Personality and Academic Performance During Years Two and Three of a Doctor of Pharmacy Curriculum.

OBJECTIVE: To evaluate academic success among students with different dominant personality styles as determined by DiSC (dominance, influence, steadiness, and conscientiousness) assessment via a comparison of grade point average (GPA) during the 3-year didactic portion of a PharmD curriculum. METHODS: This was a prospective evaluation of students admitted to the PharmD program as part of the graduating classes of 2019-2022 who provided written informed consent, completed an online DiSC assessment, and forwarded their personality style results to study investigators. Participant demographics were collected upon enrollment and individual course grades, semester, and cumulative GPA, and any academic standards penalties imposed were collected at the end of each semester. RESULTS: The overall participation rate for the student cohort studied was 96%. No significant differences were seen when evaluating the primary objective by comparing GPA of each of the 4 individual dominant personality styles. However, significant differences were found when evaluating the secondary objective comparing conscientiousness vs all other dominant personality styles regarding both individual semester and cumulative GPA. Students with conscientiousness as a dominant personality style also had significantly higher pharmacotherapeutics-focused systems-based therapy cumulative GPA during the second and third years of the PharmD didactic curriculum. CONCLUSION: Students with a dominant personality style of conscientiousness on DiSC assessment performed significantly better within the more clinically focused systems-based therapy courses in a PharmD curriculum. This ultimately culminated in higher cumulative GPA at the end of both the second and third professional years in those with a dominant personality style of conscientiousness.

Perceived stress, academic self-concept, and coping mechanisms among pharmacy students following a curricular revision.

INTRODUCTION: Pharmacy students experience high levels of perceived stress. Data regarding the impact of curricular revision on students' stress level are lacking. The primary objective of this study was to compare perceived stress, academic self-concept, and coping strategies between pharmacy students prior to and following a curricular revision. Secondary objectives included determining university resources used by students to deal with stress. METHODS: Students in the first, second, and third years of the pharmacy curriculum were asked to complete a survey, including the 14-item Perceived Stress Scale (PSS-14), Brief COPE, and Academic Self-Concept Scale (ASCS), and questions regarding use of university resources. Responses to the PSS-14, Brief COPE, and ASCS were compared to a student cohort prior to the curricular revision. RESULTS: Perceived stress was reduced to a small, statistically significant degree following a curricular revision. In both cohorts, increased stress was statistically significantly correlated with decreased academic self-concept. Students reported increased use of self-distraction, along with decreased use of active coping, substance abuse, and planning, as coping strategies when compared to the previous cohort. Approximately half of the student cohort reported no use of university resources. The most commonly used resources were financial aid and mental health services. CONCLUSIONS: Perceived stress decreased following the revision of a Doctor of Pharmacy curriculum. The most common coping strategies were positive and comparable with strategies reported by students in the former curriculum. The impact of curricular changes on student stress and the use of university resources in health professions students warrant further study.

Student Personality Style and First-Year Academic Performance in a Doctor of Pharmacy Program.

Objective. To evaluate whether the personality styles of Doctor of Pharmacy (PharmD) students as determined by the DiSC assessment are associated with students' cumulative grade point average (GPA) or with academic penalties imposed in the first year of a PharmD program. Methods. All incoming PharmD students that provided informed consent and completed the DiSC personality assessment were included in the study. Participants provided demographic data and forwarded their electronic DiSC assessment results to study investigators upon completion. Relevant academic data were collected at the end of each semester. Results. The overall response rate for the classes of 2019-2022 was 95.6%. No significant associations were found when comparing personality styles as defined by the DiSC assessment and cumulative GPA at the end of the first year. Additionally, no associations were noted when comparing students' personality style and semester GPA or academic penalties received. Conclusion. Understanding factors that contribute to students' academic success can aid in early identification of students who are likely to succeed and of students who may benefit from early academic intervention. While no significant associations were found in the first-year of the curriculum, continued evaluation will be conducted to determine the impact of personality style on students' overall academic performance beyond the first year of the PharmD curriculum.

Essential Elements for Core Required Advanced Pharmacy Practice Experiences.

Since 2004, concerns and calls for greater quality assurance in experiential education have been published. The Accreditation Council for Pharmacy Education (ACPE) "Standards 2016" provide limited differentiation across the four required practice experiences, and, as such, schools interpret them differently. Both schools and accreditation site visit teams would benefit from a common set of guidance for the required Advanced Pharmacy Practice Experiences (APPEs), so that they can ensure consistency and quality in student experiences across practice sites. To address this need for greater standardization, a taskforce of the American Association of Colleges of Pharmacy (AACP) Experiential Education (EE) Section conducted a peer-reviewed, consensus-building process, including experiential faculty and staff across multiple colleges and schools of pharmacy, to determine a common set of elements that could be used to bring consistency to the experiences and expectations for student learning in practice. Over a two year period, the taskforce reviewed the relevant literature and then drafted and revised the elements through an iterative process which allowed for established EE consortia and members of the EE section to review the draft and provide input for revision. The resulting essential elements presented here can be used to guide faculty and staff within experiential education programs in their quality assurance processes in ensuring students receive consistent experience as part of their education prior to graduation.

Introduction of a continuing professional development tool for preceptors: lessons learned.

Accreditation Council for Pharmacy Education (ACPE) guidelines state that preceptors should "have a systematic, self-directed approach to their own continuing professional development (CPD)." The objective of this study was to encourage preceptors to take advantage of the ACPE CPD resources and implement the concept of CPD (reflect, plan, act, evaluate, record) as a framework for guiding individual preceptor's continuing development as educators and to determine their opinion regarding the usefulness, effectiveness, and obstacles to implementation of this approach. A total of 3713 preceptors from the participating schools were encouraged to undergo CPD training and invited to respond to a series of questions. Of the initial respondents, 48% represented health system/hospital preceptors, followed by community/independent pharmacists (64 of 236, 28%). Preceptor respondents often train students from multiple schools/colleges (average = 1.9 schools/colleges per preceptor) and 90% agreed or strongly agreed with the statement, "the CPD model, as learned in the webcasts, is beneficial for ongoing preceptor development." The general consensus was that the preceptor portfolio provided motivation to reflect, plan, and set more defined and realistic goals for students, residents, and themselves as educators and could be a valuable starting point for promoting preceptors' reflection, planning, and action related to rotation management, professional teaching, and student learning goals.

Student and faculty perceptions of lecture recording in a doctor of pharmacy curriculum.

OBJECTIVE: To describe students' and faculty members' perceptions of the impact of lecture recording in a doctor of pharmacy (PharmD) curriculum. METHODS: Second- and third-year pharmacy students and faculty members completed an anonymous survey instrument regarding their perceptions of lecture recording with 2 classroom lecture capture software programs, Camtasia Studio and Wimba Classroom. RESULTS: Most students (82%) responded that Camtasia was very helpful and almost half (49%) responded that Wimba Classroom was helpful (p<0.001). Forty-six percent of the students reported being more likely to miss a class that was recorded; however, few students (10%) reported using recordings as a substitute for attending class. The most common concern of faculty members was decreased student attendance (27%). CONCLUSION: Pharmacy students consider lecture recordings beneficial, and they use the recordings primarily to review the lecture. While faculty members reported concerns with decreased attendance, few students reported using recordings as an alternative to class attendance.

Clinical relevance of linezolid-associated serotonin toxicity.

OBJECTIVE: To evaluate and review the literature surrounding serotonin toxicity in patients receiving linezolid and determine the clinical relevance of this reaction. DATA SOURCES: Literature was accessed via MEDLINE/PubMed and Google Scholar (both through February 2013) using the search terms linezolid, serotonin syndrome, serotonin toxicity, and adverse reaction. STUDY SELECTION AND DATA EXTRACTION: Relevant case reports, retrospective studies, surveys, and review articles were included. Bibliographies of all relevant articles were reviewed for additional sources. DATA SYNTHESIS: Linezolid exhibits mild, nonselective inhibition of monoamine oxidase and has been associated with serotonin toxicity when used in combination with other serotonergic agents. Based on published reports, the incidence of linezolid-associated serotonin toxicity is between 0.54% and 18.2%. Our review identified 32 documented cases, including 3 fatalities. Most cases occurred in patients concurrently receiving selective serotonin reuptake inhibitors. Receipt of multiple agents with serotonergic activity seems to increase the risk of serotonin toxicity. Both onset and resolution of symptoms varied from hours to days. CONCLUSIONS: Current Food and Drug Administration recommendations to avoid the use of linezolid in patients receiving select serotonergic agents highlight the need to carefully balance the risk/benefit ratio in this situation. Although linezolid has been available for 12 years, reports of serotonin toxicity with this agent are uncommon. While clinicians should be aware of this potentially severe interaction and closely monitor patients who are receiving linezolid in combination with serotonergic agents, our findings show that linezolid is not contraindicated in this situation.

Pharmacologic prophylaxis against venous thromboembolism in hospitalized patients with cirrhosis and associated coagulopathies.

PURPOSE: Published evidence on the incidence and predictors of venous thromboembolism (VTE) in patients with cirrhosis of the liver is reviewed. SUMMARY: The frequently observed phenomenon of elevated International Normalized Ratio (INR) values in patients with cirrhosis has led to a theory of "autoanticoagulation" and the assertion that such patients may not benefit from the VTE risk-reduction therapies routinely used in other groups of hospitalized patients. A literature search identified six reports specifically addressing the issue of VTE risk in patients with cirrhosis. Reported rates of VTE development in such patients vary widely (0.5-8.2%) as a result of investigators' use of varying study methods and endpoints. The results of three studies (including two studies of longitudinal data on about 100,000 and nearly 450,000 patients) found no significant correlation of INR values and VTE risk. With regard to potential clinical markers of VTE risk in the context of cirrhosis, data from two studies suggested that serum albumin might serve as a reliable marker of coagulation status and, therefore, VTE risk. The results of other studies indicated that independent predictors of VTE in patients with cirrhosis include malnutrition and significant comorbidities such as chronic kidney disease and congestive heart failure. In aggregate, the available evidence does not support the autoanticoagulation theory. CONCLUSION: In hospitalized patients with cirrhosis who have elevated INR values, pharmacologic VTE prophylaxis should be strongly considered if there is no active or recent bleeding and if more than one risk factor for VTE is present.

An in vivo-in vitro study of cefepime and cefazolin dialytic clearance during high-flux hemodialysis.

STUDY OBJECTIVES: To assess the influence of in vitro and in vivo hemodialysis with a new high-flux dialyzer on the clearance of cefazolin and cefepime; to assess the correlation of in vivo dialytic clearance of these antibiotics with blood flow rate; and to assess the correlation between in vitro and in vivo dialytic clearances of these antibiotics. DESIGN: Prospective, open-label, dialysis clearance study. SETTING: A tertiary-care, university health science center. PATIENTS: Five adults who received high-flux hemodialysis 3 times/week. Intervention. For the in vivo experiment, patients received a single intravenous infusion of cefazolin 1 g and cefepime 1 g before dialysis and then underwent a modified hemodialysis session. For the in vitro experiment, a buffered simulated plasma water (SPW) solution containing cefazolin and cefepime was used. Hemodialysis for both experiments was performed with use of a new high-flux polysulfone dialyzer. MEASUREMENTS AND MAIN RESULTS: Cefazolin and cefepime dialytic clearances were determined at blood and/or SPW flow rates of 100, 200, 300, and 400 ml/minute after a 15-minute equilibration period. The degree of correlation of in vitro and in vivo clearances with blood flow rate was determined. Cefepime dialytic clearance increased proportionally with blood flow rate (p<0.01), reaching a maximum mean +/- SD value of 178.9 +/- 24.3 ml/minute at a blood flow rate of 400 ml/minute. Cefazolin dialytic clearance ranged from a mean +/- SD of 42.3 +/- 7.7 to 52.7 +/- 16 ml/minute; no significant correlation was noted between blood flow rate and dialytic clearance. In vitro cefazolin and cefepime dialytic clearances increased proportionally with SPW flow rate (p<0.05). After adjusting the in vitro cefazolin and cefepime dialytic clearances based on their degrees of protein binding, the correlation between the in vitro and in vivo cefepime dialytic clearances was significant (r(2)=0.91, p=0.04), but no significant correlation was noted between the in vitro and in vivo cefazolin clearances (r(2)=0.61, p=0.22). CONCLUSION: The in vivo hemodialysis clearances of cefepime and cefazolin with the new high-flux polysulfone dialyzer used in this study are markedly higher than values reported with conventional dialyzers but similar to values observed with other high-flux hemodialyzers. The in vivo dialytic clearance of cefazolin was significantly lower than the in vitro values, most likely due to cefazolin's high degree of protein binding. These results highlight the limitation of directly applying in vitro data to clinical situations.

Risk of infection with intravenous iron therapy.

OBJECTIVE: To review the potential risks of administering intravenous iron to patients with infection. DATA SOURCES: Literature was accessed through MEDLINE (1977-June 2007) and Google Scholar, using the terms intravenous iron, iron sucrose, ferric gluconate, iron dextran, and infection. In addition, reference citations from publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data sources were evaluated. Studies that provided data relevant to the objective were used, including in vitro and animal studies. DATA SYNTHESIS: The role of iron in bacterial growth and the pathophysiology of cellular immunity create legitimate, yet theoretical, concerns that active infection may be exacerbated by the administration of intravenous iron. Human data relating to this issue are limited. A few small, human studies in a population with chronic kidney disease suggest a possible increased risk of developing an infection associated with intravenous iron; however, prospective human data directly linking intravenous iron to exacerbation of existing infection or infection-related mortality are lacking. In vitro data suggest that increased transferrin saturation related to iron administration may result in polymorphonuclear leukocyte dysfunction and decreased inhibition of bacterial growth. Sparse animal data have linked intravenous iron therapy with morbidity and mortality in sepsis models. CONCLUSIONS: Despite the limited human data, careful consideration of risk versus benefit should be used when administering intravenous iron to patients with ongoing infection. Additional clinical data are needed to determine whether intravenous iron administration worsens outcomes of patients with infection.