Incorporating a peer-teaching, virtual, educational activity to teach newly approved medications in a senior seminar capstone course.

BACKGROUND AND PURPOSE: Peer teaching and serious gaming are effective pedagogical approaches to actively engage learners, foster collaboration, and promote student accountability for self-directed learning. Literature describing how students learn about and are assessed on knowledge of newly approved medications is lacking. The objective of this project is to describe the design and implementation of a peer-taught virtual educational gaming activity, assess impact on knowledge of newly approved medications, and describe student perceptions of the activity. EDUCATIONAL ACTIVITY AND SETTING: Pharmacy students in the fourth professional year developed and delivered a topic discussion focusing on newly approved medications to peers utilizing a virtual escape room gaming format. The activity was delivered via Zoom, Version 4.6.9 (Zoom Video Communications, Inc). A pre- and post-activity knowledge-based assessment and perception-based questionnaire were administered to participants. Observations regarding teamwork and communication were collected by facilitators. FINDINGS: Sixteen students participated in this activity. Mean scores on the knowledge quiz were higher post-activity compared to pre-activity (8.1 vs. 6.3). The activity was perceived positively by participants with 100% of respondents agreeing or strongly agreeing that they "enjoyed the escape room theme for the activity and would recommend it to a friend." Zoom was perceived an effective platform to deliver this activity. All facilitators observed students working effectively as a team to complete the activity. SUMMARY: Virtual gaming developed and facilitated by peer teachers may be an effective method for delivering educational content and positively influencing student learning.

Pharmacy Intern Involvement in COVID-19 Immunization Practices in New York State.

BACKGROUND: Pharmacists and pharmacy interns were instrumental in vaccination efforts during the COVID-19 pandemic. Objectives: To identify pharmacy intern involvement in COVID-19 immunization practices in New York State (NYS) and explore interns' perceptions of experiences. METHODS: A 34-item survey was developed and administered at 5 pharmacy programs in NYS. Data collected included: perceptions of immunization readiness, participation in immunizations, description of experiences, and perceptions on the role of pharmacists. Respondents also reported on their preparedness to participate in the immunization process and the types of questions received from patients. Data were analyzed using descriptive statistics and thematic analysis. Questions regarding student experiences before and after participating in immunization efforts were analyzed using a two-sample t test. RESULTS: A total of 460 interns participated in the survey with 398 (87%) reporting participation in COVID-19 immunizations. Of those, 231 (58%) participated at work, 146 (36.7) during experiential rotations, and 98 (24.6%) during volunteer experiences. Respondents participated in various components of vaccine delivery including administration (n = 246, 61.8%). Respondents administered an estimated 57,100 COVID-19 vaccines from December 2020 to April 2021 resulting in significantly higher mean scores for comfort level (5-point Likert scale) administering vaccines after participation (mean score 4.08 ± 1.31) compared to before (mean score 3.61 ± 1.42) (p < .0001). Themes which emerged regarding student perceptions of their experience are described. CONCLUSION: Pharmacy intern involvement in NYS COVID-19 immunization practices contributed to public health vaccination efforts. Additionally, interns improved comfort levels with immunization administration and recognized pharmacists' emerging roles within the U.S. healthcare system.

Early Age of Cannabis Initiation and Its Association With Suicidal Behaviors.

Background: Suicide rates in the U.S. have continued to rise over the last 2 decades. The increased availability and broader legalization of cannabis is a public health concern, particularly among adolescents. The objective of this study was to examine the association between the age of cannabis initiation and lifetime suicidal ideations and attempts in a sample of adults aged 18 or older. Methods: Data are from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 to 2003 (N = 15 238). The primary objective of the CPES was to collect data about the prevalence of mental disorders, impairments associated with these disorders, and their treatment patterns from representative samples of majority and minority adult populations in the U.S. Logistic regression analyses were conducted to test the association between cannabis initiation age (early ⩽14 years old; later >14 years old) and outcomes of lifetime suicide ideation and attempts. Cigarette use, cannabis use, gender, income, race, education, and age were controlled for the analyses. Results: Overall, 12.5% of participants reported suicide ideation, while 4.2% reported attempt. Early cannabis use was associated with a higher risk of suicide ideation (AOR = 3.32, 95% CI [2.75, 3.80]) than later cannabis use (AOR = 2.15, 95% CI [1.92, 2.39]). Early cannabis use was associated with a higher risk of suicide attempt (AOR = 4.38, 95% CI [3.48, 5.52]) than later cannabis use (AOR = 2.56, 95% CI [2.14, 3.06]). Wald chi-squared tests revealed significant differences between the early and late initiation for both ideation (χ2 = 26.99; P < .001) and attempts (χ2 = 26.02; P < .001). Conclusions: Significant associations were found between early initiation of cannabis and suicide behaviors. As suicide rates continue to rise, it is recommended that clinicians, treatment providers, and other professionals consider the use of cannabis at an early age as a risk for subsequent suicide behaviors.

Impact of COVID-19 on graduating U.S. pharmacy students in the early epicenter of the pandemic in New York City.

OBJECTIVE: To describe the self-reported impact of the COVID-19 pandemic among final year student pharmacists enrolled in a Doctor of Pharmacy program in New York City during the first peak of the outbreak March through May 2020. METHODS: A required senior seminar course for graduating student pharmacists served as a conduit for faculty led monitoring of the wellbeing of the cohort through three data sources: 1) polling data regarding stress factors during a COVID-19 informational session (March 2020), 2) survey data from a 12-item COVID-19 Impact Survey developed and administered electronically in May 2020 and 3) qualitative data from reflection papers mentioning COVID-19. Descriptive statistics, bivariate analysis and thematic analysis were used to summarize data. RESULTS: In March, almost half of respondents (total = 185) reported high personal (47.6%) and school related stress (42.1%). Most students were participating in advanced pharmacy practice experiences (80%) and working in a pharmacy (80%). Survey data (n = 96) revealed the majority of participants perceived negative impact on their future career (69%) and reported concern for people close to them with suspected and confirmed COVID-19. One-third of participants reported knowing someone who died from COVID-19 and 8% were self-confirmed COVID-19 positive. Themes emerging from the reflection papers included: changed perspective, gained experience as a pharmacist during a pandemic, concern for loved ones, and positive outlook. CONCLUSION: The COVID-19 pandemic had a significant impact on the wellbeing of a cohort of graduating student pharmacists in New York during the initial peaks of the spread in the United States. The results reinforce a need for student support during emergency situations, especially during the final year.

Students' perceptions of global health competencies in the doctor of pharmacy (PharmD) curriculum.

INTRODUCTION: This study sought to determine pharmacy students' self-assessment of their level of competency in specified global health statements across various schools. It also evaluated attributes associated with competency and perception of importance, as well as explored students' perspectives on how best to incorporate global health content into pharmacy education. METHODS: Cross-sectional survey administered online to pharmacy students from three pharmacy schools in the United States. RESULTS: The self-assessed competency of pharmacy students in global health topic areas was low. Current or prior exposures outside of the PharmD curriculum to the global health content presented in the survey were significant indicators of self-assessed competency scores. Within individual participating schools, demographic characteristics such as gender, age category, speaking a non-English language, and progression through the PharmD curriculum were also significantly associated with competency scores reported. Most respondents (96%) agreed that relevant global health education should be incorporated into the pharmacy curriculum. CONCLUSIONS: Pharmacy students generally perceive global health competencies to be of great importance in practice, but acknowledge their deficiencies in this area. The current burden of global health education at the schools surveyed relies on individual student experience rather than curricular support. Ensuring that future pharmacists understand their role in global health teams and are able to achieve the necessary level of competency to function in interdisciplinary initiatives will require more strategic incorporation of relevant content into the curriculum.

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

Impact of an Integrated Pharmacy Transitions of Care Pilot Program in an Urban Hospital.

PURPOSE: To evaluate the effectiveness of an integrated Pharmacy Transitions of Care (PTC) pilot program on reducing hospital readmissions and improving patient satisfaction. METHODS: This prospective observational cohort study compares patients who participated in the PTC program to a control of usual hospital discharged patients during January through April 2014. The PTC program provided discharge medication review, medication counseling, delivery of medications to bedside, clinic scheduling, and follow-up phone calls. The primary outcome measure was 30-day readmissions. Secondary outcomes included emergency department (ED) visits, pharmacist interventions, and patient satisfaction. RESULTS: Seventy patients participated in the PTC program. Compared to the control (n = 725), the study group had decreased 30-day all-cause readmissions (5.7% vs 13.8%, P = .08), 30-day readmissions for the same diagnosis (2.9% vs 8.1%, P = .18), and ED visits (18.6% vs 25%, P = .82). Twenty-five interventions during discharge medication review included discontinuation of unnecessary medications and correction of medication dose or frequency. The majority of patients were satisfied with the medication education provided (94%) and the timely delivery of prescriptions to bedside (96%). CONCLUSION: There was no significant difference in 30-day readmission rates. However, pharmacists were able to make a positive impact on patient satisfaction and improve understanding of medications during discharge.

Vorapaxar for reduction of thrombotic cardiovascular events in myocardial infarction and peripheral artery disease.

PURPOSE: The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, dosage and administration, cost, and place in therapy of vorapaxar in the secondary prevention of atherosclerotic events are reviewed. SUMMARY: Vorapaxar is a highly selective, reversible antagonist of protease-activated receptor-1 expressed on platelets. Vorapaxar competitively inhibits thrombin from activating the receptor, thereby decreasing platelet aggregation. Vorapaxar is rapidly absorbed and distributed, with peak plasma levels being reached within 60-90 minutes. Vorapaxar's effective half-life is three to four days and its terminal elimination half-life is eight days. Vorapaxar sulfate 2.5 mg (equivalent to 2.08 mg of vorapaxar) orally daily without a loading dose was clinically effective for the secondary prevention of ischemic events in patients with a history of myocardial infarction (MI) or with peripheral arterial disease (PAD) without a history of stroke. Phase II and III trials of vorapaxar given with aspirin or a thienopyridine or both demonstrated a reduction in the primary endpoint of cardiovascular death, MI, and stroke in patients with a history of MI or coronary artery disease and PAD. Patients with a history of stroke were found to have an increased rate of intracranial hemorrhage (ICH), which led to a boxed warning placed on vorapaxar's labeling to warn of the increased risk for bleeding in patients with a history of stroke. CONCLUSION: Vorapaxar is a novel antiplatelet agent that has demonstrated efficacy in reducing atherosclerotic events in patients with a history of MI or PAD without a history of stroke, transient ischemic attack, or ICH when taken in combination with aspirin and clopidogrel.

Student preferences regarding teaching methods in a drug-induced diseases and clinical toxicology course.

OBJECTIVES: To determine which teaching method in a drug-induced diseases and clinical toxicology course was preferred by students and whether their preference correlated with their learning of drug-induced diseases. DESIGN: Three teaching methods incorporating active-learning exercises were implemented. A survey instrument was developed to analyze students' perceptions of the active-learning methods used and how they compared to the traditional teaching method (lecture). Examination performance was then correlated to students' perceptions of various teaching methods. ASSESSMENT: The majority of the 107 students who responded to the survey found traditional lecture significantly more helpful than active-learning methods (p=0.01 for all comparisons). None of the 3 active-learning methods were preferred over the others. No significant correlations were found between students' survey responses and examination performance. CONCLUSIONS: Students preferred traditional lecture to other instructional methods. Learning was not influenced by the teaching method or by preference for a teaching method.

Contemporary approaches for evidence-based pharmacotherapy.

Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. This article provides simple ways to practice everyday EBM by (1) asking patient-specific clinical questions, (2) finding the most relevant, best evidence, (3) critically appraising evidence to ensure validity, (4) applying evidence to practice, and (5) using available tools to stay abreast of relevant and valid evidence as it becomes available.

Journal clubs during advanced pharmacy practice experiences to teach literature-evaluation skills.

OBJECTIVE: To determine pharmacy students' attitudes and academic performance related to journal club during 2 advanced pharmacy practice experiences (APPEs). DESIGN: Fourth-year pharmacy students were required to complete 3 journal club assignments during drug information and internal medicine APPEs. ASSESSMENT: A majority (91.3%) of the 105 students who responded to a 21-item survey instrument indicated that journal club assignments during the drug-information APPE were valuable to their understanding of research design and statistics. Students who completed the drug-information APPE before the internal medicine APPE scored higher on their understanding of the strengths and weaknesses and the clinical relevance of studies and had a higher learning slope (p = 0.01) than did students who completed the internal medicine APPE first. CONCLUSION: Incorporating journal clubs into APPEs is an effective means of teaching literature-evaluation skills to pharmacy students.

Rifaximin: new therapeutic indication and future directions.

BACKGROUND: Rifaximin is a nonabsorbable oral antibiotic that acts locally in the gastrointestinal tract with minimal systemic adverse effects. Rifaximin received new labeling for reduction in the risk of the recurrence of overt hepatic encephalopathy (HE) in patients with advanced liver disease in March of 2010. OBJECTIVE: This article reviews the pharmacology, pharmacokinetics, and pharmacodynamics of rifaximin. The efficacy and safety of rifaximin in reducing the risk of the recurrence of overt HE in patients with advanced liver disease, the new US Food and Drug Administration-approved indication, is the focus of this review. Emerging data on the use of rifaximin in irritable bowel syndrome (IBS) and Clostridium difficile infection (CDI) are also evaluated. METHODS: MEDLINE and International Pharmaceutical Abstracts from 1983 to January 31, 2011, were searched using the key terms rifaximin, L/105, secondary hepatic encephalopathy, irritable bowel syndrome, and Clostridium difficile. Ongoing trials were identified using the clinicaltrials.gov Web site. Abstracts from the annual meetings of the American College of Gastroenterology and Digestive Disease Week from 2004 to 2010 and references from relevant articles were reviewed. Only trials examining use of rifaximin in secondary prophylaxis of HE were included. Studies on the efficacy and safety of rifaximin in the treatment of acute episodes of HE have been recently summarized elsewhere and are not reviewed here. RESULTS: Literature search identified one trial on rifaximin use in secondary prevention of HE, six trials in patients with IBS, and six small studies and case reports in patients with CDI. In a trial of 299 patients, use of rifaximin 550 mg by mouth twice daily for 6 months for prevention of recurrent HE was associated with significantly fewer breakthrough HE episodes compared with placebo (rifaximin 22%, placebo 46%; P < 0.001), with a hazard ratio of 0.42 (95% CI, 0.28-0.64). The rifaximin group also had fewer hospitalizations involving HE compared with placebo (rifaximin 13.6%, placebo 22.6%; P = 0.01), with a hazard ratio of 0.50 (95% CI, 0.29-0.87). Rifaximin improved IBS symptom management in ∼9% more patients than placebo in 2 prospective, randomized, double-blind, placebo-controlled trials of 1260 patients (in the rifaximin group, 40.8% patients reported IBS symptom improvement compared with 31.7% in the placebo group; P < 0.001). The efficacy of rifaximin has been reported for the treatment of refractory or recurrent CDI in small studies, case series, and a case report. Optimal dosing, duration, and role of rifaximin for CDI management is unclear. In clinical trials of rifaximin for prevention of recurrent HE and for nonconstipated IBS, its safety profile was comparable to placebo. In the trial of rifaximin for prevention of recurrent HE, the most common adverse events occurring in 10% to 15% of patients were ascites, dizziness, fatigue, and peripheral edema. Most common adverse effects in IBS trials included abdominal pain, diarrhea, bad taste, headache, and upper respiratory tract infection, occurring in <10% of patients. CONCLUSIONS: Rifaximin can be an effective option for reduction in the risk of the recurrence of HE in patients with advanced liver disease. Studies suggest that rifaximin provides relief of global symptoms of diarrhea-predominant IBS and bloating. Use of rifaximin in CDI requires further study.