The Importance of Written Feedback on the Individual and Team Performance of Student Pharmacists.

Objective. To analyze the impact of written feedback provided using an online peer and self-evaluation tool on the individual and team performance of student pharmacists.Methods. Student pharmacists enrolled in two sections (section A=29 students; section B=32 students) of a required first-year pharmacy course were assigned to teams of six and given a project-based assignment in which they worked together to solve an authentic health care-related problem. Students used the Comprehensive Assessment of Team-Member Effectiveness (CATME) online peer and self-evaluation system to evaluate their peers at several points during the project. Students in section A were given both the survey ratings and written feedback from their peers, while students in section B were only given the survey ratings. Data from CATME as well as from student focus groups were used to assess students' perceptions of the usefulness of peer assessments and the impact of written feedback.Results. For 14 of the 15 items on the survey, mean scores of students in section A were higher than those for students in section B, indicating that students in section A had generally higher agreement with and affirmation of positive statements related to peers giving and receiving feedback from one another. Quantitative and qualitative data indicated that students had an overall positive perception about the usefulness of the CATME tool for evaluating individual and team performance. More specifically, both the quantitative analysis and focus group feedback revealed notable differences in perceptions about peer feedback between students in the group that only received survey ratings and students in the group that received both survey ratings and written feedback.Conclusion. The survey results and focus group themes indicated that student pharmacists had positive perceptions about the CATME tool but that the ratings had a more meaningful impact when the written comments of their peers were also shared with them.

Potassium-lowering agents for the treatment of nonemergent hyperkalemia: pharmacology, dosing and comparative efficacy.

Hyperkalemia represents a common and potentially life-threating electrolyte abnormality, a complication frequently observed in patients with heart failure, kidney disease, diabetes or in those receiving drug therapies influencing the renin-angiotensin-aldosterone system. Elevated serum potassium levels are often the result of impaired urinary potassium elimination, inadequate or reduced cellular potassium uptake, severe heart failure, use of medications influencing potassium levels in the circulation, or, more commonly, a combination of these factors. Strategies for the treatment of nonemergent hyperkalemia include the use of cation-exchange resins, polymers or other novel mechanisms of potassium trapping, including sodium polystyrene sulfonate, patiromer and sodium zirconium cyclosilicate. These agents differ in their pharmacology and mechanism of action, clinical efficacy, including onset and extent of potassium-lowering effect, dosage and administration, and potential safety and adverse effect profiles. In this review, an evaluation of these characteristics, including clinical evidence and safety concerns, in the management of nonemergent hyperkalemia will be explored.

A pharmacy-based medication reconciliation and review program in hemodialysis patients: a prospective study.

BACKGROUND: Hemodialysis (HD) patients are on multiple medications, see many prescribers and have many hospitalizations which put them at risk for medication record discrepancies and medication related problems (MRP). Being able to effectively identify and reconcile these medication issues is crucial in reducing hospitalizations, morbidities, and mortalities. The care of the hemodialysis patients can be enhanced by incorporating a pharmacist into the interprofessional team. There is little data in the literature on medication record discrepancies and MRP's in dialysis patients. OBJECTIVE: The objectives of this research were to determine the types of medication discrepancies and MRPs in dialysis patients and if recommendations for changes based on these findings were accepted by providers. METHODS: Patients were asked to bring medications to the dialysis unit for review. Discrepancy and MRP recommendations were communicated to the unit staff via written progress notes. A follow-up was performed an average of 33 days later to determine if the recommendations were accepted. RESULTS: Overall, in 93 unique patients, 376 discrepancies (3.1 per patient) and 64 MRPs (0.5 per patient) were identified. The most common type of discrepancy and MRP was drug omission and indication without drug, respectively. Of the total 440 interventions, 77% were ultimately accepted. Discrepancies were more likely to be accepted as compared to MRPs (85% vs. 27%, respectively). CONCLUSION: Medication record discrepancies and MRPs are common in dialysis patients. Recommendations related to discrepancies were more likely to be accepted by the providers as compared to MRPs. Medication records became inaccurate within 12 months. A pharmacy-based medication reconciliation and review program may have an important impact on the care of hemodialysis patients.

Development and evaluation of a regional, large-scale interprofessional collaborative care summit.

The Northeastern/Central Pennsylvania Interprofessional Education Coalition (NECPA IPEC) is a coalition of faculty from multiple smaller academic institutions with a mission to promote interprofessional education. An interprofessional learning program was organized, which involved 676 learners from 10 different institutions representing 16 unique professions, and took place at seven different institutions simultaneously. The program was a 3-hour long summit which focused on the management of a patient with ischemic stroke. A questionnaire consisting of the Interprofessional Education Perception Scale (IEPS) questionnaire (pre-post summit), Likert-type questions, and open comment questions explored the learners' perceptions of the session and their attitudes toward interprofessional learning. Responses were analyzed using descriptive statistics and statistical tests for difference and qualitative thematic coding. The attitude of learners toward interprofessional education (as measured by the IEPS) was quite high even prior to the summit, so there were no significant changes after the summit. However, a high percentage of learners and facilitators agreed that the summit met its objective and was effective. In addition, the thematic analysis of the open-ended questions confirmed that students learned from the experience with a sense of the core competencies of interprofessional education and practice. A collaborative approach to delivering interprofessional learning is time and work intensive but beneficial to learners.

A regional model of interprofessional education.

This paper describes the innovative features of the first regional model of interprofessional education (IPE) in the US, developed by The Commonwealth Medical College, Scranton, PA, USA, as a new, independent, community-based medical school in northeastern Pennsylvania. Essential educational components include collaborative care seminars, interprofessional sessions, simulations, live web-based seminars and newly innovative virtual environment interactive exercises. All of these elements are being integrated into the curricula of 14 undergraduate and allied professional schools, and three graduate medical education programs located in the region. Activities incorporate simulation, standardized patients, student leadership, and faculty and student facilitation. As this new regional model of interprofessional education is fully implemented, its impact will be assessed using both quantitative and qualitative outcomes measurements. Appropriate ongoing modifications to the model will be made to ensure improvement and further applicability to collaborative learning.

Safety of high-dose iron sucrose infusion in hospitalized patients with chronic kidney disease.

PURPOSE: The safety of high-dose iron sucrose infusion in hospitalized patients with chronic kidney disease was studied. METHODS: A retrospective analysis was conducted at a 478-bed community hospital. A medical informatics search was performed to identify all hospitalized patients who were prescribed i.v. iron sucrose to deliver elemental iron 300 mg every other day for three doses between January and December 2002. Patients were eligible for inclusion in the analysis if they had chronic kidney disease, had an estimated creatinine clearance of <60 mL/min, and were prescribed the above regimen. Information on iron administration, vital signs, hematologic values, and iron indexes was gathered from patients' medical records. Medical record review was also used to identify possible adverse events. RESULTS: A total of 73 patients met eligibility criteria and received a total of 167 doses of iron sucrose. Twenty adverse events were judged as possibly related to iron sucrose administration and included nausea (n = 8 events), reduced blood pressure (n = 4), vomiting (n = 2), dysgeusia (n = 2), constipation (n = 2), fatigue (n = 1), and anxiety (n = 1). The majority of these adverse events were low in severity, as determined by an objective scale. No severe adverse events occurred. There was no association between infusion rate and the occurrence of potential adverse events (p = 0.44). CONCLUSION: Every-other-day i.v. infusion of iron sucrose, to deliver elemental iron 300 mg/dose, was associated with adverse events that were relatively uncommon, minor in severity, and unlikely to require medical intervention.

Disposition of Misoprostol and Its Active Metabolite in Impaired Hepatic Function.

The pharmacokinetics of misoprostol and its active metabolite, misoprostol acid, was assessed in 17 healthy subjects and 17 subjects with various degrees of hepatic impairment. Before misoprostol administration, subjects underwent antipyrine and indocyanine green clearance studies to assess hepatic functional capacity. Subjects were administered 400 mcg of oral misoprostol in an open-label design. There was a lower antipyrine clearance in the group with hepatic disease as compared to normal volunteers (0.56 versus 0.80 ml min(minus sign1) kg(minus sign1), respectively, p = 0.022). There was no difference in indocyanine green clearance values between groups. The C(max), t(1/2)&bgr, and [Formula: see text] tended to be larger in the hepatic group; however, there was no statistical difference. Adverse events, mostly gastrointestinal in nature, occurred more often in the subjects with hepatic disease. These data suggest the pharmacokinetics of misoprostol may be altered in the presence of hepatic disease. However, because of significant interpatient variability, definitive dosing recommendations cannot be made. Further study in this area is needed.