Comparative prevalence of anogenital injury following sexual assault in women who have had recent consensual sexual contact.

OBJECTIVE: The purpose of this study was to compare the frequency and types of anogenital trauma in rape victims as a function of the time interval between the assault and recent (72 h) consensual sexual intercourse. METHODS: This retrospective cohort trial evaluated consecutive female patients, age 13 years or older, presenting to a community-based nurse examiner clinic (NEC) during a 5-year study period. The NEC facility is staffed by forensic nurses trained to perform medical-legal examinations using colposcopy with nuclear staining and digital imaging. Eligible patients were classified into five different groups based on the time interval from the last consensual intercourse to the forensic examination (none, 0-24 h, 25-48 h, 49-72 h, 73-96 h). Patient demographics, assault characteristics, and injury patterns were recorded using a standardized classification system. RESULTS: A total of 947 cases of sexual assault met the inclusion criteria and were divided into five groups. The age range was 13 to 87 years (mean, 23.9 years); 78% were examined within 24 h following sexual assault. The five study groups were comparable in terms of demographics, assault history, and incidence of non-genital injuries. The overall frequency, type, or location of anogenital injury did not vary significantly between groups (p > 0.5). CONCLUSION: This is the first clinical study to systematically compare the prevalence and typology of anogenital injuries in sexual assault victims who have had consensual intercourse within four days before a forensic exam. The frequency, type or location of anogenital trauma did not vary significantly based on the time interval from last consensual intercourse to the forensic examination.

Pyogenic sacroiliitis: A rare complication of inflammatory bowel disease.

Although sacroiliitis is not uncommon in patients with inflammatory bowel diseases (IBD), bacterial infection of the sacroiliac joint is rare. The diagnosis is often delayed because of low clinical suspicion, a vague clinical picture and poorly defined localization of symptoms. We report a case of pyogenic sacroiliitis in a patient with Crohn's disease caused by Clostridia spp. and discuss key clinical components and protocol for the successful evaluation, diagnosis, and treatment of this uncommon illness.

A Randomized Trial of SMART Goal Enhanced Debriefing after Simulation to Promote Educational Actions.

INTRODUCTION: Goal setting is used in education to promote learning and performance. Debriefing after clinical scenario-based simulation is a well-established practice that provides learners a defined structure to review and improve performance. Our objective was to integrate formal learning goal generation, using the SMART framework (Specific, Measurable, Attainable, Realistic, and Time-bound), into standard debriefing processes (i.e., "SMART Goal Enhanced Debriefing") and subsequently measure the impact on the development of learning goals and execution of educational actions. METHODS: This was a prospective multicenter randomized controlled study of 80 emergency medicine residents at three academic hospitals comparing the effectiveness of SMART Goal Enhanced Debriefing to a standard debriefing. Residents were block randomized on a rolling basis following a simulation case. SMART Goal Enhanced Debriefing included five minutes of formal instruction on the development of SMART learning goals during the summary/application phase of the debrief. Outcome measures included the number of recalled learning goals, self-reported executed educational actions, and quality of each learning goal and educational action after a two-week follow-up period. RESULTS: The mean number of reported learning goals was similar in the standard debriefing group (mean 2.05 goals, SD 1.13, n=37 residents), and in the SMART Goal Enhanced Debriefing group (mean 1.93, SD 0.96, n=43), with no difference in learning goal quality. Residents receiving SMART Goal Enhanced Debriefing completed more educational actions on average (Control group actions completed 0.97 (SD 0.87), SMART debrief group 1.44 (SD 1.03) p=0.03). CONCLUSION: The number and quality of learning goals reported by residents was not improved as a result of SMART Goal Enhanced Debriefing. Residents did, however, execute more educational actions, which is consistent with the overarching intent of any educational intervention.

Residents as preceptors and educators: What we can learn from a national survey to improve our residency programs.

INTRODUCTION: Developing pharmacy residents into effective preceptors is essential to meet the demands of pharmacy education. A survey was created to assess the availability of resident precepting educational opportunities, identify common barriers associated with developing preceptors' skills, and discover strategies to optimize programming. METHODS: An online survey focused on the development of residents as preceptors was e-mailed to all residency program directors (RPD) for American Society of Health-System Pharmacists accredited residencies in the United States. Information was collected on program demographics, level of support and precepting activities offered and resident employment outcomes. RESULTS: Five hundred thirty-eight responses were received. The majority were postgraduate year one RPDs and had less than six residents. Sixty-one percent of programs were affiliated with a college of pharmacy. Seventy-eight percent devoted 10hours or less per month in developing residents as preceptors with 33% providing less than five hours. Seventy-one percent of the residency programs did not offer a formal precepting rotation. However, 59% of respondents indicated that their residency graduates frequently accepted positions, which required teaching/precepting. The most common barriers to developing residents as preceptors included: lack of time for residents to precept within the residency structure (41%), availability of preceptors to mentor residents throughout experience (33%) and lack of preceptors' availability to mentor residents' precepting abilities over time (30%). DISCUSSION AND CONCLUSIONS: RPDs should prioritize training of residents as preceptors. Requiring residents to serve as primary preceptors in rotations dedicated to teaching is important to prepare for future job responsibilities.

Needs assessment for developing a program to help train advanced-practice pharmacists for research.

PURPOSE: Results of a needs assessment to determine priority topics and preferred formats for research training in pharmacy residency programs are reported. SUMMARY: For pharmacists seeking advanced-practice positions in academia, the ability to conduct practice-based research is expected. Pharmacy residency programs are a primary recruitment source for these positions, but research training varies by residency site and available expertise. To help define the optimal content and format of resident research training, ASHP and the ASHP Research and Education Foundation conducted a needs assessment targeting postgraduate year 1 (PGY1) pharmacy residency directors (RPDs). The response rate was 36.5% (271 of 743 invitees); the information obtained was used to guide development of a Web-based training series. Only 12% of the RPDs who participated in the survey indicated that currently available research training resources within their residency programs were sufficient. Sixty-seven percent of surveyed RPDs agreed that a Web-based training program would be a useful resource, and 81% agreed that the target audience should be pharmacy residents. Training topics of greatest interest to RPDs included (1) components of a resident research plan, (2) identifying research questions, (3) study design and sample selection, (4) project management, (5) data acquisition, cleaning, management, and analysis, and (6) presenting and publishing project results. CONCLUSION: This needs assessment clearly identified opportunities for improving the infrastructure and content of PGY1 residency research training. At a minimum, training programs should focus on practice-based research concepts using readily accessible health-system data systems and provide universal accessibility and sufficient flexibility to allow residency programs to integrate the training in a manner that works best for the program.

National survey of pharmacy residents nearing completion of the 2014-15 residency year.

PURPOSE: The results of a national survey targeting postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) resident's perceptions of their residency programs and postresidency job prospects are presented. METHODS: An electronic survey was distributed to PGY1 and PGY2 residents identified through the ASHP membership database. The survey asked basic demographic questions, questions related to the residency experience (satisfaction, hours spent on various general activities such as patient care, research, and staffing), and various questions related to residents' job search and future career plans (search methods, outcomes, and satisfaction with the process). RESULTS: A total of 529 responses were received from the 2,766 surveys that were distributed, yielding a response rate of 19%. Most respondents reported having a favorable opinion of their residency. At the time of the survey, 71% of residents reported having found a full-time job; 17% of residents were still looking for a position. Eighty-five percent of PGY2 residents reported accepting a position in their specialty area and accepted clinical specialist roles in larger numbers than did PGY1 residents. Geographic location, practice/specialty area, and shift/schedule were the 3 areas of compromise most frequently mentioned when accepting a position and were the 3 areas ranked highest in terms of job importance. CONCLUSION: A survey of PGY1 and PGY2 pharmacy residents revealed that about one sixth of respondents entering the job market were having difficulty finding a position before finishing residency training and that most respondents were satisfied with their residency experience.

Reassessment of Health-System Capacity for Experiential Education Requirements.

Objective. To provide an update to the 2007 ASHP-AACP survey by examining the current capacity of hospitals/health systems' ability to conduct experiential education for doctor of pharmacy students. Methods. Pharmacists identified as pharmacy directors were sent an invitation to participate in an online survey tool. The survey tool asked IPPE- and APPE-specific questions, the nature of support provided by colleges/schools of pharmacy, the types of experiences available for students, and the factors influencing the quality, value, and challenges of experiential education. Results. Four hundred sixty five of the 2,911 surveys sent were completed yielding a response rate of 16%. Respectively, 45.1% and 28.5% of respondents believe that the capacity for APPE and IPPE will increase in the next five years. Overall, respondents believe that students receive a high-quality experiential education (91.4%). Conclusion. The results of this survey provide insight to the capacity, benefits and challenges of experiential education from the perspective of hospitals/health systems.

Variations in pharmacy-based transition-of-care activities in the United States: a national survey.

PURPOSE: A national survey was conducted to assess pharmacist roles in transition-of-care (TOC) activities in the United States. METHODS: An online survey was sent to 1246 pharmacy directors who were members of the American Society of Health-System Pharmacists to assess their involvement in TOC activities including medication reconciliation, admission histories, medication counseling, and postdischarge follow-up; pharmacy student and pharmacy technician involvement in TOC activities; the use of technology to facilitate TOC activities; and barriers to performing such activities. RESULTS: A total of 393 respondents completed the survey (31.5% response rate). Twenty-seven percent of respondents indicated that pharmacists complete medication histories on admission, and 5% indicated that pharmacy technicians complete medication histories. Most respondents indicated that pharmacists do not routinely or consistently provide patients with tools to facilitate medication adherence before hospital discharge and that pharmacists do not routinely or consistently follow up with patients after discharge. Fifty-six percent of respondents indicated that pharmacists provide patient education for specific medications or for medications for specific diseases. Few respondents indicated that student pharmacists are involved with TOC activities. Most respondents either agreed or strongly agreed that it is important for pharmacists to be involved in TOC activities for hospitalized patients. CONCLUSION: Approximately one third of survey respondents indicated that pharmacists complete medication histories. Most respondents indicated that pharmacists do not routinely or consistently provide patients with tools to facilitate medication adherence before hospital discharge or follow up with patients after discharge. Lack of pharmacy staff resources and insufficient recognition of the value of pharmacists' provision of TOC by health care executives, medical staff, nursing staff, and other health care professionals were the most frequently cited barriers to pharmacists assuming more significant roles in the TOC at the respondent's institution.

Impact of shortages of injectable oncology drugs on patient care.

PURPOSE: Results of a survey regarding shortages of injectable oncology drugs in U.S. hospitals and health systems are presented. METHODS: An online survey was sent to all members of the American Society of Health-System Pharmacists self-identified as directors of pharmacy. Survey participants provided information on the extent to which their facilities were affected by oncology drug shortages, strategies for responding to shortages, and the effects of shortages on costs, patient safety, and outcomes. RESULTS: Ninety-eight percent of the 358 survey respondents reported at least one drug shortage during the previous 12 months, with 70% reporting instances of an inadequate supply to treat patients and 63% reporting that their facility had completely run out of at least one injectable oncology drug. Sixty-two percent of respondents reported using alternative drug regimens due to shortages; 46% reported drug dosage changes, 43% reported treatment delays, and 21% reported patient referrals to or from other facilities as a result of shortages. Survey respondents indicated the use of various strategies to manage oncology drug shortages (e.g., increasing inventories of certain drugs, identifying alternatives and substitution protocols, altered purchasing practices), all of which have led to cost increases. Twenty-five percent of respondents reported safety events resulting from oncology drug shortages. Only 40% of respondents agreed that currently available information is useful in mitigating the effects of shortages. CONCLUSION: Shortages of injectable oncology drugs appear to be widespread and to be having a significant impact on patient care. Currently available information about shortages does not meet administrative or clinical needs.

Emergency medicine residents' self-assessments play a critical role when receiving feedback.

OBJECTIVES: Emergency medicine (EM) faculty often aim to improve resident performance by enhancing the quality and delivery of feedback. The acceptance and integration of external feedback is influenced by multiple factors. However, it is interpreted through the "lens" of the learner's own self-assessment. Ideally, following an educational activity with feedback, a learner should be able to generate and act upon specific learning goals to improve performance. Examining the source of generated learning goals, whether from one's self-assessment or from external feedback, might shed light on the factors that lead to improvement and guide educational initiatives. Using a standard oral board scenario, the objective of this study was to determine the effects that residents' self-assessment and specific feedback from faculty have on not only the generation of learning goals but also the execution of these goals for performance improvement. METHODS: In this cross-sectional educational study at four academic programs, 72 senior EM residents participated in a standardized oral board scenario. Following the scenario, residents completed a self-assessment form. Next, examiners used a standardized checklist to provide both positive and negative feedback. Subsequently, residents were asked to generate "SMART" learning goals (specific, measurable, attainable, realistic, and time-bound). The investigators categorized the learning goals as stemming from the residents' self-assessments, feedback, or both. Within 4 weeks, the residents were asked to recall their learning goals and describe any actions taken to achieve those goals. These were grouped into similar categories. Descriptive statistics were used to summarize the data. RESULTS: A total of 226 learning goals were initially generated (mean ± SD = 3.1 ± 1.3 per resident). Forty-seven percent of the learning goals were generated by the residents' self-assessments only, while 27% were generated by the feedback given alone. Residents who performed poorly on the case incorporated feedback more often than high performers when generating learning goals. Follow-up data collection showed that 62 residents recalled 89 learning goals, of which 52 were acted upon. On follow-up, the numbers of learning goals from self-assessment and feedback were equal (25% each, 13 of 52), while the greatest number of reportedly executed learning goals came from self-assessments and feedback in agreement (40%). CONCLUSIONS: Following feedback on an oral board scenario, residents generated the majority of their learning goals from their own self-assessments. Conversely, at the follow-up period, they recalled an increased number of learning goals stemming from feedback, while the largest proportion of learning goals acted upon stemmed from both feedback and self-assessments in agreement. This suggests that educators need to incorporate residents' self-assessments into any delivered feedback to have the greatest influence on future learning goals and actions taken to improve performance.