The effectiveness of written communication for decision support in clinical practice.

BACKGROUND: The application of various tools suggests limitations in the usage of drug information provided to medical professionals. Concurrent views of utility and suggested improvements for written information by health care practitioners are lacking. OBJECTIVE: This study's objectives were to: (1) assess practice-based perspectives on the relative efficacy and utility of different medication-related written materials for health care practitioners, (2) discern aspects of written communications that are valued for actionable information and merit health care practitioners' attention, (3) determine common or unique themes of clinicians practicing as physicians, pharmacists, physician assistants, and nurses regarding medication-related written information; and (4) organize constructs and themes as a cogent array of current deficiencies in written communications to guide improvements. METHODS: Two focus group panels (physicians, physician assistants, pharmacists, nurses) were convened to address clinical decisional balance and the utility of written information about medicines in assisting them with those decisions. A facilitated dialogue followed a semi-structured interview guide including overarching questions and tap-root probes derived from the literature. Comparative analyses were used to interpret data. An a priori coding framework informed the interview guide and served as a basis for initial identification of themes. RESULTS: Panelists from diverse practices and settings voiced convergent agreement on the limited utility of written materials, attributed primarily to current structure, formatting, content, and design. Recommendations thematically supported the need for greater accuracy, recency, adaptability, sequencing, and accessibility of information in formats more frequently digitalized. CONCLUSIONS: Focus group panels of practitioners provided rich information on how current written information such as Dear Doctor letters and package inserts could be improved to facilitate real-time decision-making. Overall, improvements could contribute to an improved capacity for efficient, effective, and sustained evidence-based practice behavior.

Native English speakers and English as a Foreign Language (EFL) students' performance and notetaking in a Doctor of Pharmacy health systems course.

BACKGROUND: Academic pharmacy programs continue to diversify in student population. While the challenges of non-native language speakers have been opined, there is scant research on their performance in comparison with native language speakers nor is there much information on differences in the processes used in academic preparation, such as on note-taking. OBJECTIVE: The objectives of this study were to: (1) identify differences in test performance between native English speakers and students for whom English is a foreign language (EFL) in a health systems PharmD course, and (2) examine differences between these two groups in note-taking attitudes and behaviors. METHODS: Students' self-reported data as native English-speaking or EFL were acquired from the University Office of Admissions. Students' performance was measured on examinations covering lecture content, with independent-sample t tests discerning differences on all 3 examinations. T-tests were also used to ascertain differences on examination scores by student race/ethnicity and on differences in their response to a survey on attitudes, behaviors, and satisfaction with note-taking. RESULTS: EFL students scored significantly lower on the latter two examinations and on the average of the three examinations by over 7%. EFL students reported lower satisfaction with the accuracy and completeness of their notes and indicated that peers were less likely to borrow their notes. They also reported being more likely to be distracted in class by peers' laptop note-taking, even though there were many similarities between the two groups in how they approached note-taking. CONCLUSIONS: EFL student performance was lower than that of native English speakers on examinations. EFL students were less satisfied with the quality of their notes. Further research is needed to identify effective strategies for improving the learning experience of EFL students. Academic administration can identify mechanisms to facilitate a learning environment conducive for their success.

Laptop Versus Longhand Note Taking in a Professional Doctorate Course: Student Performance, Attitudes, and Behaviors.

OBJECTIVE: To determine the relationship between longhand note taking versus laptop note taking on pharmacy students' examination performance and identify differences in attitudes and behaviors as it relates to the note taking process. METHODS: A small group of students consented voluntarily to take longhand notes, doing away with their laptops during portions of the course administered by study investigators. Analyses were conducted on block examination performance, with each student's score on the first examination serving as a performance benchmark to assess change. Laptop and longhand note takers completed a survey regarding various aspects of their note taking attitudes and behaviors, and also included open text comments to capture qualitative experiential data. RESULTS: Based upon a relatively small number of participants in the longhand cohort (n=11), the differences between the groups on subsequent examinations was approximately 3.5 percentage points in favor of the longhand note-takers. There were significant differences observed between the two groups on several survey items, with longhand note takers less likely to be distracted in class and more likely to agree that other students ask to review their notes due to the quality of those notes. CONCLUSIONS: Longhand note taking might facilitate more accurate recall or retrieval in test situations, thus producing improved test scores for certain types of students in certain types of courses; however additional research is needed. Faculty may consider whether modifying students' classroom note taking practices may contribute to an improved learning experience.

Patient and clinical characteristics that heighten risk for heart failure readmission.

BACKGROUND: Within 30 days of hospital discharge, heart failure (HF) readmission rates nationally accumulate to more than 20%. Due to this high rate of unplanned re-hospitalization, predictive models are needed to identify patients who pose the highest readmission risk. OBJECTIVE: To evaluate the diagnosis and timing and to identify patient and clinical characteristics associated with 30 day readmissions among HF patients. METHODS: A retrospective analysis of electronic health records was conducted to study HF admissions during the period October 2008 to November 2014. Patients with a primary discharge diagnosis consistent with HF were included. Descriptive statistics were used to compare the readmitted and non-readmitted cohorts. Logistic regression was used to develop a predictive model to determine patient and clinical variables associated with 30 day readmission. RESULTS: Characteristics of the study cohort (n = 2420) are: a mean age of 72, predominantly male (55%), white (55%), currently not employed (91%), and utilizing Medicare as a payer (68%). Overall, 42% were married. Over the study time period there were 394 (16.3%) 30 day readmissions after 2420 hospitalizations. The 3 most common reasons for readmission were HF (36.0%), renal disorders (8.4%), and other cardiac diseases (6.9%). Analysis showed that 11.9% of patients readmitted during days 0-3, 15.2% during days 4-7, 31.5% during days 8-15, and 41.4% during days 16-30. The final multivariate predictive model included 5 variables that were associated with an increased risk for 30-day readmission: employment status as retired or disabled, > 1 emergency department visit in the past 90 days, length of stay >5 days during index visit, and a BUN value > 45 mg/dL. CONCLUSION: This study provides a deeper understanding of patient and clinical characteristics that are associated with readmission in HF. Evaluation of these characteristics will provide additional information to guide strategies meant to reduce HF readmission rates.

Assessing the effectiveness of community-based substance abuse treatment for adolescents.

The Adolescent Treatment Models initiative, a 10-site, multimodality, prospective study, was designed to evaluate adolescent substance abuse treatment outcomes and to assess the relative efficacy of different treatment models. Based upon longitudinal data gathered at multiple assessment points using a standardized instrument, treatment outcome trajectories were determined for a cohort of 1,057 adolescents from entry into substance abuse treatment until 12 months post-intake. Client outcomes on substance use and program effectiveness were explored across individual treatment programs and levels of care. Strong treatment effects, defined as a significant reduction in alcohol and other drug use at three months post-intake, were found. The reductions of greatest magnitude in relation to pretreatment use occurred among adolescents in residential treatment. Within level of care, few significant differences in treatment effects were found between programs. Relapse effects, defined as an increase in substance use at 12 months relative to three months, were observed across nearly all programs, but varied in relation to treatment modality. This is most evident among those entering residential treatment, with the highest rate of relapse occurring among adolescents in long-term residential treatment care. Despite strong evidence of treatment effectiveness, continuing care is vital to maintenance of treatment benefit.

Bullying in the clinical training of pharmacy students.

OBJECTIVE: To determine whether bullying is a significant factor in the clinical training of pharmacy students. METHODS: The literature as well as the Accreditation Council for Pharmacy Education (ACPE) Standards and American Association of Colleges of Pharmacy (AACP) surveys were reviewed for mention and/or measurement of bullying behaviors in the clinical training of pharmacy students. The authors used a Delphi process to define bullying behavior. The consensus definition was used to analyze 2,087 in-house student evaluations of preceptors for evidence of bullying behaviors. The authors mapped strings of text from in-house student comments to different, established categories of bullying behaviors. RESULTS: The ACPE Standards and AACP surveys contained no mention or measures of bullying. The 2013 AACP survey data reported overwhelmingly positive preceptor ratings. Of the 2,087 student evaluations of preceptors, 119 (5.7%) had at least 1 low rating. Within those 119 survey instruments, 34 comments were found describing bullying behaviors. Students' responses to the AACP survey were similar to data from the national cohort. CONCLUSIONS: Given the evidence that bullying behaviors occur in pharmacy education and that bullying has long-term and short-term damaging effects, more attention should be focused on this problem. Efforts should include addressing bullying in ACPE Standards and AACP survey tools developing a consensus definition for bullying and conducting more research into bullying in the clinical training of pharmacy students.

Impact of victimization on substance abuse treatment outcomes for adolescents in outpatient and residential substance abuse treatment.

This paper considers whether victimization moderates adolescents' outcomes in substance abuse treatment. Adolescents (N=975) in outpatient and residential settings were assessed at intake, three, six, nine, and 12 months. Differential outcomes by gender and degree of victimization were analyzed. Dependent variables were marijuana use and substance-related problems. The residential sample reported higher baseline marijuana use and victimization. Both samples significantly reduced marijuana use and associated problems during treatment. Victimization was significantly related to more substance-related problems at intake and follow-up. More severe trauma histories in residential females were associated with significantly greater persistence in substance-related problems post-discharge.