Search

In light of the COVID-19 pandemic, pharmacy education has shifted from in-person teaching and assessments to the virtual environment. Many education programs had previously adopted objective structured clinical examinations (OSCEs) to assess communication abilities in-person with standardized patients (SPs). However, comparative student outcome data between virtual and in-person methods as well as guidance on how to conduct communication-based OSCEs in the virtual environment is lacking. The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) describes its methods of conducting two types of communication-based OSCEs (patient counseling and gathering a medical history). Student performance data from the two virtual OSCEs in 2020 was compared to results from two 2019 in-person OSCEs using Mann Whitney U Tests. The 2020 cohort scored significantly higher than the 2019 cohort in all variables (i.e., using effective verbal and non-verbal communication, using patient friendly education, organizing the encounter, demonstrating empathy, establishing trust, professionalism) and in overall score. However, the effect size for these findings indicate the differences between performances are generally small and more likely due to changes in grading patterns due to the pandemic.

Introduction: To evaluate the design of an interprofessional introductory pharmacy practice experience (IP-IPPE) designed to integrate third-year pharmacy students in patient care workflow under the direct supervision of non-pharmacist practitioners in a federally qualified health center., Methods: Data was gathered to evaluate the success of the IP-IPPE from the students', providers', and clinic's perspectives. Preceptors completed a mixed-methods survey to determine satisfaction and value of the IP-IPPE. Students completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) post-IP-IPPE to assess change in interprofessional outcomes. Student performance and competency demonstration was assessed using a modified interprofessional professional assessment scoring tool. Finally, a retrospective patient chart review was conducted to determine student value to the clinic., Results: During a 12-week period at the studied clinic, 32 students were supervised by eight primary care providers (PCPs) and cared for 516 patients. Six providers (75%) endorsed students' ability to provide value-added interventions during clinical care. A chart review of 200 patient records indicated students provided medication education to 12% of patients engaged with, in addition to other contributions. Students' ICCAS self-assessments indicated significant improvement across all outcomes following the IP-IPPE. Qualitative provider responses indicated meaningful investment into the IP-IPPE and appreciation for pharmacy student's collaboration during patient care., Conclusion: All 32 students in this study were able to earn the trust of their assigned PCP preceptors. The IP-IPPE design created value for learners, patients, and providers., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective. To hold a storytelling event and assess its effect on Doctor of Pharmacy (PharmD) students' perspectives on and attitudes toward reflection. Methods. Story Slam, a four-hour storytelling competition, was incorporated into the spring semester of the first professional year of a PharmD program. The event featured short first-person stories told by faculty members as well as students. Students were invited to participate in a pre- and post-intervention survey and focus group. An inductive qualitative analysis of the resulting data was conducted using textual and audio artifacts. Results. All 136 first professional year (P1) students participated in the 2019 Story Slam. Eleven students submitted qualitative pre- and post-intervention survey instruments and participated in a semi-structured recorded focus group. Thematic analysis revealed nine themes. Students' perspectives regarding the importance of self-reflection changed after participating in Story Slam, with students expressing a greater willingness to engage in self-reflection in the context of professional practice following the event. Students believed Story Slam created an environment conducive to reflection and engagement, resulting in strengthened relationships with peers and faculty members. Students expressed feeling a wide range of emotions as they shared their story and listened to the stories of others. Conclusion. Story Slam is an effective strategy for introducing P1 students to reflection, while also strengthening the school's reflective culture. Additionally, sharing stories may foster positive relationships and cultivate trust and respect between students and faculty members., (© 2020 American Association of Colleges of Pharmacy.)

Objective. To develop and validate three assessment tools to measure student performance in clinical settings during required advanced pharmacy practice experiences (APPEs). Methods. Each assessment tool was developed by subject-matter experts and validated using three sources of evidence. Proposed content underwent a job-task analysis by external APPE preceptors, evaluating each outcome in terms of importance and frequency of opportunity for student demonstration. After implementation, tool performance was evaluated using a measure of item applicability and student achievement. Finally, a two-step grade verification process was developed and grade acceptance by preceptor was determined. A priori benchmarks for acceptable tool performance were established for each strategy. Results. The job-task analysis was completed by 131 preceptors (52% response), with items achieving a composite score from 1.08 to11.83 (possible range: 1=most valuable, 25=least valuable). The mean item applicability ranged from 91.3% to 94.1% (n=849 student assessments) during the first year. Preceptors accepted the tool-generated grade in 798 (94%) assessments. Conclusion. Data from three evaluation strategies provide evidence of effective design and use of three unique APPE setting-specific student assessment tools. Pharmacy programs can adopt similar methodologies to develop and validate their assessment tools., (© 2019 American Association of Colleges of Pharmacy.)

Objective. To provide a novel culminating experience that assesses student competence and achievement of five curricular outcomes during the P4 year. Methods. This two-week Intersession course provided faculty assessment of student competence after completing five of seven Advanced Pharmacy Practice Experiences (APPEs). Students completed written pre-work assignments generated from real-world experiences from APPEs. Faculty assessed and provided feedback to improve students' competency on curricular outcomes related to four course components: clinical case, drug information, clinical pearl and reflection. After incorporating faculty feedback, students verbally presented to faculty and peers for additional assessment during the in-class portion of the course. Results. There were 149 students who completed the course in 2016; 145 (97%) demonstrated achievement of ability-based outcomes. Using the Kirkpatrick's Evaluation Model, level 1 data (reaction) indicated 93% of students and 100% of faculty believed the course was valuable. Level 2 data (learning) revealed that 80% of students and 85% of faculty agreed/strongly agreed learning occurred. Level 3 data (behavior) demonstrated increased student performance on assessments between pre-work and in-class components. Preliminary level 4 data (results) indicated this course complemented learning from previous courses and met the intended purpose. Conclusion: This novel Intersession course provided structured faculty assessment of student competence during the final experiential year and successfully provided a near-final evaluation of student competence of core curricular ability-based outcomes.

Background: Diabetes and its complications disproportionately affect Hispanic patients, many of whom receive care at federally qualified health centers (FQHCs) and prefer to receive care in a language other than English. There is little published data on clinical pharmacy diabetes services in this setting., Objective: This study aims to measure the impact of a Collaborative Drug Therapy Management-driven bilingual clinical pharmacy service on diabetes outcomes in an FQHC that primarily serves Hispanic patients, many of whom prefer to receive their care in Spanish., Methods: Patients were included if they had a diagnosis of diabetes and initial pharmacy visit between July 1, 2015, and March 31, 2016. Individual charts were analyzed for changes in hemoglobin A 1C (A1C), changes in blood pressure (BP), number of visits, ethnicity, and primary language preference. Data for these patients were collected through September 30, 2016., Results: The median preintervention A1C was 10.5%; the median postintervention A1C was 9.1% (n = 211; P < 0.0001). Statistically significant BP reductions were also found in patients with uncontrolled hypertension at baseline. There were no statistically significant differences in A1C improvement based on ethnicity or language preference. Conclusion and Relevance: Patients with diabetes managed by Spanish-speaking clinical pharmacists had significant improvement in their A1C. Hispanic and non-Hispanic patients, as well as patients who preferred their care in Spanish, had similar improvements in A1C. Clinical pharmacists who speak Spanish may help reduce diabetes-related health disparities in this population. This collaborative care model could be replicated at other institutions to help underserved patients.

The Center for the Advancement of Pharmacy Education 2013 Affective Domain mandates students develop self-awareness of personal attributes affecting professional growth. Students should self-identify needs, create and implement goals, and evaluate success. This case study describes the qualitative and quantitative findings of an intentional reflection assignment prompting students to engage in a cycle of goal writing - monitoring - reflection - new goal writing, during an immersive clinical practice experience. A blinded review of 144 student assignments is presented in the context of a curricular review of the Reflective Practitioner Program (RPP), a longitudinal reflective thread spanning four years of professional pharmacy training. Evidence gathered in the assignment review indicates that students are sufficiently capable of establishing meaningful goals and describing why the goal is important to their professional development. In contrast, students struggle with articulating strategies for goal achievement and emotions experienced during goal monitoring. In consideration of these findings, RPP faculty identified three major themes when discussing key aspects of the RPP curricular design: 1) students need to articulate strategies for goal achievement in addition to stated aims, 2) students hesitate to identify emotions when reflecting, and 3) reflection needs to be both retrospective and prospective in nature. This case study has resulted in meaningful changes to RPP curricular design and illustrates how programs may approach assessment of the Affective Domain via common curricular elements., (© University of Minnesota Libraries Publishing.)

The prevalence of opioid abuse in the United States has been steadily increasing over the last several years among many major demographics, including pregnant women. Rise in prenatal opioid abuse has resulted in subsequent escalation of neonatal abstinence syndrome incidence, prompting the US Congress to pass the Protecting Our Infants Act of 2015. This act specifically calls for a critical review of current treatment options for prenatal opioid abuse which may ultimately lead to the development of better therapies and a decreased incidence of neonatal abstinence syndrome. Currently, the American College of Obstetricians and Gynecologists recommends methadone, buprenorphine, or buprenorphine/naloxone in the treatment of prenatal opioid abuse. In this review, each maintenance therapy treatment option is discussed and compared revealing inconsistencies in postpartum retention rates, effects on fetal development, and availability to patients due to restrictions in health care coverage. Although each of these treatment options reduces opioid abuse and potential negative outcomes for the fetus, the shortcomings of these drugs highlight the overarching need for an improved standard of care. Drug developers and lawmakers should consider that affordability, coverage by health insurance, and success in retention rates substantially impacts the decision of the patient and healthcare provider regarding utilization of a particular opioid maintenance therapy.

Although the pathology of Morbillivirus in the central nervous system (CNS) is well described, the molecular basis of neurodegenerative events still remains poorly understood. As a model to explore Morbillivirus-mediated CNS dysfunctions, we used canine distemper virus (CDV) that we inoculated into two different cell systems: a monkey cell line (Vero) and rat primary hippocampal neurons. Importantly, the recombinant CDV used in these studies not only efficiently infects both cell types but recapitulates the uncommon, non-cytolytic cell-to-cell spread mediated by virulent CDVs in brain of dogs. Here, we demonstrated that both CDV surface glycoproteins (F and H) markedly accumulated in the endoplasmic reticulum (ER). This accumulation triggered an ER stress, characterized by increased expression of the ER resident chaperon calnexin and the proapoptotic transcription factor CHOP/GADD 153. The expression of calreticulin (CRT), another ER resident chaperon critically involved in the response to misfolded proteins and in Ca(2+) homeostasis, was also upregulated. Transient expression of recombinant CDV F and H surface glycoproteins in Vero cells and primary hippocampal neurons further confirmed a correlation between their accumulation in the ER, CRT upregulation, ER stress and disruption of ER Ca(2+) homeostasis. Furthermore, CDV infection induced CRT fragmentation with re-localisation of a CRT amino-terminal fragment, also known as vasostatin, on the surface of infected and neighbouring non-infected cells. Altogether, these results suggest that ER stress, CRT fragmentation and re-localization on the cell surface may contribute to cytotoxic effects and ensuing cell dysfunctions triggered by Morbillivirus, a mechanism that might potentially be relevant for other neurotropic viruses.

The canine distemper virus (CDV) belongs to the Morbillivirus genus which includes important human pathogens like the closely related measles virus. CDV infection can reach the nervous system where it causes serious malfunctions. Although this pathology is well described, the molecular events in brain infection are still poorly understood. Here we studied infection in vitro by CDV using a model of dissociated cell cultures from newborn rat hippocampus. We used a recombinant CDV closely related to the neurovirulent A75/17 which also expresses the enhanced green fluorescent protein. We found that infected neurons and astrocytes could be clearly detected, and that infection spreads only slowly to neighboring cells. Interestingly, this infection causes a massive cell death of neurons, which includes also non-infected neurons. Antagonists of NMDA-type or alpha-amino-3-hydroxy-5-methylisoxazole-4-propinate (AMPA)-type glutamate receptors could slow down this neuron loss, indicating an involvement of the glutamatergic system in the induction of cell death in infected and non-infected cells. Finally, we show that, following CDV infection, there is a steady increase in extracellular glutamate in infected cultures. These results indicate that CDV infection induces excitotoxic insults on neurons via glutamatergic signaling.

The wild-type A75/17 canine distemper virus (CDV) strain induces a persistent infection in the central nervous system but infects cell lines very inefficiently. In contrast, the genetically more distant Onderstepoort CDV vaccine strain (OP-CDV) induces extensive syncytia formation. Here, we investigated the roles of wild-type fusion (F(WT)) and attachment (H(WT)) proteins in Vero cells expressing, or not, the canine SLAM receptor by transfection experiments and by studying recombinants viruses expressing different combinations of wild-type and OP-CDV glycoproteins. We show that low fusogenicity is not due to a defect of the envelope proteins to reach the cell surface and that H(WT) determines persistent infection in a receptor-dependent manner, emphasizing the role of SLAM as a potent enhancer of fusogenicity. However, importantly, F(WT) reduced cell-to-cell fusion independently of the cell surface receptor, thus demonstrating that the fusion protein of the neurovirulent A75/17-CDV strain plays a key role in determining persistent infection.

The glutathione S-transferase (GST)-pi gene is overexpressed in many human cancers and preneoplastic lesions and is associated with failure of cancer chemotherapy and poor patient survival. Although GST-pi overexpression in tumors of the central nervous system has been observed, the prognostic and/or clinical relevance of this overexpression has, to date, not been investigated. In this study, we analyzed the level of GST-pi expression and its subcellular localization in 61 primary gliomas and correlated the results with tumor histology, patient age, and patient survival. We observed a strong positive correlation between the level of GST-pi expression and tumor grade and between the presence of GST-pi in glioma cell nuclei and patient age. Univariate and multivariate Cox regression analyses and Kaplan-Meier curves showed the level of GST-pi expression and its nuclear localization to be inversely correlated with patient survival. Relative risk for death of patients with high versus low tumor GST-pi expression was 3.2 (P = 0.0069) by univariate analysis and 2.6 (P = 0.036) by multivariate analysis. The relative risk of death associated with the presence of nuclear GST-pi in glioma cells was 3.9 (P = 0.0001) by univariate analysis and 4.4 (P < 0.0001) by multivariate analysis. These data indicate that high GST-pi expression in tumor cells and the presence of the GST-pi protein in tumor cell nuclei are associated with clinically more aggressive gliomas and are strong predictors of poor patient survival.