Analysis of Teaching-Related Criteria Within Promotion and Tenure Documents from US Pharmacy Schools.

OBJECTIVE: To describe teaching-related criteria within promotion and tenure (PT) guidance documents from US-based colleges/schools of pharmacy. METHODS: PT guidance documents were retrieved from college/school websites or via electronic mail. Institutional characteristics were compiled using available online data. Using qualitative content analysis, a systematic review of PT guidance documents was conducted to identify how teaching and teaching excellence were considered in decision of promotion and/or tenure at each institution. RESULTS: PT guidance documents were analyzed from 121 (85%) colleges/schools of pharmacy. Of these, 40% included a requirement that faculty must achieve excellence in teaching for promotion and/or tenure, though excellence was infrequently defined (14% of colleges/schools). Criteria specific to didactic teaching were most frequently included (94% of institutions). Criteria specific to experiential (50%), graduate student (48%), postgraduate (41%), and interprofessional (13%) teaching were less frequently included. Institutions frequently required student (58%) and peer (50%) evaluations of teaching to be considered in PT decisions. Most institutions acknowledged many teaching accomplishments as examples indicating teaching success rather than strictly requiring specific criteria to be fulfilled. CONCLUSION: Teaching-related criteria within PT criteria of colleges/schools of pharmacy often lack clear guidance regarding quantitative or qualitative requirements for advancement. This lack of clearly specified requirements may result in faculty members' inability to self-assess for readiness for promotion and inconsistent application of criteria in PT decisions by review committees and administrators.

Depression and diabetes distress in patients with diabetes.

We aimed to identify the prevalence of comorbid depression, diabetes, and diabetes distress and assess glycemic control and rates of diabetes-related complications. While the presence of either depression or distress did not predict the level of glycemic control, certain macro- and microvascular complications were more prevalent with depression.

Recurrent Thrombi in an Obese Patient With History of Bariatric Surgery Despite Anti-Xa Therapy.

Obesity and gastric bypass surgery can complicate anticoagulation therapy. In general, patients post-bariatric surgery are considered to be at a moderate risk for deep venous thromboembolism or pulmonary embolism. American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists guidelines recommend chemical prophylaxis with unfractionated heparin or low molecular weight heparin after surgery until the patient is fully mobile, and for those who require chronic anticoagulation, the International Society of Thrombosis and Haemostasis recommend warfarin if body mass index (BMI) is above 40 kg/m2 or weight is more than 120 kg. Clinical decision making regarding anticoagulation in the following patient case is complicated by multiple factors, most notably the combination of obesity and history of gastric bypass surgery. This patient failed multiple anticoagulation regimens, with apixaban and rivaroxaban therapies each ending in venous thromboemboli and warfarin leading to subtherapeutic International Normalized Ratio (INR)s despite dose adjustment. However, she is currently therapeutic on the combination of enoxaparin and warfarin as shown by INR and anti-Xa level monitoring. In this case and similar instances, there could be a need for anticoagulant dose adjustments, different INR goals, or a combination of different anticoagulants. Providers should take an individualized approach to patients who have had bariatric surgery with elevated BMI as a key factor in anticoagulant selection.

Impact of a Pharmacist-Led Group Diabetes Class.

BACKGROUND/OBJECTIVES: Diabetes is a chronic disease that is associated with many other health problems, but studies have shown that patient education can improve outcomes. The purpose of this project was to determine if a pharmacist-led group diabetes education class led to improvement in hemoglobin A1c levels. METHODS: Pharmacists in a family medicine clinic conduct a group diabetes education class for patients seen within the health system. The once monthly, 90-minute education class includes content regarding pathophysiology, complications, monitoring, dietary and exercise recommendations, and common antidiabetic medications. Data were collected via retrospective chart reviews and included 66 patients. The primary outcome was change in A1c from pre-class measurement to first, post-class measurement at least 3 months after pre-class measurement. Secondary outcomes included pre-class to post-class changes in weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Outcome data were analyzed using a paired t-test and demographic data were presented with descriptive statistics. RESULTS: The pharmacist-led diabetes education class was associated with statistically significant improvements on A1c lab values (mean decrease = 1.16%, p-value = 0.001) and weight (mean decrease = 1.8 kg, p-value = 0.03). However, SBP (mean decrease = 1.5 mmHg, p-value = 0.57) and DBP (mean decrease = 3.4 mmHg, p-value = 0.15) did not improve significantly. IMPLICATIONS: The results from this study support the idea that diabetes education classes are beneficial for the patient in learning how to properly manage this disease state. Pharmacists can play a vital role in diabetes management through counseling and patient education, which can improve patient outcomes.

A historical cohort study of glycemic control in patients with concurrent type 2 diabetes and substance use disorder treated in a primary care setting.

BACKGROUND: Substance use disorder (SUD) is a known barrier to patient-self-management, which can hinder efforts to achieve treatment goals in type 2 diabetes (T2D) when the conditions coexist. OBJECTIVE: Identify the association between SUD and glycemic control in patients with T2D treated in a primary care setting. METHODS: This retrospective cohort study included patients with T2D treated by providers at family medicine clinics at an academic medical center and its affiliated regional sites from January 2014 to October 2019. Study index date was the first A1c recorded when T2D and SUD diagnoses had both been documented in the medical record. Glycemic control, measured by hemoglobin A1c (A1c), was identified at baseline and over a 12-month follow-up period and was compared between SUD and non-SUD patients. RESULTS: Of 9568 included patients with T2D, 468 (4.9%) had a SUD diagnosis. In 237 SUD and 4334 non-SUD patients with A1c data, mean (SD) baseline A1c was 8.2% (2.5) and 7.9% (2.1), respectively (P = 0.043). A1c reduction was statistically greater in SUD patients than non-SUD patients (-0.31% versus -0.06%, respectively; P = 0.015), although the clinical significance is modest. In a multivariable linear regression analysis, follow-up A1c was lower in the SUD versus non-SUD patients (coefficient -0.184, 95% CI -0.358, -0.010; P = 0.038). CONCLUSIONS: Patients with T2D and SUD had higher baseline A1c but this difference was minimized over a 12-month follow-up period. Additional research is warranted to determine long-term glycemic control and barriers to attaining and maintaining glycemic control in patients with T2D and SUD.

Postgraduate year 1 pharmacy residency director perceptions of elective courses about residency training.

INTRODUCTION: There are few research articles that give college faculty insight into how pharmacy residency programs evaluate applicants, and there is no data to indicate how residency program directors (RPDs) view pharmacy residency elective courses when evaluating applicants' transcripts. This study sought to describe post-graduate year 1 (PGY1) RPD perceptions of pharmacy residency electives. METHODS: An online, 8-item survey was distributed to 1335 PGY1 RPDs, identified through the American Society of Health-System Pharmacists Online Residency Directory. RESULTS: Two hundred thirty-two residency program directors participated in the survey. The majority of respondents (68.1%) stated that a residency elective would not change their perception of candidates, though 75.9% agreed that a residency elective is beneficial to the student and 53% responded that the elective would be beneficial to the residency program. Time management and research skills were the topics that were most often recommended to be included in such courses. CONCLUSIONS: Overall, responses were favorable toward pharmacy residency electives, though most stated completion of such a course would not change their assessment of candidates. These courses could be most beneficial if they include development in skills necessary for successful residency training.