An Exploration of the Relationships Between Multiple Mini-Interview Scores and Personality Traits.

Objective. To explore the relationship between pharmacy students' social and behavioral competencies assessed using multiple mini-interviews (MMIs) and their personality traits. Methods. A retrospective study was conducted using data from two Doctor of Pharmacy (PharmD) cohorts. Students' self-reported scores from an externally validated tool completed during their first professional year that assessed five personality traits (openness to experiences, conscientiousness, extraversion, agreeableness, and emotionality) were collected. Students' scores on empathy, integrity, adaptability, critical thinking, and collaboration were collected during MMIs conducted during the admissions process. Analysis of variance was used to test the homogeneity of the sample, and correlation analyses were used to determine the strength of relationships between variables. Results. When examining for associations between students' personality traits and their social and behavioral competencies measured during the MMIs, we found a few significant but very weak correlations with extraversion. Conclusion. Our results revealed weak to negligible correlations between scores on competencies measured during the MMIs and personality traits, potentially because the assessments measured different constructs.

Physician-pharmacist collaboration on chronic non-cancer pain management during the opioid crisis: A qualitative interview study.

BACKGROUND: Management of chronic non-cancer pain is complex, requiring clinicians to balance pain management with the risk of opioid abuse. The role of ambulatory care pharmacists in chronic pain management is well-established, but little research has explored the feasibility of building collaboration on chronic pain and opioid management between physicians and community pharmacists. OBJECTIVE: To explore physician and pharmacist perspectives on the opioid crisis and the possibility of physician and community pharmacist collaborations to manage chronic non-cancer pain in the context of the opioid crisis. METHODS: Semi-structured interviews were performed with a snowball convenience sample 15 physicians and 25 pharmacists in North Carolina between November 2016 and April 2017. Transcribed data were analyzed using applied thematic analysis, and resulting codes were organized into themes and domains which emerged from analysis. RESULTS: Both physicians and pharmacists described current care deficiencies and steps needed to mitigate opioid abuse and diversion. Physicians discussed the need for additional supports and resources for chronic pain management and regarded positively the role of the community pharmacist in chronic pain management and mitigating opioid abuse. Pharmacists identified cost as the major barrier to implementing new services, and expressed willingness to participate in new chronic pain and opioid interventions. CONCLUSION: Within the study sample, strong interest exists for collaboration between physicians and community pharmacists. This highlights a potential opportunity to expand care for patients with chronic non-cancer pain.

Approach to initiating QT-prolonging oncology drugs in the ambulatory setting.

Since the introduction of regulatory drug approval guidance on the evaluation of QT interval prolongation, an increasing number of drug monographs has included cautions on the risk of QT prolongation. For example, QT prolongation is mentioned in the Canadian product monographs of 29 drugs commonly seen in oncology practice. This presents two major challenges. First, most guidelines and risk predictive tools for QT prolongation have been developed for hospitalized patients in acute care settings. In contrast, most QT-prolonging oncology drugs are used in medically stable patients in the ambulatory setting. Second, many oncology drugs are unique for their indications and non-QT prolonging alternative agents are often not available. In this review, we will outline an empiric initial approach to ambulatory cancer patients who are treated with oncology drugs which may prolong QT interval. This includes the predictive value of QT prolongation on torsades de pointes, the risk factors of the patients and the drugs, and the limitations of existing guidance in this area.

Assessing student academic time use: assumptions, predictions and realities.

CONTEXT: In an era of medical education reform and increasing accountability at all levels of higher education, there is a need to understand how the time in which students engage in academic activities can inform evidence-based quality improvement of the curriculum. Time logging provides an opportunity to quantify student use of academic time and guide data-informed decision making in curriculum design. OBJECTIVES: This study aimed to evaluate faculty staff and student predictions of students' academic time use and to assess students' reported academic time use. METHODS: Graduate-level professional students engaged in a time use exercise during the first semester of Year 1 (autumn 2015) and second semester of Year 2 (spring 2017) of a redesigned curriculum launched in autumn 2015. This exercise involved three key activities: (i) prediction of time use; (ii) time logging, and (iii) reflection on time use. Key faculty staff predicted students' weekday time use in both semesters. RESULTS: Students' predictions of academic time use strongly correlated with their reported academic time use during both the first semester of Year 1 and second semester of Year 2 (r = 0.55 and r = 0.53, respectively). Faculty members' predictions of academic time use did not correlate with student academic time use during either semester. Although 63.8% of Year-1 students reported the time use exercise motivated them to change their time use, students reported spending similar amounts of time on academic activities during the first semester of Year 1 (7.8 ± 1.5 hours per weekday) and the second semester of Year 2 (7.9 ± 2.0 hours per weekday). Most students reported that the exercise had been useful and indicated that their logged time accurately reflected their actual time use. CONCLUSIONS: Although curriculum reform efforts may always require that some assumptions be made, time logging can quantify students' academic use of time. Although students predict their use of time more accurately than do faculty staff, negligible changes in students' academic time use despite reported desires to make changes indicate that students' academic time use may remain inelastic. Educators must consider these findings as they design curricula, identify academic rigour, and establish student expectations of academic time use.

Efficacy of bevacizumab and temozolomide therapy in locally advanced, recurrent, and metastatic malignant solitary fibrous tumour: A population-based analysis.

BACKGROUND: Patients with locally advanced, recurrent or metastatic solitary fibrous tumour are often treated with bevacizumab and temozolomide based on the clinical efficacy reported in a case series of 14 patients. Given the rarity of solitary fibrous tumour, large trials are not feasible. We report the efficacy of this regimen based on a population-based analysis. METHODS: This was a population-based retrospective, multi-centre analysis using patient data from a provincial cancer registry and treatment database. Cases from June 2006 through October 2016 were identified for patients receiving bevacizumab and temozolomide for locally advanced, recurrent or metastatic solitary fibrous tumour or hemangiopericytoma, which is sometimes used to describe tumours arising from the meninges. The primary outcome was overall response rate. Secondary outcomes included time to response, progression free survival and overall survival estimated using the Kaplan-Meier method. RESULTS: Fourteen patients were identified: median age 59 (range 44-70), male 78.6%. Diagnoses were solitary fibrous tumour in 10 (71.4%) and hemangiopericytoma in four (28.6%), with metastatic disease in 10 (72.7%) patients. The most common primary sites were meninges in four (28.6%) and pelvis in three (21.4%) patients. The median follow-up was 15.5 months, with median treatment of four months. Overall response rate was 21.4% (no complete response, 3 partial response), with median time to response of four months. Median progression free survival, six-month progression free survival and overall survival were 17 months, 65.0%, and 45 months, respectively. CONCLUSIONS: Efficacy of bevacizumab and temozolomide in solitary fibrous tumour appeared to be similar to that previously reported. Our findings confirmed that bevacizumab and temozolomide is an effective and tolerated treatment for this patient population.

Expression of 5-HT3 receptors and TTX resistant sodium channels (Na(V)1.8) on muscle nerve fibers in pain-free humans and patients with chronic myofascial temporomandibular disorders.

BACKGROUND: Previous studies have shown that 5-HT3-antagonists reduce muscle pain, but there are no studies that have investigated the expression of 5-HT3-receptors in human muscles. Also, tetrodotoxin resistant voltage gated sodium-channels (NaV) are involved in peripheral sensitization and found in trigeminal ganglion neurons innervating the rat masseter muscle. This study aimed to investigate the frequency of nerve fibers that express 5-HT3A-receptors alone and in combination with NaV1.8 sodium-channels in human muscles and to compare it between healthy pain-free men and women, the pain-free masseter and tibialis anterior muscles, and patients with myofascial temporomandibular disorders (TMD) and pain-free controls. METHODS: Three microbiopsies were obtained from the most bulky part of the tibialis and masseter muscles of seven and six healthy men and seven and six age-matched healthy women, respectively, while traditional open biopsies were obtained from the most painful spot of the masseter of five female patients and from a similar region of the masseter muscle of five healthy, age-matched women. The biopsies were processed by routine immunohistochemical methods. The biopsy sections were incubated with monoclonal antibodies against the specific axonal marker PGP 9.5, and polyclonal antibodies against the 5-HT3A-receptors and NaV1.8 sodium-channels. RESULTS: A similar percentage of nerve fibers in the healthy masseter (85.2%) and tibialis (88.7%) muscles expressed 5-HT3A-receptors. The expression of NaV1.8 by 5-HT3A positive nerve fibers associated with connective tissue was significantly higher than nerve fibers associated with myocytes (P < .001). In the patients, significantly more fibers per section were found with an average of 3.8 ± 3 fibers per section in the masseter muscle compared to 2.7 ± 0.2 in the healthy controls (P = .024). Further, the frequency of nerve fibers that co-expressed NaV1.8 and 5-HT3A receptors was significantly higher in patients (42.6%) compared to healthy controls (12.0%) (P < .001). CONCLUSIONS: This study showed that the 5-HT3A-receptor is highly expressed in human masseter and tibialis muscles and that there are more nerve fibers that express 5-HT3A-receptors in the masseter of women with myofascial TMD compared to healthy women. These findings indicate that 5-HT3-receptors might be up-regulated in myofascial TMD and could serve as potential biomarkers of chronic muscle pain.