The Role of Consumerism in Pharmacy Education

The notion of consumerism and that students are customers of pharmacy colleges was explored by proponents and opponents of the idea. First, a working definition of a "customer" in pharmacy education is pondered with respect to the roles and responsibilities of students and schools/colleges of pharmacy. Second, the pros and cons of "student-centered" education are considered in the light of students and their families being consumers of the educational experience. Third, the duality of student-centered education is discussed including student engagement/disengagement in their learning, professional/unprofessional behaviors, and shared/individual responsibilities. Lastly, learning and teaching environment dynamics are discerned when higher education becomes more student-centric and how that may affect the overall outcome of the student and the goals of pharmacy educational programs.

Incorporating Interprofessional Education into a Required Introductory Pharmacy and Nursing Didactic Course

OBJECTIVE

The primary objective was to describe the pedagogical approach of conducting 2 Interprofessional Education (IPE) sessions focused on IPE Collaborative (IPEC) Core Competencies in a required pharmacy and nursing didactic course. The secondary objective was to use quantitative and qualitative methods to assess students' self-reported IPE knowledge, skills, and attitudes after the IPE sessions.

METHODS

Sessions consisted of active learning exercises with supplemental lectures, emphasizing students work together to find optimal solutions to both clinical and nonclinical problems. Time was allotted for debriefing and discussion. Students completed a post-session reflection with 6 guided questions to collect qualitative themes. Participants also completed the W(e) Learn Interprofessional Program Assessment Scale, a survey designed to assess student perceptions of the interprofessional sessions. We used t tests for comparing scores among relevant subgroups.

RESULTS

From 2017-2019, 263 students attended 2 annual IPE sessions in a required, introductory course. Small group didactic activities with faculty-led debriefing were included in each session. A total of 111 students fully completed the scale and average scores were high (Mean = 197.5, SD = 15.96). Thematic analysis of reflections revealed that students recognized teamwork, mutual respect, effective communication, and understanding the roles and responsibilities of the interprofessional team helped improve patient care.

CONCLUSION

Including joint IPE sessions in a foundational didactic course was a feasible and successful IPE component. Sessions provided students with experience practicing foundational skills for interprofessional communication and teamwork. Students reported high satisfaction and valued the sessions, as indicated by quantitative surveys and qualitative themes.

Evaluation of a murder mystery activity to teach patient communication interviewing skills

INTRODUCTION

While gamification has been used in pharmacy education, more research is needed to establish that these methods are effective. The objective of our study was to evaluate the effectiveness of a murder mystery activity to teach patient communication and interviewing skills to first year pharmacy students in a pharmacy skills laboratory.

METHODS

A non-medical murder mystery activity was used to introduce and provide practice on communication techniques needed for obtaining a medical history. These techniques included an introduction, confirmation of patient identity, nonverbal expression, self-expression, empathy, emotional response, question style, organization, and appropriate closure. In groups of three to five, students interviewed five different suspects and were assessed as a group on their second and fifth suspect interviews within one, three-hour laboratory session using a standardized rubric. Assessments were completed by students, standardized patients, and faculty.

RESULTS

A total of 161 students completed the murder mystery exercise over three years. Total student scores all significantly improved from the second to fifth interview. In addition to total scores, each subtotal score significantly improved from the second to fifth interview, regardless of the evaluator.

CONCLUSIONS

Within the murder mystery laboratory, students' communication scores improved on a standardized communication rubric. Use of a murder mystery is an effective, engaging way to introduce and practice communication skills that could be adapted by other institutions.

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.

National survey of schools of pharmacy on prevalence and description of wellness initiatives

INTRODUCTION

Although the importance of student wellness has been emphasized across health professions including pharmacy, there is a lack of information on the prevalence of such wellness programs in pharmacy schools. The objectives of this study were to determine the prevalence of student wellness programs in United States (US) schools of pharmacy and to describe their basic structure.

METHODS

Deans from the 143 US schools of pharmacy were asked to participate in this study by completing an electronic survey. Institutions with wellness programs were prompted to answer questions related to their program, including who initiated the program, who participated, where wellness principles were taught and incorporated, and what dimensions of wellness were promoted.

RESULTS

Forty-six responses were collected for a response rate of 32.2%. Thirty-four (73.9%) of respondents answered that they had a school wellness program. Similar numbers of private and public schools completed the survey at 24 (52.3%) and 22 (47.8%), respectively. The majority of programs targeted students (97.1%), faculty (79.4%), and staff (76.5%), were initiated by either the office of the dean (73.5%) and/or faculty (58.8%), and were comprised of faculty (88.2%), staff (82.4%), and office of the dean (67.6%). Wellness principles were most often taught and practiced during extracurricular events and didactic courses.

CONCLUSIONS

This descriptive, survey-based study provides a snapshot on the current incorporation of wellness initiatives across US schools of pharmacy. Further studies are needed to elucidate best wellness practices within pharmacy academia.

Implementation of an Opioid Overdose and Naloxone Distribution Training in a Pharmacist Laboratory Course

Objective. To describe the instructional design, implementation, and evaluation of an opioid overdose response program (ORP) and opioid overdose education and naloxone distribution (OEND) training program to third-year pharmacy (P3) students. Methods. Using the 5-E learning cycle during a three-hour laboratory session, the authors developed an OEND training program. The training began with an engagement exercise encompassing validated pre-Opioid Overdose Knowledge Scale (OOKS) and pre-Opioid Overdose Attitudes Scale (OOAS) assessments. Directly after, students moved to the exploration phase of the program, which consisted of two stations with placebo naloxone products. There, instructors explained key content related to OEND. Students applied what was learned during the elaboration by completing two cases: using group-based point-by-point counseling as well as a scenario with a simulation patient manikin. The class ended with an evaluation exercise that involved completing post-OOKS and post-OOAS. Results. Fifty-six students participated in the ORP certification and OEND training. Significant increases in total scores were seen on the pre- and post-assessment. Additionally, significant increases in student confidence in providing overdose response counseling and dispensing naloxone were observed. Students rated all the learning activities as very effective. Conclusion. Use of the 5-E learning cycle as an educational design method to structure active-learning activities was effective in increasing students' knowledge and improving their attitudes toward and confidence in providing overdose response.

Coverage of pharmacogenetic tests by private health insurance companies

OBJECTIVE

To assess the coverage of clinically relevant pharmacogenetic tests by the top 41 private insurance companies in the United States.

DESIGN

Websites of insurance companies were searched for medical policies addressing 34 common and clinically relevant pharmacogenetic tests referenced by the Clinical Pharmacogenetics Implementation Consortium, PharmGKB, and Food and Drug Administration product labeling. Those policies were subsequently reviewed for the coverage of the tests by gene-drug pair and by company. Policies were subsequently reviewed to determine coverage of pharmacogenetic tests by gene-drug indication group (GDIG) and an insurance company.

SETTINGS AND PARTICIPANTS

Not applicable.

OUTCOME MEASURES

Within unique policy sets, the following were analyzed: (1) the number of times each GDIG was mentioned; (2) the percentage of times each GDIG was mentioned; (3) when mentioned, the number of times each GDIG was covered; (4) when mentioned, the percentage of times each GDIG was covered; and (5) regardless of being mentioned, the percentage of times each GDIG was covered.

RESULTS

A total of 223 medical policies mentioning pharmacogenetic tests were retrieved, representing 34 unique policy sets from 41 companies. Thirty-three companies had their policies accessible on their website. Approximately 50% of GDIGs were unanimously mentioned in all policies but were covered only < 20% of the time. When mentioned in a policy, 7 GDIGs were uniformly covered, and 11 GDIGs were uniformly not covered. Overall, insurance companies covered approximately 40% of GDIGs mentioned in their policies.

CONCLUSION

The medical policies addressing recommended pharmacogenetic tests were not readily accessible on websites of the top private health insurance companies. The coverage and payments of the tests varied by the company and gene-drug pairs and remain suboptimal.

AdvoCaring: A Cocurricular Program to Provide Advocacy and Caring to Underserved Populations in Baltimore

Objective. To incorporate direct patient care and service components throughout a 4-year pharmacy program to enable students to apply knowledge learned in the classroom and develop the human and caring dimensions of Fink's Taxonomy of Significant Learning. Design. Groups of 10-12 students and a faculty advisor partnered with a local agency serving an underserved population of the greater Baltimore area to provide seven hours of service per student each semester. Activities were determined based on students' skills and agency needs. Assessment. Over 10 000 hours of care were provided from fall 2009 through spring 2014 for clients at 12 partner agencies. Student feedback was favorable. Conclusion. Cocurricular learning enables students to use their skills to benefit local communities. Through an ongoing partnership, students are able to build on experiences and sustain meaningful care initiatives.

Abstract 179: Ischemic Stroke in Atrial Fibrillation: 30-day Outcomes and Factors Associated with Severity

Background and Hypothesis: Ischemic stroke (IS) in atrial fibrillation (AF) is associated with high mortality. Inflammation, endothelial dysfunction, and hypercoagulability, in addition to blood stasis in the left atrium, play a critical role in thrombogenesis in AF. Hyperglycemia and chronic kidney disease (CKD) are potent triggers for inflammation, oxidative stress, and thrombogenesis. Statins have been shown to possess anti-inflammatory, anti-oxidant, and anti-thrombotic properties. Accordingly, we assessed the hypothesis that statin use may modulate stroke severity in AF.

Methods: Consecutive IS admissions were identified from 2006-2010. All events were subject to CT or MRI and assessed for functional independence at discharge using modified Rankin scale (mRS). AF was confirmed by ECG at presentation or within the prior 6 months in all cases. Covariates were abstracted from the medical record. To account for confounding by treatment, we used multivariable logistic regression analysis adjusted using inverse probability weighting.

Results: We identified 1,030 AF-related IS; mean age was 77, 56% were female, mean CHA 2 DS 2 VASC score was 4.8 designating high baseline stroke risk. IS resulted in severe neurological deficit or death (mRS ≥ 4) for 69%; 21% died within 30-days. Severe stroke was associated with older age, diabetes, dementia, prior ischemic stroke, prior venous thromboembolism, and CKD (Table). Baseline statin use was associated with a 33% reduced risk of sustaining a severe stroke.

Conclusion: Strokes in AF are associated with high morbidity and mortality. Clinical markers of thrombophilia, including prior IS, DVT, and PE, were significantly associated with severe strokes. Diabetes and CKD independently increased this risk. Statin use resulted in less severe outcomes. Advancing our basic understanding of these interrelated thrombogenic pathways will inform clinical interventions to reduce these devastating outcomes.

Abstract 100: Influence of Race on Presentation, Treatment, and Outcome Among Patients With Atrial Fibrillation-related Ischemic Stroke

Background: Blacks have been underrepresented (<2% of 71,683) in recent atrial fibrillation (AF) trials of novel anticoagulants vs. warfarin. Blacks with AF have also been underrepresented in stroke cohort studies from which the stroke risk prediction rules are derived.

Objective: We examined whether there exist racial differences in presentation, treatment, and outcome among patients with AF-related ischemic stroke (IS).

Methods: Consecutive IS were identified from 2006-2010 at 3 U.S. sites. All events were evaluated by CT or MRI, and assigned a discharge modified Rankin score (mRS). AF was confirmed by ECG. Baseline medications and clinical characteristics were abstracted from the medical record. Race was determined by self-report.

Findings: We identified 1,030 AF-related IS; 96% (n=985) had race reported as White (n=764, 74%) or Black (n=221, 21%). Compared to Whites, Blacks were younger, had a higher burden of risk factors, had higher prevalence of paroxysmal or new onset AF, and more often presented outside the t-PA window. Among patients with known AF, 40% Whites and 39% Blacks were taking warfarin on admission. INR on admission was not different by race (mean 1.4, SD =0.7; p=0.64). These strokes resulted in severe neurological deficit (mRS >3) in a majority of Blacks and Whites (70% vs. 64%; p=0.09).

Conclusion: Blacks with AF who suffer IS are younger, have a higher burden of risk factors, and more often present with paroxysmal or new onset AF. IS in the setting of AF was associated with significant mortality and morbidity in both Blacks and Whites.

Photometric calibration for quantitative spectral microscopy under transmitted illumination

Over the past decade, there have been significant developments in the mechanisms for examination of biological and material samples. These developments exploit techniques in light microscopy to elucidate specific parts of cells and tissues, as well as inorganic particles. In recent years, spectral microscopy has become more prevalent for characterization of samples. Simultaneously, sensor technology has progressed as well and modern charge-coupled devices (CCD) cameras are now capable of achieving high spatial resolution and high sensitivity measurements of signals in the optical microscope. One major impediment in obtaining absolute quantitative information of imaged samples is the lack of automated photometric calibration mechanisms for spectral microscopes. In this paper, we present a methodology for achieving photometric calibration of an automated spectral imaging system targeted towards examination of biological samples. By acquiring spatial and spectral data simultaneously, spectral imaging allows one to exploit physical connections between a particle's morphology and its characteristic response to the optical spectrum. In composite biological material, the interpretation of the spectra is a complicated problem. This is because any light source and charge-coupled device camera used for data acquisition does not have a uniform illumination spectra and quantum efficiency, respectively, across the emitted light spectra. To balance the spectral response across individual wavelengths, our method modulates the exposure duration for the charge-coupled device camera during image acquisition. We present an image similarity based method to calibrate the system. Experiments to test the effectiveness of the calibration method under the various image similarity metrics are presented along with results to show the calibrated system's ability to accurately measure spectra based on the measured transmission profiles of optical filters.

Mercury toxicity awareness in the nursery

Mercury vapor may pose an environmental risk to the developing newborn. Two case reports from Southeastern urban hospitals are presented describing potential problem identification, air sampling methods, and recommendations for minimizing the risk. Current convenience sampling of hospital nurseries revealed 11% to 20% use of mercury-filled glass thermometers. Because this use continues to place infants at risk, health care provides must be educated in removing mercury to the extent possible and in ensuring a mechanism for cleaning mercury spills.

Discordant twins: a case report

Multiple gestations account for 10 to 12 percent of perinatal deaths. Of all intrauterine deaths in twins, 73 percent are associated with monochorionic placentation. Monochorionic twins have higher rates of perinatal mortality, birthweight discordancy, and intrauterine growth retardation than do dichorionic twins. Follow-up studies indicate that twins remain at a disadvantage for subsequent growth and intellectual achievement. The history and hospital course of a set of discordant twins is presented, describing the extensive morbidity and prolonged hospitalization.

Organization and function of a hospital ethics committee

The developing ethics committee must address many issues around the structure and function of the committee. This article reviews such matters as membership, training, and committee policy. Committee functions are reviewed with suggestions about education as well as ethics consultation.

Increased microvascular permeability in dog lungs due to high peak airway pressures

The effect of peak airway pressure (Paw) on vascular permeability and the "safety factor" against edema formation was determined in isolated blood-perfused lower lobes of dog lungs. Microvascular permeability was evaluated using the measured filtration coefficient (Kf,C), isogravimetric capillary pressure (Pc,i), and critical capillary pressure (Pcrit) for exhaustion of tissue safety factors. Airway pressure was maintained constant at -3 cmH2O except for the test period of 20 min when the lungs were ventilated at 6/min with sufficient volume to generate a peak inflation pressure ranging from 5 to 60 cmH2O. Mean Kf,C (in ml X min-1 X cmH2O X 100 g-1) were measured before and immediately after the period of peak airway pressures. Kf,C was significantly increased in all lungs where Paw exceeded 42 cmH2O, but in only two experiments at a lower Paw. Mean Pc,i was significantly reduced from control in the 45-55 and 55-65 cmH2O Paw groups, and both Pc,i and Pcrit were found to be inversely related to Kf,C measured after Paw ventilation. These data indicate that ventilation with Paw above 42 cmH2O (30.9 Torr) and in some cases lower pressures for 20 min significantly increased capillary hydraulic conductivity, reduced the effective osmotic effect of plasma proteins at the capillary wall, and reduced the total tissue safety factor against edema formation.

Effects of vascular pressure on the pulmonary microvasculature in isolated dog lungs

The effects of short periods of high pulmonary vascular pressures on the filtration characteristics of the lung's microcirculation have been studied in isolated dog lungs. When left atrial pressures (Pla) were less than 30 cmH2O, the capillary filtration coefficient (Kf,c) was not different from that of controls (0.192 +/- 0.009 ml X min-1 X cmH2O-1 X 100 g-1). In 17 of 23 observations, where Pla exceeded 55 cmH2O, Kf,c was at least 1.5 times control. In 10 of 13 lungs, Kf,c returned to control values within 2 h after the Pla increase. However, in the other three experiments, Kf,c did not return to control values. These findings indicate that the filtration coefficient of pulmonary microvessels increases at high left atrial pressures (greater than 55 cmH2O) and may represent either a "stretching" of existing pores or opening of a few large pores.

Impact of a maternal transport program on a newborn service

We reviewed the maternal transfers for one year (1980) to the Emory Perinatal Center, a tertiary care center for North Georgia. Of 445 telephone consultations or patient referrals, 150 women gave birth at the tertiary center. Indications for maternal transfer were predominantly based on the needs or anticipated needs of the fetus. There were a total of 163 births, 10 of them stillborn and 153 live-born. Three infants expired in the delivery room. Sixty infants (40%) required 580 days of intensive care. A total of 1,439 days of care in the intermediate unit was required and 1,077 days of care in other areas of the nursery. Adjusting these figures for a 0.8 occupancy rate revealed that two intensive care beds, 4.9 intermediate care beds, and 3.6 minimal care beds were required for just these maternally transported infants. Maternal transfers will result in a disproportionate increase in the workload of a nursery because of the immaturity and small size of these infants. When considering a maternal transfer service, appropriate planning must be made to meet the special needs of both the infants and their mothers.