Population-level changes in perinatal death for pregnancies prior to and during the COVID-19 pandemic: A pregnancy cohort analysis.

BACKGROUND: Results of population-level studies examining the effect of the COVID-19 pandemic on the risks of perinatal death have varied considerably. OBJECTIVES: To explore trends in the risk of perinatal death among pregnancies beginning prior to and during the pandemic using a pregnancy cohort approach. METHODS: This secondary analysis included data from singleton pregnancies ≥20 weeks' gestation in Alberta, Canada, beginning between 5 March 2017 and 4 March 2021. Perinatal death (i.e. stillbirth or neonatal death) was the primary outcome considered. The risk of this outcome was calculated for pregnancies with varying gestational overlap with the pandemic (i.e. none, 0-20 weeks, entire pregnancy). Interrupted time series analysis was used to further determine temporal trends in the outcome by time period of interest. RESULTS: There were 190,853 pregnancies during the analysis period. Overall, the risk of perinatal death decreased with increasing levels of pandemic exposure; this outcome was experienced in 1.0% (95% confidence interval [CI] 0.9, 1.0), 0.9% (95% CI 0.8, 1.1) and 0.8% (95% CI 0.7, 0.9) of pregnancies with no overlap, partial overlap and complete pandemic overlap respectively. Pregnancies beginning during the pandemic that had high antepartum risk scores less frequently led to perinatal death compared to those beginning prior; 3.3% (95% CI 2.7, 3.9) versus 5.7% (95% CI 5.0, 6.5) respectively. Interrupted time-series analysis revealed a decreasing temporal trend in perinatal death for pregnancies beginning ≤40 weeks prior to the start of the COVID-19 pandemic (i.e. with pandemic exposure), with no trend for pregnancies beginning >40 weeks pre-pandemic (i.e. no pandemic exposure). CONCLUSION: We observed a decrease in perinatal death for pregnancies overlapping with the COVID-19 pandemic in Alberta, particularly among those at high risk of these outcomes. Specific pandemic control measures and government response programmes in our setting may have contributed to this finding.

Evaluation and comparison of risk-based and universal prenatal HCV screening programs in Alberta, Canada.

BACKGROUND & AIMS: Canadian clinical practice guidelines currently recommend risk-based screening for HCV in pregnant individuals. However, no provinces or territories have ever compared the effectiveness of risk-based vs. universal screening for the prenatal diagnosis of HCV. We aimed to evaluate and compare HCV screening programs after implementing a universal population-level pilot program among prenatal patients in Alberta, Canada. METHODS: The Alberta Prenatal Screening Program for Select Communicable Diseases was amended to include universal HCV antibody screening. Cohorts of pregnant individuals screened for HCV through risk-based or universal programs were generated over 1-year periods. HCV screening rates and prevalence were analyzed and compared between cohorts to evaluate the effectiveness of screening methods. Social and demographic risk factors for HCV-positive individuals were compared between screening cohorts to identify which populations may be overlooked with risk-based guidelines. RESULTS: HCV antibody screening rates were 11.9% and 99.9% among pregnant individuals in the risk-based and universal cohorts, respectively. HCV prevalence among the cohorts was 0.07% and 0.11% (difference = 0.04%, p = 0.032), with an average of 21 additional HCV-positive pregnant individuals identified annually with universal screening. HCV-positive pregnant patients diagnosed through universal screening were more likely to engage in high-risk sexual behaviours/sex work compared to those diagnosed through risk-based screening (47.6% vs. 12.5%, respectively p = 0.035), suggesting that these high-risk cases are being missed by risk-based screening. CONCLUSIONS: Universal HCV screening diagnoses significantly higher numbers of pregnant individuals infected with HCV compared to risk-based screening. Universal HCV screening or amending risk-based guidelines to incorporate more proxy variables for risk factors should be considered to improve prenatal HCV screening guidelines in Canada and help achieve HCV elimination in the next decade. IMPACT AND IMPLICATIONS: HCV is a bloodborne pathogen that can cause severe liver disease and be vertically transmitted from a mother to her baby during pregnancy. Pregnant individuals in Alberta are currently only tested for HCV if they disclose engaging in activities that put them at risk of acquiring the infection (risk-based screening). Using a population-wide universal prenatal HCV screening program, our work shows that testing based on patient disclosed risk alone leads to the significant underdiagnosis of HCV in pregnant individuals and suggests individuals engaging in sex work or risky sexual behaviours are being overlooked by the current risk-based program. Our outcomes represent the first province-wide study to evaluate and compare prenatal HCV risk-based and universal screening programs in Canada and provide evidence to support the update of prenatal HCV screening policies across the country and in similar jurisdictions.

Impact of the Integrative Oncology Scholars Program on Oncology Providers' Key Knowledge of Dietary Supplements and Antioxidants for Providing Evidence-based Oncology Care.

Dietary supplements are commonly used among cancer survivors. Oncology providers rarely receive training about dietary supplements. We evaluated whether e-learning modules could improve oncology providers' dietary supplement knowledge. Oncology providers participated in the National Cancer Institute funded Integrative Oncology Scholars (IOS) program. We used posttest readiness assurance tests (RAT) to measure knowledge acquisition from modules. One cohort completed a pre and posttest RAT to assess change in knowledge. Multivariate linear regression models adjusted for gender, race, profession, and years in practice were used to determine if these characteristics were associated with posttest RAT performance and change in pre to posttest RAT scores. Scholars (N = 101) included 86% (N = 87) females; age 44 ± 10 years; 72% (N = 73) Non-Hispanic White; years in practice mean range 11-15 ± 10. There were 37 physicians, 11 physician assistants, 23 nurses, 21 social workers, 2 psychologists, 4 pharmacists, and 2 physical therapists. The posttest dietary supplement and antioxidant RAT scores for all Scholars were 67 ± 18% and 71 ± 14%. In adjusted models there were no significant associations between dietary supplement and antioxidant posttest RAT scores with Scholar characteristics. Change in RAT scores for dietary supplement and antioxidants were 25% ± 23 and 26% ± 27 (P < 0.0001). In adjusted models, there were no significant predictors of change in dietary supplement RATs. For antioxidant RATs, profession was associated with change in scores (P = 0.021). Improvement in Scholar's test scores demonstrate the IOS program can significantly increase oncology providers' knowledge of dietary supplements and antioxidants.

DEFINING ELIGIBILITY CRITERIA FOR FUNDING POLICIES AROUND IN VITRO FERTILIZATION.

OBJECTIVES: This review aims to assess the state of the science around the potential impact of certain patient characteristics on the safety and effectiveness of in vitro fertilization (IVF). METHODS: Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of reviews and recent primary studies examining the impact of paternal age and maternal age, smoking, and body mass index (BMI) on the safety and effectiveness of IVF was performed. Papers, published between January 2007 and June 2014, were independently reviewed and critically appraised by two researchers using published quality assessment tools for reviews and primary studies. Due to heterogeneity across papers (different study designs and patient selection criteria), a qualitative analysis of extracted information was performed. RESULTS: Seventeen papers (ten systematic reviews and seven primary studies) were included. They comprised evidence from retrospective observational studies in which maternal age, BMI, and smoking status were explored as part of secondary analyses of larger studies. The majority of papers found that the likelihood of achieving a pregnancy was lower among women who were >40 years, had a BMI ≥ 25 and smoked. Advanced maternal age and BMI were also associated with higher rates of preterm birth and low birth weight. CONCLUSIONS: Based on available evidence, it may be appropriate to consider "maternal age" and "morbid obesity" in public funding policies that aim to maximize the effectiveness of IVF. However, given inconsistencies in the effect of smoking across different pregnancy-related outcomes, support for incorporating it into funding conditions appears weak.

Assisted reproductive technologies (ARTs): evaluation of evidence to support public policy development.

Over the years, IVF/ICSI protocols have continued to evolve with efforts to improve outcomes. As a result, treatment success may be related to certain procedural factors, including number of embryos transferred and stage at which they are transferred. This review aims to assess the safety and effectiveness of IVF/ICSI in comparison to spontaneous conception and less invasive ARTs and the impact of procedure-related factors on the outcomes of IVF/ICSI in order to support the development of local clinical and policy guidance. Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of literature examining the impact of procedural characteristics on the safety or effectiveness of IVF/ICSI from 2007 to date was performed. 33 systematic reviews and 3 primary studies evaluating the impact of procedural differences, IVF/ICSI in comparison to less invasive ARTs, and ARTs in comparison to spontaneous conception were found. IVF was shown to offer significant benefits over no treatment and IUI in achieving pregnancy and live birth among couples with endometriosis or unexplained infertility. Frozen and blastocyst-stage embryo transfers were as effective as fresh and cleavage-stage embryo transfers, respectively. In comparison to single embryo transfer, double embryo transfer significantly increased pregnancy, live birth and multiple pregnancy/birth rates. IVF/ICSI was associated with more complications during pregnancy and delivery, and in infants compared to naturally conceived pregnancies, particularly when multiple embryo transfer was used. Frozen embryo transfer had fewer adverse events during pregnancy and delivery than fresh embryo transfer, and was at least as safe in terms of infant outcomes. The potential complications of IVF/ICSI may be minimized through procedural choices, but such choices often impact effectiveness. Thus, in developing clinical and policy guidance around IVF/ICSI, the risk-benefit trade-offs patients and providers are willing to accept must be carefully considered.

Prevalence and Impact of Workplace Bullying among Pharmacy Practice Faculty in the United States.

Objective: To identify the prevalence and impact of workplace bullying among pharmacy practice faculty in the United States. Methods: Members of the Pharmacy Practice section of the American Association of Colleges of Pharmacy were invited to complete an online survey about the frequency with which they experienced negative workplace behaviors in the communication, humiliation, manipulation, discrimination, and violence domains as well as workplace bullying in the previous 12 months. Independent t-tests and chi-squared tests were used to investigate associations between workplace bullying and pharmacy practice faculty demographic and employment characteristics. Results: Participants (n=256) reported a median of 6 negative behaviors in the workplace, most often in the communication and humiliation domains. A total of 50 (19.5%) reported experiencing workplace bullying. The most common impacts of workplace bullying included increasing their stress level (n=44/49, 89.8%), negative effects on their emotional health (n=42/49, 85.7%), and job dissatisfaction (n=40/49, 81.6%). Female participants more frequently reported workplace bullying (n=43/196, 21.9%) compared to male participants (n=4/56, 7.1%; p=0.012). Individuals who identified as white were less likely to report workplace bullying (n=40/233, 17.2%) compared to individuals of all other races (n=8/19, 42.1%; p=0.008). Conclusion: Most pharmacy practice faculty reported experiencing some degree of negative workplace behaviors during the past 12 months. Additional strategies are needed to create inclusive work environments with transparent, actionable policies when workplace bullying occurs.

Text Message Reminders to Improve Immunization Appointment Attendance in Alberta, Canada: The Childhood Immunization Reminder Project Pilot Study.

BACKGROUND: Vaccine coverage for 18-month-old children in Canada is often below the recommended level, which may be partially because of parental forgetfulness. SMS text message reminders have been shown to potentially improve childhood immunization uptake but have not been widely used in Alberta, Canada. In addition, it has been noted that language barriers may impede immunization service delivery but continue to remain unaddressed in many existing reminder and recall systems. OBJECTIVE: This study aimed to assess the effectiveness and acceptability of using SMS text messages containing a link to web-based immunization information in different languages to remind parents of their child's 18-month immunization appointment. METHODS: The Childhood Immunization Reminder Project was a pilot intervention at 2 public health centers, one each in Lethbridge and Edmonton, Alberta, Canada. Two SMS text message reminders were sent to parents: a booking reminder 3 months before their child turned 18 months old and an appointment reminder 3 days before their scheduled appointment. Booking reminders included a link to the study website hosting immunization information in 9 languages. To evaluate intervention effectiveness, we compared the absolute attendance no-show rates before the intervention and after the intervention. The acceptability of the intervention was evaluated through web-based surveys completed by parents and public health center staff. Google Analytics was used to determine how often web-based immunization information was accessed, from where, and in which languages. RESULTS: Following the intervention, the health center in Edmonton had a reduction of 6.4% (95% CI 3%-9.8%) in appointment no-shows, with no change at the Lethbridge Health Center (0.8%, 95% CI -1.4% to 3%). The acceptability surveys were completed by 222 parents (response rate: 23.9%) and 22 staff members. Almost all (>95%) respondents indicated that the reminders were helpful and provided useful suggestions for improvement. All surveyed parents (222/222, 100%) found it helpful to read web-based immunization information in their language of choice. Google Analytics data showed that immunization information was most often read in English (118/207, 57%), Punjabi (52/207, 25.1%), Arabic (13/207, 6.3%), Spanish (12/207, 5.8%), Italian (4/207, 1.9%), Chinese (4/207, 1.9%), French (2/207, 0.9%), Tagalog (1/207, 0.5%), and Vietnamese (1/207, 0.5%). CONCLUSIONS: The study's findings support the use of SMS text message reminders as a convenient and acceptable method to minimize parental forgetfulness and potentially reduce appointment no-shows. The diverse languages accessed in web-based immunization information suggest the need to provide appropriate translated immunization information. Further research is needed to evaluate the impact of SMS text message reminders on childhood immunization coverage in different settings.

Update to the Minimum Requirements for Core Competency in Pediatric Hospital Pharmacy Practice.

Colleges of pharmacy provide varying amounts of didactic and clinical experiential hours in pediatrics therapeutics, resulting in variability in the knowledge, skills, and perceptions of new graduates toward the pharmacist role in providing care to pediatric patients. The Pediatric Pharmacy Association continues to endorse a minimum set of core competencies for all pharmacists involved in the care of hospitalized pediatric patients of all ages. To that end, we have updated our 2015 Position Statement.

Practical Considerations for Community-Based Health Promotion Events during the COVID- 19 Pandemic.

Community-based health promotion events provide student pharmacists the opportunity to give back to the local community while simultaneously applying the knowledge and skills they are learning in the classroom (Accreditation Council for Pharmacy Education Standards 3, 4, and 12). In turn, community members receive benefits, such as receiving a vaccination and learning their blood pressure, as well as strategies to manage their health conditions. Traditionally, both individual community members and student pharmacists receive benefit. As a result of the coronavirus disease 2019 (COVID-19) pandemic, it is critical to consider the impact of public health via the local community when choosing to hold or suspend these activities. It is necessary to consider whether the benefits to individual community members who choose to participate (e.g., older adult with type 2 diabetes or underserved adults with limited access to the influenza vaccine) outweigh the risks to the public due to the pandemic. If there is sufficient benefit, there are practical considerations related to regulations, recruitment of community members, involvement of students and preceptors, location, supplies, delivery of patient care services, and activities after the event.

Career and professional development services for pharmacy students.

INTRODUCTION: As the number of pharmacy programs and graduates continue to rise, pharmacy students are being faced with new challenges in seeking post-graduate positions. A Career Connections program was established as part of the student affairs office to develop, implement, and evaluate career and professional development at the University of Michigan College of Pharmacy. The objective of this paper was to evaluate student perceptions and value of career and professional development services in preparing students for competitive job and residency markets. METHODS: An electronic survey was administered to second-, third-, and fourth-professional year students and 2017 graduates to evaluate all facets of career and professional development services offered by the college of pharmacy. RESULTS: The majority of students (76.8%) were satisfied with their access to career development services. Of all the services and events evaluated, students were most satisfied with the internship panel, fourth-year residency seminars, and third-year professional development elective course. Additional services recommended by students included more networking opportunities with alumni, continued exposure to different careers in pharmacy, and more emphasis on the job searching process. CONCLUSIONS: Career development services were generally perceived favorably. The college has implemented several changes based on feedback from students, including splitting students into career-based tracks in the professional development elective and adding additional job-searching seminars. Future initiatives will include increasing outreach to college alumni. Career and professional development services at pharmacy programs should be continuously evaluated in a rapidly changing post-graduate landscape.

Impact of virtual simulation in self-care therapeutics course on introductory pharmacy practice experience self-care encounters.

BACKGROUND AND PURPOSE: Pharmacy education programs use simulation to provide a realistic and safe environment for student learning. We studied whether incorporation of virtual simulation into a required first year self-care therapeutics course impacted frequency of interactions, self-reported student confidence, and preceptor-reported student performance during second-year community pharmacy introductory pharmacy practice experiences (IPPEs). EDUCATIONAL ACTIVITY AND SETTING: Virtual simulation cases using MyDispense were incorporated into a self-care therapeutics course in winter 2017. Students and preceptors were surveyed at the end of the fall semester community pharmacy IPPE. Data from IPPE experiences was compared with students who took the self-care therapeutics course in winter 2016 (control). FINDINGS: Students completed 30 virtual simulation cases and three cases as part of the final examination (n = 33). Students in the intervention group reported more patient care interactions during their IPPEs than students who did not complete virtual simulation cases, but there was no difference in self-reported confidence. Preceptors did not report any differences in the ability of students to complete over-the-counter medication interactions during IPPEs. SUMMARY: Cases were well received by students although they took longer to complete than initially anticipated. Students in the intervention group reported significantly more patient care interactions during IPPEs than those in the control group; however, there were no differences in self-reported confidence. Incorporation of virtual simulation was a sustainable change as the cases were able to be re-used the following year with minimal edits.

Joint Statement on Pediatric Education at Schools of Pharmacy.

Providing health care for children is a unique specialty, and pediatric patients represent approximately 25% of the population. Education of pharmacy students on patients across the lifespan is required by current Accreditation Council for Pharmacy Education standards and outcomes; thus, it is essential that pharmacy students gain a proficiency in caring for children. A collaborative panel of pediatric faculty members from schools and colleges of pharmacy was established to review the current literature regarding pediatric education in Doctor of Pharmacy curricula and establish updated recommendations for the provision of pediatric pharmacy education. This statement outlines five recommendations supporting inclusion of pediatric content and skills in Doctor of Pharmacy curricula.

Incorporating preauthorization into antimicrobial stewardship pharmacist workflow reduces Clostridioides difficile and gastrointestinal panel testing.

OBJECTIVE: To evaluate whether incorporating mandatory prior authorization for Clostridioides difficile testing into antimicrobial stewardship pharmacist workflow could reduce testing in patients with alternative etiologies for diarrhea. DESIGN: Single center, quasi-experimental before-and-after study. SETTING: Tertiary-care, academic medical center in Ann Arbor, Michigan. PATIENTS: Adult and pediatric patients admitted between September 11, 2019 and December 10, 2019 were included if they had an order placed for 1 of the following: (1) C. difficile enzyme immunoassay (EIA) in patients hospitalized >72 hours and received laxatives, oral contrast, or initiated tube feeds within the prior 48 hours, (2) repeat molecular multiplex gastrointestinal pathogen panel (GIPAN) testing, or (3) GIPAN testing in patients hospitalized >72 hours. INTERVENTION: A best-practice alert prompting prior authorization by the antimicrobial stewardship program (ASP) for EIA or GIPAN testing was implemented. Approval required the provider to page the ASP pharmacist and discuss rationale for testing. The provider could not proceed with the order if ASP approval was not obtained. RESULTS: An average of 2.5 requests per day were received over the 3-month intervention period. The weekly rate of EIA and GIPAN orders per 1,000 patient days decreased significantly from 6.05 ± 0.94 to 4.87 ± 0.78 (IRR, 0.72; 95% CI, 0.56-0.93; P = .010) and from 1.72 ± 0.37 to 0.89 ± 0.29 (IRR, 0.53; 95% CI, 0.37-0.77; P = .001), respectively. CONCLUSIONS: We identified an efficient, effective C. difficile and GIPAN diagnostic stewardship approval model.

Pre-Class Learning Methods for Flipped Classrooms.

Objective. To review the types of pre-class learning modalities used in flipped classrooms (FC) and team-based learning (TBL) and determine best practices. Findings. Forty-eight articles were included. Reading materials or video lectures were used most often as the primary modality to deliver the pre-class learning. Students favored assignments that have clear objectives, provide guidance, are guided, and are brief. Summary. This study describes how pharmacy schools and colleges are implementing FC into their curricula and the types of pre-class learning that are being developed and assigned with the implementation. More research should be done in comparing the impact of different types of pre-class material on learning outcomes, such as knowledge retention. This is especially important in FC settings because the in-class learning and higher order activities are built upon having a good foundational knowledge, which comes from the pre-class learning.

Impact of a Pharmacy Student Organization on the Admissions Experience and Student Professional Development.

Objective. To evaluate the impact of a program which integrated student pharmacists into the admissions process on pharmacy school candidates' perceptions of the program and on participants' professional development. Methods. An anonymous survey regarding the pharmacy school admission process was sent to candidates following their visit to campus and interviews from fall 2014 through spring 2017. A second survey of all student pharmacists enrolled in January 2018 was conducted to assess the impact of a student-led organization, Pharmacy Student Ambassadors (PSA), on their professional development. Results. The response rate for the survey completed by candidates was 66% (335/504) and the response rate for the survey completed by enrolled student pharmacists was 50% (166/330). Almost all of the candidates were satisfied with the admissions process (96%, 322/335). They cited the welcoming and friendly environment and opportunity to interact with student pharmacists as the best aspects of the admissions process. In the survey of enrolled students, the majority of PSA volunteers agreed or strongly agreed with statements regarding their organization's influence on professional development (76%), enhancing communication skills (77%), self-reflection (78%), and feeling respected and valued (73%). Furthermore, the majority of student pharmacists agreed or strongly agreed that participation in the PSA positively impacted their own admissions process (87%), made interviewees more at ease and comfortable (88%), increased their knowledge and understanding of the culture in the program (82% and 75% respectively), and influenced their personal decisions to attend the University of Michigan College of Pharmacy (63%). Conclusion. Student pharmacist involvement in the admissions process was correlated with pharmacy school candidate satisfaction and contributed to enrolled students' positive perceptions regarding their professional development.

Identifying Opportunities for Improvement in Safety and Efficacy of Community Pharmacy Immunization Programs.

OBJECTIVE: To identify opportunities to improve safe and effective immunization delivery in community pharmacies. METHODS: Pharmacy managers from chains in Michigan were interviewed about their company's immunizations programs. A survey regarding immunization training, quality assurance measures, pharmacist comfort level immunizing different patient populations, and resources used in practice was distributed to community pharmacists throughout Michigan. RESULTS: Most pharmacists (88.8%) confirmed they received American Pharmacists Association immunization training and felt they followed the guidelines outlined in that training course very well. No routine reassessment of immunization technique was reported. In a minority of respondents, some issues were identified: (1) not being up-to-date on cardiopulmonary resuscitation certification as required by state law (7.1%), (2) lack of awareness of location of emergency kit (4.2% for epinephrine, 13.5% for diphenhydramine), and (3) feeling uncomfortable immunizing children (51% for children <7 years). CONCLUSION: To address quality control issues identified in the survey, we recommend chain pharmacies incorporate credential checks into annual pharmacy training requirements. Pharmacists may benefit from immunization-related continuing education requirements. State pharmacy organizations may want to take the lead in developing the material to ensure that it is timely and abides by state and federal laws.

Implementation of a Palivizumab Order Panel to Decrease Inappropriate Use.

OBJECTIVE: Palivizumab is a monoclonal antibody used to prevent infection from respiratory syncytial virus (RSV) in certain patients who are at high risk for complications. A previous medication use evaluation (MUE) demonstrated 12% of our palivizumab use did not meet criteria for use. Prior to the start of the 2016-2017 RSV season, an order panel was implemented requiring prescribers to select the approved criterion for each patient prescribed palivizumab. In addition, our restriction policy changed to state that palivizumab use outside of preapproved criteria would require authorization from pediatric infectious diseases or the antimicrobial stewardship team. An MUE was conducted during the summer of 2017 to determine whether the order panel had an impact on appropriate prescribing of palivizumab. METHODS: Medication orders for patients who received palivizumab from December 2015 to April 2016 and from December 2016 to April 2017 were reviewed to determine the proportion of patients who did not meet the preapproved restriction criteria. Charts were reviewed to verify indications of palivizumab for each patient during both seasons. A χ2 test was used to compare the proportion of inappropriate orders between the 2 seasons. RESULTS: During the 2015-2016 RSV season, of the 80 palivizumab orders, there were 11 inappropriate administrations (13.8%). During the 2016-2017 RSV season, 70 orders were administered to patients, and 4 doses (5.7%) were inappropriate. The cost of palivizumab increased from year 1 to year 2 (acquisition cost of $2477.44 per 100 mg/mL vial during year 1, $2613.71 per 100 mg/mL vial during year 2). An estimated cost avoidance of $12,807.18 was observed due to the decrease in the number of inappropriate administrations of palivizumab following implementation of the order panel (n = 7). There was an overall reduction in the number of inappropriate orders from year 1 to year 2 (8.1%); however, the reduction was not significant (p = 0.102). CONCLUSIONS: Following the implementation of the order panel plus restriction policy, we observed a decrease in the proportion of inappropriate doses that were administered from the preimplementation period to the postimplementation period, which also resulted in a cost avoidance of approximately $13,000.

From clinical assistant to clinical associate professor: Examination of a sample of promotion guidelines.

INTRODUCTION: As accreditation standards for doctor of pharmacy programs have placed a greater emphasis on practice experiences, programs have a need for more clinical faculty. While clinical faculty are expected to achieve success in teaching, scholarly activity, and service, they tend to hold lower academic ranks and take more time to achieve promotion. This may be especially true when promotion guidelines lack clarity. METHODS: Guidelines for promotion of clinical faculty from assistant to associate rank for 10, research-intensive pharmacy programs were reviewed for predetermined factors in the areas of teaching, scholarly activity, and service using the following scale: required, desired, considered, not considered, or not specified. Some factors reviewed included: classroom teaching hours, number of clerkship students, types of scholarly activity considered, grantsmanship, and patient care services. RESULTS: There is significant variation in criteria utilized when considering promotion of clinical faculty from assistant to associate rank; few programs provide quantifiable requirements. All programs expect clinical faculty to participate in teaching. Only one program quantifies the amount of teaching expected. One program does not describe types of scholarly activity considered for promotion. No programs expect salary support from grants for clinical faculty. All programs consider direct patient care activities. CONCLUSIONS: A wide variety of criteria are considered when evaluating a clinical faculty member for promotion to the rank of associate professor. Clearly defined promotion criteria may help faculty direct their efforts toward activities that are recognized to ensure timely promotion.