Impact of Collaborative Testing on Academic Performance in Pharmacy Education.

OBJECTIVE: To determine the impact of two-stage collaborative testing (CT) on academic performance of pharmacy students, and secondarily, to characterize pharmacy student perceptions of CT. METHODS: Two-stage CT was piloted in a two-course patient assessment sequence within a Doctor of Pharmacy program. Students were randomized into two groups, and further divided into teams of four-five students. Student-teams alternated taking section exams in a traditional one-stage (individual) and two-stage CT (individual then team) format to establish an experimental design. Near the end of each semester, students individually took a post-test to facilitate assessment of CT on academic performance. A 12-item, anonymous survey-instrument assessed student perceptions of two-stage CT. Group differences in academic performance and survey responses were analyzed statistically. RESULTS: There were 128 students enrolled in the course sequence, 123 of whom met inclusion criteria for assessment of academic performance and 100 of whom completed the survey (response rate=83%). Generally, students performed better on post-test items initially assessed through two-stage CT (retention marker) and on post-test items that were answered incorrectly under two-stage CT conditions (learning marker). Approximately nine in ten survey respondents preferred two-stage CT over traditional one-stage, individual testing, with an equivalent proportion reporting it helped them learn from their mistakes and retain what they learned. There was high-level agreement among respondents that two-stage CT improved their ability to work as a team and think critically. CONCLUSION: Implementation of two-stage CT in a patient assessment course sequence was associated with improved learning and retention and was well-received by students.

Evaluating the Impact of an Innovative Integrative Health-Focused Elective in a Doctor of Pharmacy Program.

OBJECTIVE: To assess knowledge and perceptions of integrative health principles. METHODS: This was a retrospective, pre-post observational cohort study evaluating Doctor of Pharmacy students following completion of an innovative elective course that was offered between 2020-2022. This Integrated Health in Pharmacy elective was created at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences in the Spring of 2020. The primary objective was to assess student knowledge of integrative health principles. The secondary objective was to assess student confidence and perceptions of integrative health principles. RESULTS: Students completed a pre-course assessment (n = 80/81) and a post-course assessment (n = 73/81). Overall, the mean (SD) performance on the assessment questions increased between the pre-post assessment groups (57.59 [12.98]% vs 65.46 [14.43]%). Survey results indicated that students' perceptions and confidence pertaining to integrative health increased after completing this elective course offering. CONCLUSION: Participation in this innovative elective course was associated with improved knowledge and perceptions of integrative health principles.

A Practical Guide to Understanding and Treating Peripheral Artery Disease.

ABSTRACT: Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic morbidity after coronary heart disease and stroke yet is widely underdiagnosed and undertreated. Treatment of risk factors such as diabetes and cigarette smoking can benefit patients with PAD. Patients should have adequate blood pressure and lipid control to decrease clinical manifestations and symptoms of PAD. Use of antithrombotic medications should be individualized to the patient depending on the presence of symptoms, revascularization, and comorbidities. All patient care providers, including physicians, pharmacists, nurse practitioners, and physician assistants, should incorporate PAD screening in their at-risk patients to improve access for appropriate earlier diagnosis, initiation of guideline directed therapy, and risk factor modification to reduce both major adverse CV and limb outcomes. The purpose of this narrative review is to provide an overview of PAD and summarize clinical trial evidence and guideline recommendations for screening and treatment to increase awareness among health care providers to ultimately have a positive impact on patient care.

A systematic review of therapeutic enoxaparin dosing in obesity.

Enoxaparin is a hydrophilic drug with obesity having little effect on its apparent volume of distribution, therefore patients with obesity receiving standard 1 mg/kg dosing may be at a higher risk of supratherapeutic dosing. Conversely, dose reducing patients with obesity could place already at risk patients at higher risk of a thrombotic event. Data and recommendations are variable for the most appropriate weight-based dose of therapeutic enoxaparin in obese patients, particularly those a weight > 100 kg or a body mass index (BMI) ≥ 40 kg/m2. The purpose of this systematic review was to globally evaluate these data to surmise optimal dosing recommendations for patients with obesity. A systematic review of English language studies was conducted and identified articles via Pubmed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) searches. Studies were included if they reported therapeutic enoxaparin use in adult patients with a BMI ≥ 40 kg/m2 or body weight > 100 kg and the percentage of patients achieving a therapeutic anti-Xa based on a weight-based dose or the weight-based dose required to produce a therapeutic anti-Xa level. Therapeutic attainment of anti-Xa levels were assessed across enoxaparin weight-based dosing categories including a very low dose group: < 0.75 mg/kg, low dose group: 0.75-0.85 mg/kg, and standard dose group: ≥ 0.95 mg/kg. Rates of bleeding and thrombosis were also evaluated. A total of eight studies were included. For anti-Xa level assessment, 682 patients were included. A total of 62% of anti-Xa levels were therapeutic in the very low dose group, 66% in the low dose group, and 42% in the standard dose group. Overall rates of total bleeding and thrombosis were assessed in 798 patients. A total of 29 bleedings (3.6%) occurred, and 27 reported a relationship to dose. Most bleedings, 85.2% (n = 23/27), occurred with doses in the standard dose group (≥ 0.95 mg/kg). Thrombosis occurred in 5 patients (0.6%). Utilization of a reduced weight-based dosing strategy for therapeutic enoxaparin in obese patients may increase the percentage of patients with a therapeutic anti-Xa level.

NAPLEX Preparatory Perceptions from Recent Graduates at One College of Pharmacy.

OBJECTIVES: The current study assessed how students prepared for the North American Pharmacist Licensure Examination (NAPLEX), and examined factors associated with first-time pass rates. In addition, updated information on student perceptions of several currently available NAPLEX preparation resources was collected. METHODS: A survey was administered to 2022 graduates from 1 school, which collected data on student demographics, and NAPLEX-related items regarding when the exam was taken and how students prepared, including resources used. The association between first-time success (pass, no pass) and grade point average (GPA), timing of test date after graduation, effort toward exam, and number of hours studied was examined. In addition, student ratings of NAPLEX preparation resources in terms of usefulness, representativeness to actual examination, and monetary value were reported. RESULTS: A total of 52 individuals completed the survey. Pharmacy GPA over 3.5, taking the NAPLEX within 60 days of graduation, and exerting moderate to extensive effort to pass the NAPLEX were all associated with higher first-time pass rates. All students reported using at least 1 RxPrep resource, which students rated highly and suggested the school provide as a resource for NAPLEX preparation. CONCLUSION: This study found that taking the NAPLEX examination within 60 days of graduation, contributing moderate to extensive effort to pass the examination, as well as a cumulative GPA of 3.5 (out of 4) or above were related to success on the NAPLEX. Additionally, students reported high satisfaction with RxPrep resources.

Longitudinal Assessment of Pharmacy Students' Collaborative Practice Abilities.

OBJECTIVE: Interprofessional education (IPE) varies across schools/colleges of pharmacy. Long-term impact of IPE on interprofessional collaborative competencies remains uncertain despite available data on singular experiences. This study aimed to evaluate changes in pharmacy students' collaborative abilities over the second and third professional years (PYs). METHODS: Students completed the Interprofessional Collaborative Competency Attainment Scale - Revised (ICCAS-R) after 2 large-scale interprofessional forums that occurred approximately 8 months apart. Four cohorts of students were used to examine the longitudinal change in collaborative abilities: cohort 1 (2019), cohort 2 (2020), cohort 3 (2021) and cohort 4 (2022). The ICCAS-R was used to capture data from 4 timepoints for each student in each cohort: prior to the Spring Forum in PY2 (T1), after the Spring Forum in PY2 (T2), prior to the Fall Forum in PY3 (T3), and after the Fall Forum in PY3 (T4). Using repeated measures analysis of variance, 4 total mean scores (T1 = pre1, T2 = post1, T3 = pre2, T4 = post2) were compared. RESULTS: Four cohorts (N = 414) completed the interprofessional forums and 336 (81%) completed the ICCAS-R instrument and were included. In each cohort, total mean scores increased T1 to T2 and T3 to T4, indicating an increase in self-assessed abilities pre/post-forum. Total mean scores decreased between T2 and T3, indicating that collaborative abilities decreased during the period between interprofessional forums. CONCLUSION: While students' collaborative abilities increased around the time of the forum experiences, these changes decreased in between experiences. These findings suggest that interprofessional competencies should be reinforced at multiple time points to support enduring effects.

Implementation and Evaluation of a Residency Preparation Program for Fourth-Year Doctor of Pharmacy Students.

OBJECTIVE: To describe the impact of a formal residency preparation program on student match rates, and to evaluate student-reported advisement activities and perceptions of the residency application process. METHODS: An optional, noncredit-bearing, residency preparation program was implemented in professional year 4 (PY4) of the Doctor of Pharmacy curriculum. The program consisted of 4 residency preparation presentations and/or workshops: curriculum vitae writing, navigating the residency application process and American Society of Health-Systems Pharmacy Midyear Clinical Meeting, letter of intent writing, and interview skills. Students attended either virtually or in person, with 3 of the 4 sessions including small group breakout sessions. The program also included dedicated, 1-on-1 residency advisement with residency-experienced advisors. RESULTS: Residency match rates following program implementation increased from 74.3% (comparison group) to 87.5% (intervention group). More students in the intervention group reported that their advisor assisted them with curriculum vitae review, letter of intent review, and interview skills. In addition, the intervention group reported significantly more time spent meeting with their advisor during PY4 than the comparison group. Students found the program to be beneficial to their professional development, indicated that it helped them to obtain a residency position, and expressed that they would participate in the residency preparation program again. CONCLUSION: Implementation of a formal residency preparation program for PY4 students that included 1-on-1 dedicated residency advisement increased match rates and interaction between students and their residency advisor.

Comparison of bleeding and ischemic events with apixaban vs. rivaroxaban in triple antithrombotic therapy regimens.

OBJECTIVE: To compare the risk of readmissions for major bleeding within one year between apixaban and rivaroxaban as a component of triple antithrombotic therapy. METHODS: This study was a multicenter, retrospective cohort study conducted at two academic medical centers in the Western New York and New York City region between July 1, 2011 and September 25, 2019. Adult patients were included if they were diagnosed with atrial fibrillation or venous thromboembolism and discharged on new triple antithrombotic therapy. The primary outcome compared the rates of 1-year readmission for major bleeding between apixaban and rivaroxaban groups. Secondary outcomes included rate of ischemic outcomes. Time to event analysis was determined with a Kaplan-Meier plot and Cox proportional hazard ratios (HR). RESULTS: A total of 378 patients were included in the study, 212 in the apixaban group and 166 in the rivaroxaban group. Within 1 year, readmission for major bleeding events occurred in six (2.8%) patients in the apixaban group and four (2.4%) patients in the rivaroxaban group ( P  = 1.000). After adjustment, the major bleeding event rate was not statistically significantly different between apixaban and rivaroxaban [adjusted hazard ratio (aHR) 0.68, 95% confidence interval (CI) 0.12-3.77; P  = 0.6624]. Higher albumin levels were identified to be protective against major bleeding related readmission events (aHR 0.18, 95% CI 0.05-0.63; P  = 0.0072). The ischemic outcome occurred in seven (3.3%) patients in the apixaban group and three (1.8%) in the rivaroxaban group ( P  = 0.7368). CONCLUSION: Use of apixaban or rivaroxaban in a triple antithrombotic regimen was not associated with bleeding or ischemic outcomes.

Community pharmacist recommendations regarding raspberry leaf for induction of labor: A mystery caller approach.

BACKGROUND: Raspberry leaf products are recommended by health care providers to induce labor despite insufficient efficacy and safety data. Less is known about community pharmacists' knowledge and recommendations regarding raspberry leaf products. OBJECTIVE: The primary end point was to describe New York State community pharmacist recommendations regarding raspberry leaf for labor induction. Secondary end points evaluated pharmacists' assessment of the patient for additional information, citation of a supporting reference, provision of safety and efficacy information, recommendation of a patient-appropriate reference, and change in recommendation after learning about the obstetrician-gynecologist's recommendation. DESIGN: Using a list of registered New York State pharmacies via a Freedom of Information Law request, a randomized representative sample of included pharmacy types (grocery store, drugstore chain, independent, and mass merchandising) was called using a mystery caller approach. Calls were conducted by one investigator throughout July 2022. Data collection included items specific to the primary and secondary outcomes. This study was approved by the associated institutional review board. SETTING AND PARTICIPANTS: New York State community pharmacists from grocery store, drugstore chain, independent, and mass merchandising pharmacies were called using the mystery caller approach. OUTCOME MEASURES: The primary endpoint was measured by the number of evidence-based recommendations made by pharmacists. RESULTS: The study included 366 pharmacies. Despite insufficient efficacy and safety data, there were 308 recommendations to use raspberry leaf products (n = 308 of 366, 84.1%). Most pharmacists attempted to collect additional patient information (n = 278 of 366, 76.0%). Many pharmacists did not clearly convey safety (n = 168 of 366, 45.9%) or efficacy (n = 197 of 366, 53.8%) information. Of those who discussed safety or efficacy, many said raspberry leaf products were safe and effective (n = 125 of 198, 63.1%; n = 82 of 169, 48.5%). Pharmacists often referred or deferred the patient to another medical professional for more information (n = 92 of 282, 32.6%). CONCLUSION: There is an opportunity to improve pharmacists' knowledge on the use of raspberry leaf products for the induction of labor and in making evidence-based recommendations when limited or conflicting efficacy and safety data exist.

A Retrospective Review of Cardiogenic Shock Development in Patients With ST-Elevation Myocardial Infarction and Percutaneous Coronary Intervention Receiving Early Beta-Blockers.

ABSTRACT: Beta-blockers (BBs) have proven to improve morbidity and mortality in patients after an ST elevation myocardial infarction (STEMI). Guidelines suggest initiating a BB within 24 hours, except in those with risk factors for developing cardiogenic shock, although published literature is conflicting regarding the true association of these risk factors with shock. This retrospective cohort study aimed to assess whether the presence of defined risk factors was associated with cardiogenic shock after early BB administration in patients with a STEMI and percutaneous coronary intervention. The primary outcome determined the rate of cardiogenic shock development and secondarily determined any characteristics associated with cardiogenic shock in patients who received beta blockers. The population included 299 patients and cardiogenic shock occurred in 8 patients (2.7%). There were no median (interquartile range) differences in age [63 years (60-71) versus 62 years (52-71); P = 0.4965], systolic blood pressure [110 mm Hg (105-115) versus 109 mm Hg (103-114); P = 0.6027], or heart rate [90 (78-104) versus 76 (64-90); P = 0.0697] before BB administration in patients who developed shock versus those who did not, respectively. Hours to BB administration from arrival [15.6 (6.0-54.8) versus 21.9 (10.6-42; P = 0.6968] and the number (%) with anterior infarction [3 (37.5%) versus 107 (36.8%); P = 1.000] were similar between groups. There was a statistically significant higher median (interquartile range) peak troponin [140 ng/mL (54-304) versus 49 ng/mL (16-132); P = 0.0354] in patients who developed shock. Early initiation of a BB in patients with STEMI and percutaneous coronary intervention with risk factors for cardiogenic shock does not seem to be associated with shock in most patients.

Students' knowledge and perceptions of social determinants of health utilizing interactive computer simulation-based learning.

INTRODUCTION: The purpose of this study was to assess if using computer simulations as a supplemental tool for teaching social determinants of health (SDoH) would impact first-year pharmacy students' knowledge and perceptions of SDoH. METHODS: A brief lecture and online poverty game were followed by completion of two, in-class, computer-simulated SDoH clinical scenarios and corresponding case discussion. Students completed a pre- and post-quiz and perception survey with two open-ended questions. Qualitative analysis of the open-ended questions and quantitative analyses of the poverty game choices, quiz, and perception survey were conducted. RESULTS: In total, 132 students were enrolled in this study. Thematic analysis of the open-ended question asking students what they learned included empathy (42%), general SDoH knowledge (30%), culture/religion (18%), and economic impact (15%). Student perceptions for all teaching modalities had a mean score of 4. Mean quiz scores on the pre- and post-class quizzes were 2.31 (SD 0.93) and 2.51 (SD 0.89), respectively. CONCLUSIONS: Computer simulations can be utilized as a supplemental tool to teach and apply clinical patient cases focused on SDoH. Strategically threading SDoH throughout the pharmacy curriculum is recommended to further develop SDoH knowledge and clinical skills.

Comparison of Higher-Than-Standard to D-Dimer Driven Thromboprophylaxis in Hospitalized Patients With COVID-19.

Introduction: Coronavirus disease 2019 is a global health threat often accompanied with coagulopathy. Despite use of thromboprophylaxis in this population, thrombotic event rates are high. Materials and methods: This was a multicenter, retrospective cohort study comparing the safety and effectiveness of thromboprophylaxis strategies at 2 institutions in hospitalized patients with coronavirus disease 2019. Regimen A utilized a higher-than-standard thromboprophylaxis dosage and Regimen B received full-dose anticoagulation for any D-dimer 3 mcg/mL or greater and prophylactic for less than 3 mcg/mL. The primary outcome compared the rate of thrombotic events between treatment groups. Secondary endpoints compared rates of major or clinically relevant non-major bleeding as well as the proportion of patients in each group experiencing thrombotic events within 30 days of discharge. Results: One-hundred fifty-three patients were included in the analysis, 64 receiving Regimen A and 89 receiving Regimen B. Seven (4.6%) thrombotic events occurred, 3 (4.7%) in patients receiving Regimen A, and 4 (4.5%) in Regimen B (P = 1.0). Twelve patients (13.5%) receiving Regimen B had a bleeding event versus 2 (3.1%) in Regimen A (P = .04), half of which were major in each group. All patients who bled in either treatment group were receiving mechanical ventilation, and 12 of 14 were receiving full-dose anticoagulation. One patient receiving Regimen A was readmitted with a pulmonary embolism. Conclusions: In this study, the thromboprophylactic regimen impacted bleeding, but no significant difference was seen with thrombotic outcomes. Almost all patients who experienced a bleed were mechanically ventilated and receiving full-dose anticoagulation. The use of full-dose anticoagulation should be cautioned in this population without an additional indication.

Comparison of Bleeding Rates between Oral Anticoagulants in Combination with Dual Antiplatelet Therapy (Triple Therapy) in a Real-World Cohort.

Background: Triple antithrombotic therapy including an anticoagulant, P2Y12 inhibitor, and aspirin increases bleed risk up to 27%. The components of this regimen can vary, which may impact bleed risk. Objective: To compare the safety of various triple antithrombotic regimens. Methods: An Institutional Review Board approved retrospective cohort study was conducted from 2014 to 2017. Patients admitted to a large urban health system on triple therapy were evaluated for inclusion. The primary outcome compared rates of International Society of Thrombosis and Hemostasis major and clinically relevant nonmajor bleeding during index admission or within 90 days in patients receiving warfarin, rivaroxaban, or apixaban; aspirin; and a P2Y12 inhibitor. A multivariable logistic regression assessed the association between bleeding, antithrombotic use, and relevant confounding variables. Results: Three hundred and seventy-two patients were included: 238 patients received warfarin, 63 received rivaroxaban, and 71 received apixaban. Forty-five patients (12.1%) experienced a bleed, 25 of which (55.6%) were major. The rate of bleeding was 12.2% (n = 29) with warfarin, 14.3% (n = 9) with rivaroxaban, and 9.9% (n = 7) with apixaban (P = .7335). The use of prasugrel versus clopidogrel (OR 4.35, 95% CI 1.20-15.72; P = .025) and admission hemoglobin less than 12 mg/dL (OR 2.54, 95% CI 1.28-5.04; P = .008) were identified as risk factors associated with bleeding in the model. Conclusion: In patients on triple antithrombotic therapy, choice of oral anticoagulant did not impact bleeding rates, but use of prasugrel and a low baseline hemoglobin were associated with increased bleed rates which warrants further investigation.

Comparison of Ischemic and Bleeding Events Between Short-Duration Versus Long-Duration Tirofiban Regimens in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

ABSTRACT: Tirofiban has been used historically as a bridge to platelet inhibition with clopidogrel in ST-segment myocardial infarction (STEMI) during percutaneous coronary intervention (PCI) to prevent stent thrombosis. However, ticagrelor and prasugrel reach similar levels of platelet inhibition at 30 minutes to that of clopidogrel at 6 hours, challenging the need for long-duration tirofiban. This 1-year, retrospective cohort study compared ischemic and bleeding outcomes of short-duration versus long-duration tirofiban regimens in patients with STEMI who received ticagrelor or prasugrel at the time of PCI. The primary outcome was major adverse cardiovascular events (MACEs) including cardiovascular mortality, recurrent myocardial infarction, urgent target vessel revascularization, or stroke. Secondary outcomes included individual MACE, all-cause mortality, bleeding events defined by the International Society on Thrombosis and Hemostasis, thirty-day readmissions for MACE and bleeding, and tirofiban pharmacy cost. A total of 283 charts were reviewed and 177 included (short duration n = 57; long duration n = 120). MACE rates were similar between short-duration and long-duration groups (0 [0%] vs. 5 [4.2%]; P = 0.18), including 4 cardiovascular deaths and 1 recurrent myocardial infarction. Bleeding event rates were also similar in short-duration versus long-duration groups including major bleeds (2 [3.5%] vs. 2 [1.7%]; P = 0.60) and clinically relevant nonmajor bleeds (3 [5.3%] vs. 9 [7.5%]; P = 0.75). Cost analysis indicated lower pharmacy cost with the short-duration group. In this cohort of patients with STEMI receiving a fast-acting P2Y12 inhibitor, the length of tirofiban infusion did not affect ischemic or bleeding outcomes, yet short-duration regimens were lower cost.

Implementation and Assessment of a Heart Failure Virtual Patient Simulation in a Required Pharmacotherapy Course.

Objective. To assess second year Doctor of Pharmacy students' academic performance in and perceptions of a heart failure (HF) virtual patient simulation used in a required pharmacotherapy course.Methods. A heart failure virtual patient simulation was created to augment heart failure pharmacotherapy course material at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences in the fall of 2019. This was a retrospective, pre-post observational cohort study. The primary objective was to compare student performance on heart failure pharmacotherapy examination questions in a cohort of students who completed a virtual patient simulation in 2019 compared to a control cohort who completed a paper-based case activity in 2018. Student perceptions of the simulation experience were assessed via electronic survey.Results. Students completed either the virtual patient simulation (n=122) or a paper-based case activity (n=123). Overall, the proportion of correctly answered heart failure pharmacotherapy examination questions was 83.3% in the virtual simulation group compared to 79.2% in the paper-based case group. Survey results indicated that students would prefer that the virtual patient simulation be incorporated in the pharmacotherapy curriculum.Conclusion. Use of a heart failure virtual patient simulation was associated with improved examination performance and was well received by students.

Inpatient Initiation of Sacubitril/Valsartan.

OBJECTIVE: Discuss the literature and describe strategies to overcome barriers of inpatient initiation of sacubitril/valsartan in patients with heart failure with reduced ejection fraction (HFrEF). DATA SOURCES: A PubMed, EMBASE, and Google Scholar literature search (January 2014 to June 2020) limited to English language articles was conducted with the following terms: sacubitril/valsartan, initiation, inpatient, hospitalized, B-type natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), diuretic, cost, and cost-effectiveness. STUDY SELECTION AND DATA EXTRACTION: Included articles described inpatient initiation of sacubitril/valsartan or described its impact on BNP, NT-proBNP, diuretic dosing, or cost of care. DATA SYNTHESIS: A total of 20 studies were identified based on included search terms. CONCLUSIONS: Sacubitril/valsartan should be considered for hemodynamically stable patients with HFrEF (New York Heart Association class II or III), potassium <5.2 mmol/L, without a history of angioedema, and after a 36-hour washout from angiotensin-converting enzyme (ACE) inhibitor or aliskiren, if applicable. An appropriate dose can be determined based on the patient's previous ACE inhibitor or angiotensin receptor blocker dose and/or blood pressure along with patient-specific factors. To overcome barriers of use, the following are recommended: NT-proBNP or BNP with establishment of a new baseline 1 month after initiation may be used for prognosis or diagnosis; careful monitoring of diuretic requirements; utilization of multiple strategies to overcome cost barriers; and use of interdisciplinary care.

Assessment of a Scholars Program Designed to Enhance Pharmacy Students' Competitiveness for Postgraduate Residency Training.

Objective. To assess pharmacy residency match/placement rates and student perceptions of a program designed to enhance Doctor of Pharmacy (PharmD) student competitiveness for postgraduate residency positions. Methods. The Scholars Program was developed to provide advanced training to select PharmD students who had an interest in postgraduate residency training and was completed during the third and fourth professional years. The program consisted of mentoring; elective coursework encompassing clinical practice, teaching, and leadership; modified experiential education; journal club meetings; teaching assistant duties; conducting research and/or scholarship; and delivering professional presentations. Residency match/placement rates of students who had completed the program were compared to national data and to students in the school who were not enrolled in the program. Perceptions of the program were assessed using an online survey. Results. Sixty-four students enrolled in and completed the Scholars Program from 2013 to 2019. Of these, 58 (91%) pursued postgraduate residency training. Students enrolled in the program had a higher combined phase 1/phase 2 match rate (91.4% vs 67.4%) than students in other PharmD programs across the United States. Similarly, students enrolled in the Scholars Program had a higher combined phase 1/phase 2 match rate (91.4% vs 62.9%) and overall residency placement rate (96.6% vs 67.0%) compared to students in the school who were not enrolled in the program. More than 85% of students enrolled in the Scholars Program who pursued residency training agreed that the program prepared them for and helped them attain a postgraduate residency. Conclusion. Pharmacy students enrolled in the Scholars Program experienced high residency match/placement rates and viewed the program as valuable preparation for postgraduate training.

Association between prothrombin time and bleeding in hospitalized patients receiving rivaroxaban.

PURPOSE: Results of an investigation of the pharmacodynamic effect of rivaroxaban anticoagulation, as measured by prothrombin time (PT), on bleeding risk and other outcomes in hospitalized patients are reported. METHODS: In a single-center retrospective cohort study, adult inpatients who had a PT measured within 24 hours after rivaroxaban administration during a designated 23-month period were identified. Patients who experienced in-hospital bleeding events were compared with those who did not. A multivariable logistic regression model was used to quantify the association between PT and bleeding events while adjusting for albumin levels and use of nonsteroidal antiinflammatory drugs and/or antiplatelet agents. Thromboembolic events were assessed as a secondary outcome. RESULTS: A total of 199 patients met the criteria for inclusion in the analysis; 41 experienced a bleeding event. Among patients with a PT of ≥30 seconds versus a PT of <30 seconds, the overall rate of bleeding events was significantly higher (38.7% versus 17.3%, p = 0.0067). Results of multivariable regression modeling showed that a PT of ≥30 seconds correlated with an approximately 3-fold higher bleeding risk (odds ratio, 3.25; 95% confidence interval, 1.09-9.66). Hypoalbuminemia was also a positive predictor of bleeding risk. There was no significant between-group difference in thromboembolic events. CONCLUSION: In hospitalized patients receiving rivaroxaban who had coagulation tests performed, a PT of ≥30 seconds was associated with a higher risk of bleeding. Hypoalbuminemia was also associated with bleeding in this population.

Comparing Pharmacotherapy Instruction to the 2009 and 2016 ACCP Toolkit Recommendations.

Objective. To compare pharmacotherapy instruction in Doctor of Pharmacy (PharmD) programs with the 2009 and 2016 American College of Clinical Pharmacy (ACCP) pharmacotherapy toolkits. Methods. A survey was sent to representatives at US schools and colleges with PharmD programs. The survey consisted of questions pertaining to pharmacotherapy credit-hours, contact time spent for each therapeutic subject area, and pedagogical methods used. Data were analyzed using descriptive statistics. Results. Representatives from 75 of 129 PharmD programs responded (response rate 58%). A median of 23 credit-hours were devoted to required pharmacotherapy. Infectious diseases and cardiology were taught with the most number of contact hours. Lecture was the most popular principal method of instruction delivery but the incorporation of case-based learning was also common. Conclusion. Devoted curricular time to pharmacotherapy is adequate to provide coverage of tier 1 and 2 topics from the ACCP toolkit. PharmD programs should continue to review their pharmacotherapy coursework to adjust topic coverage as needed to incorporate active learning strategies whenever possible.

Discharge Diuretic Dose and 30-Day Readmission Rate in Acute Decompensated Heart Failure.

BACKGROUND: Loop diuretics play a crucial role in symptom management in patients with fluid overload. There is a paucity of data regarding optimal diuretic dose at hospital discharge for acute decompensated heart failure (ADHF) patients requiring loop diuretics. OBJECTIVE: To compare all-cause 30-day readmission in ADHF patients on chronic loop diuretics who had an increase in loop diuretic dose at discharge (relative to their preadmission dose) with patients without a change or a decrease in loop diuretic dose at discharge. METHODS: This was a multicenter, retrospective cohort study. Institutional review board approval was obtained. Patients admitted with a primary discharge diagnosis of heart failure, evidence of fluid overload, and reduced ejection fraction were included. Patients were divided into 2 groups based on total daily loop diuretic dose at discharge: those discharged on an increased dose and those discharged on a dose less than or equal to their preadmission dose. RESULTS: A total of 131 patient admissions met inclusion criteria; 50 had an increase in loop diuretic dose at discharge, and 81 were discharged with no change or a decrease in diuretic dose. Patients in the increased dose group had an all-cause 30-day readmission rate of 20% compared with 38% of patients with no change or a decrease in diuretic dose (adjusted odds ratio = 0.320; 95% CI = 0.117-0.873). CONCLUSION: In patients admitted for ADHF with reduced ejection fraction and evidence of fluid overload, an increase in loop diuretic dose at discharge was associated with a reduced rate of 30-day hospital readmission.