort (n = 271), we separately modeled the therapeutic dose after 2 and 3 initial doses. We prospectively validated these 2 models in an independent cohort (n = 105). RESULTS About half of the therapeutic dose variability was predictable after 3 days of therapy: R2 was 53% in the derivation cohort and 42% in the validation cohort. INR response after 3 warfarin doses (INR3) inversely correlated with therapeutic dose (p < 0.001). Intraoperative blood loss transiently, but significantly, elevated the postoperative INR values. Other significant (p < 0.03) predictors were the first and second warfarin doses (+7% and +6%, respectively, per 1 mg), and statin use (-15.0%). The model derived after 2 warfarin doses explained 32% of the variability in therapeutic dose. CONCLUSIONS We developed and validated algorithms that estimate therapeutic warfarin doses based on clinical factors and INR response available after 2-3 days of warfarin therapy. The algorithms are implemented online at www.WarfarinDosing.org.
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Affiliation(s)
- Petra A Lenzini
- Washington University in St. Louis, St. Louis, MO 63110, USA
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Abstract
Pharmacogenetics (PG), the study of human genome function and its effects on drug response, represents an exciting approach for reducing adverse drug events and increasing therapeutic efficacy. However, there is no clear information of the potential impact of PG in the primary care setting. Therefore, a study was conducted to determine the frequency of use of medications under PG influence, including 16 PG adverse drug reaction (ADR)-associated medications, in the primary care setting. Patients and methods: A cohort of 607 consecutive patients was accrued over a 3-month period from three primary care practices. Patients were asked to answer a verbal survey of demographics and medication use during the past 12 months. The survey specifically evaluated 16 drugs known to commonly cause ADRs and undergo metabolism by polymorphic enzymes. Patients also disclosed information on all other medication use in the last year. Medication use was verified by chart review. The primary outcome was the frequency of medication use. Results: Among the 16 ADR-associated medications, patients used analgesics (88.5%), antihypertensives (14.3%) and antidepressants (9.6%) most commonly. Overall, 28.6% of patients took more than one of the PG ADR-associated medications. Neither gender nor race appeared to influence the frequency of use of these medications (p = 0.5 and p = 0.08, respectively). Patients taking one or more of the drugs were older (p < 0.001). More patients seen for a chronic visit took one or more of the ADR-associated drugs than patients seen for an acute visit (35.8 versus 18.5%, p < 0.001). Discussion: This is the first attempt to describe the potential role of pharmacogenetics in the primary care setting. The findings indicate that at least one in four primary care patients take at least one medication that commonly causes adverse drug reactions due to genetic variability in drug metabolism, indicating that there is a potential role of pharmacogenomics in primary care. Nearly every patient was on a medication with putative PG association. Conclusions: Studies of the ability of PG should not be limited to medical subspecialties, as there is a great potential impact of PG on the primary care setting.
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Affiliation(s)
- Gloria R Grice
- St Louis College of Pharmacy, Division of Pharmacy Practice, St Louis, MO 63110, USA
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Abstract
Two letter-classification experiments that investigated target-redundancy effects on reaction time (RT) were conducted. Both experiments were replicated with choice reaction time (CRT) and go/no-go (GNG) procedures. In each experiment, there were two single-target conditions, one with a noise letter and one without. In one experiment, the letter classes were two letters that could be of either case. In the second experiment, each class consisted of two different capital letters. In both experiments, there were two redundant-targets conditions, one with identical targets and one with the different members of a class. In both of the GNG experiments, redundancy gains were obtained comparing the different-targets condition with the no-noise, single-target condition. Redundant stimuli are ones that lead to the same response. Visually different stimuli may be processed in parallel and jointly activate a response. GNG procedures are more sensitive than CRT in the investigation of redundancy effects.
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Affiliation(s)
- G R Grice
- Department of Psychology, University of New Mexico, Albuquerque 87131
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Abstract
Results are reported for two go/no-go reaction time (RT) experiments, in which the redundant targets advantage was investigated. These experiments were replications of two earlier choice reaction time (CRT) experiments, in which letter stimuli were used. Important differences between the go/no-go RT experiments and the CRT experiments were obtained. Equal and significant redundancy advantages were obtained whether redundant targets were compared with a single target presented with a noise letter or without noise. In the CRT experiments, the advantage was not obtained in the comparison with a single target presented alone. Noise letters did not slow the RTs to single targets with which they were presented as was the case with CRT. Since the differing results of the two procedures depend on the response requirements, explanation of differing CRT data in terms of perceptual or attentional concepts is probably inappropriate. The presence and absence of response competition in the two situations may be the best interpretation. The results tend to support a conclusion of the parallel processing of two letter stimuli separated spatially by as much as 3 degrees.
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Affiliation(s)
- G R Grice
- Department of Psychology, University of New Mexico, Albuquerque 87131
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Grice GR, Gwynne JW. Temporal characteristics of noise conditions producing facilitation and interference. Percept Psychophys 1985; 37:495-501. [PMID: 4059004 DOI: 10.3758/bf03204912] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Grice GR, Boroughs JM, Canham L. Temporal dynamics of associative interference and facilitation produced by visual context. Percept Psychophys 1984; 36:499-507. [PMID: 6535094 DOI: 10.3758/bf03207509] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Grice GR, Canham L, Gwynne JW. Absence of a redundant-signals effect in a reaction time task with divided attention. Percept Psychophys 1984; 36:565-70. [PMID: 6535102 DOI: 10.3758/bf03207517] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Grice GR, Canham L, Boroughs JM. Combination rule for redundant information in reaction time tasks with divided attention. Percept Psychophys 1984; 35:451-63. [PMID: 6462872 DOI: 10.3758/bf03203922] [Citation(s) in RCA: 75] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Grice GR, Nullmeyer R, Schnizlein JM. Variable criterion analysis of brightness effects in simple reaction time. J Exp Psychol Hum Percept Perform 1979. [PMID: 528941 DOI: 10.1037//0096-1523.5.2.303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Using light onset as the stimulus in simple reaction time (SRT), the effect of stimulus intensity was studied in both between-subjects and within-subjects experimental designs. There was a strong intensity effect in both conditions but no significant interaction between the effect of stimulus intensity and the type of design. This differs from previous results with auditory stimuli where such an interaction has been demonstrated. When the criterion parameters of variable criterion theory were evaluated directly, the only significant effect was greater criterion variability in the between-subjects condition. Theoretical functions describing the growth of sensory strength for each intensity had different starting points and were largely parallel, showing only late temporal divergence. This provides an explanation of the rarity, in the SRT literature, of interactions between visual intensity and criterion variables. Correlations illustrating the relations between reaction time (RT) measures and theoretical criterion parameters are presented. Absence of the predicted relation between intensity and RT variability is evidence against theories relating RT to impulse rate treated as a Poisson process.
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Grice GR, Spiker VA, Nullmeyer R. Variable criterion analysis of individual differences and stimulus similarity in choice reaction time. Percept Psychophys 1979; 25:353-70. [PMID: 461096 DOI: 10.3758/bf03199844] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
Using light onset as the stimulus in simple reaction time (SRT), the effect of stimulus intensity was studied in both between-subjects and within-subjects experimental designs. There was a strong intensity effect in both conditions but no significant interaction between the effect of stimulus intensity and the type of design. This differs from previous results with auditory stimuli where such an interaction has been demonstrated. When the criterion parameters of variable criterion theory were evaluated directly, the only significant effect was greater criterion variability in the between-subjects condition. Theoretical functions describing the growth of sensory strength for each intensity had different starting points and were largely parallel, showing only late temporal divergence. This provides an explanation of the rarity, in the SRT literature, of interactions between visual intensity and criterion variables. Correlations illustrating the relations between reaction time (RT) measures and theoretical criterion parameters are presented. Absence of the predicted relation between intensity and RT variability is evidence against theories relating RT to impulse rate treated as a Poisson process.
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Grice GR, Henriksen K, Speiss JM. Response mediated generalization in eyelid conditioning with reduced conflicting information. J Exp Psychol 1972; 92:398-404. [PMID: 5060709 DOI: 10.1037/h0032362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Grice GR, Kohfeld DL. Mediational effects in finger conditioning. J Exp Psychol 1969; 79:358-62. [PMID: 5785648 DOI: 10.1037/h0026902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Grice GR, Masters L, Kohfeld DL. Classical conditioning without discrimination training: a test of the generalization theory of CS intensity effects. J Exp Psychol 1966; 72:510-3. [PMID: 5969723 DOI: 10.1037/h0023761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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