Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK.

Background: Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting. Methods: 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey. Results: 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD. Conclusion: We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting.

A National Survey Exploring Practices and Perceptions of Sharing Experiential Evaluations With Future Preceptors.

OBJECTIVE: This study aimed to understand pharmacy programs' policies and processes of sharing Advanced Pharmacy Practice Experience (APPE) assessment information among preceptors and to determine the types of grading scales currently being used nationally. METHODS: A 14-question survey was utilized to collect information on Experiential Education policies and practices regarding APPE evaluations and assessment data sharing. The survey was administered electronically to Experiential Education Administrators at accredited schools of pharmacy nationally and gathered information on approach to APPE assessment, information sharing with future preceptors and open-ended responses on how struggling student learners are supported. Descriptive statistics were used to analyze quantitative responses, while qualitative open-ended comments were analyzed using thematic analysis. RESULTS: A total of 95 responses were included in the analysis (67.9% response rate). The majority of programs (83.2%) reported not sharing student performance assessments with future preceptors. Themes that emerged from the analysis of open-ended comments included concerns about bias and privacy violations, and the benefits of sharing evaluations for preceptor preparation and longitudinal student growth. The grading approach varied, with 53.7% of programs using traditional tiered letter grades and 45.3% using a pass/fail grading system. CONCLUSION: Most pharmacy programs do not share APPE assessment information with future preceptors due to concerns about bias and protecting student privacy. However, programs may be looking for alternative processes that address the need to facilitate student growth and to support struggling learners. Examples shared may provide stimulus and insight for Experiential Education Offices to engage in programmatic discussions about the approach to assessment sharing practices.

A Call to Action to Address Well-Being Within Experiential Education.

There is a significant lack of literature exploring or describing pharmacy student well-being during experiential learning even though students spend 30% of their doctor of pharmacy curricula in this environment. Drawing on inspiration from literature describing well-being challenges and solutions for pharmacy residents and other health disciplines, this commentary explores the unique challenges of supporting pharmacy student well-being during experiential education. Approaches for interventions are described along with a call to action for the academy.

A Mixed-Methods Analysis of the Promotion and Tenure Process for Experiential Education Faculty.

OBJECTIVE: To understand the process of the promotion and tenure (P&T) as experienced by faculty members in experiential education (EE). METHODS: A quantitative survey of EE faculty at any academic rank investigated the general landscape of experiences in P&T. Phenomenological qualitative interviews with faculty who currently work in EE and who achieved promotion to full professor while working within EE provided additional context. Analysis was completed using a mixed-methods approach. Incomplete survey responses were excluded. RESULTS: Survey respondents indicated feeling different from other clinical faculty, particularly in the need to justify their work to the P&T committee (26/38; 68%). Respondents noted how challenging the P&T process was and perceived a lack of understanding of EE work among P&T committee members, chairs, and/or colleagues. In qualitative interviews, 3 themes emerged, which were characterizing a misunderstood role; navigating an unclear process with creativity and courage; and seeking outside-of-the-box mentoring. CONCLUSION: Experiential education faculty may require specific guidance and a thoughtful approach in tailoring their dossier for the P&T process, especially in accounting for administrative work and other unique aspects of the role. To promote inclusivity and retention of EE faculty, greater understanding of the EE role is needed as it applies to guidelines for P&T. Furthermore, EE faculty and others with unique roles should receive guidance to meaningfully apply P&T guidelines in a manner that best represents their role.

Qualitative analysis of advanced pharmacy practice experience goals.

INTRODUCTION: This study identified advanced pharmacy practice experience (APPE) activities students wish to pursue via a qualitative analysis of goal setting. It also aimed to understand student goal setting alignment with core Entrustable Professional Activities (EPAs). METHODS: SMART (specific, measurable, achievable, realistic/relevant, time-bound) goal data were reviewed, analyzed, and coded to develop an inductive thematic analysis. Overall frequency of SMART goal coding themes was analyzed using descriptive statistics, along with frequency of themes based on rotation type. Relative percentages of each rotation type were compared. A crosswalk between themes and EPA was created post-coding. RESULTS: Several themes among student SMART APPE goals from one complete academic year were identified (n = 79). A total of 1690 SMART goals were categorized into 22 themes. The top five most frequently utilized themes represent 60.6% of all goals, and included "Assess, Select, Recommend Therapy" (19%); "Patient Communication" (15.4%); "Foundational Knowledge" (12.4%); "Interprofessional Collaboration" (7.9%); and "Workflow, Roles and Responsibilities" (6%). The core EPA Patient Care Provider Domain was most common and accounted for 46.4% of SMART goals. The remainder included Information Master (18.8%); Practice Manager (16.1%); Interprofessional Education Team Member (7.9%); Population Health Promoter (6.6%); and Self-Developer (3.6%). CONCLUSIONS: Our analysis revealed that students set goals in alignment with the profession's primary focus of providing direct patient care however some EPAs were infrequently citied by students in their goal setting process which may mean there is less focus on these important skills.

A Call to Action to Remove ACPE Limits on Non-Patient Care Elective Advanced Pharmacy Practice Experiences.

The terms practice ready and direct patient care are evolving as the pharmacy profession transforms into a wide-ranging field of highly trained individuals. In a crowded job market, students are seeking opportunities to utilize their training beyond traditional patient care roles. As pharmacy colleges and schools update curricula to reflect current practice and drive this transformation, they are faced with the challenge to accommodate student interest in these growing nontraditional areas with the limit of two non-patient-care elective advanced pharmacy practice experiences (APPEs). This Commentary aims to bring attention to the curricular confinement by accreditation standards on elective APPEs. The time is right as ACPE is gathering input for standards revision. This is a call to action to remove the restriction of non-patient-care elective APPEs, support nontraditional career interests, and enhance opportunities for advocacy, leadership development, and innovation without sacrificing developing proficient direct patient-care skills for all future pharmacy professionals.

Assessing student reflections of significant professional identity experiences.

INTRODUCTION: Professional identity formation (PIF) is an essential component of pharmacy education. A student-focused holistic approach can be introduced through exposure to a variety of curricular and co-curricular activities. It is essential for students to not only participate in these activities but also to reflect on their actions and thoughts about those activities. The objective of this study was to better understand the experiences students identify as significant in their PIF. METHODS: A mixed methods approach with qualitative thematic analysis was conducted for first-year (P1) and second-year (P2) student pharmacist end-of-year reflections to understand the types and impact of various experiences on PIF. Students identified which experience was most impactful; additional analysis based on this identification was conducted. RESULTS: A review of 151 student reflections led to coding and analysis of 453 experiences. Co-curricular experiences were identified most frequently in both P1 and P2 groups (59.8% and 56.4%, respectively). Curricular experiences were more likely to be mentioned by P1 students than P2 students (28.8% vs. 9.8%, P < .001). P2 students were more likely to identify experiential rotations (17.9% vs. 6.4%, P < .001) or work (13.7% vs. 9.1, P < .001). Other experiences were cited less frequently but were ranked as most impactful by students. Students often identified experiences that allowed them to apply skills and knowledge and opportunities to attend seminars and lectures. CONCLUSIONS: When reflecting on experiences and their impact on PIF, student pharmacists discussed a variety of experiences but identified co-curricular opportunities most frequently as impactful.

Remote medico-legal assessment by telephone during COVID-19: Monitoring safety and quality when documenting evidence of torture for UK asylum applicants.

INTRODUCTION: Due to the COVID-19 pandemic, Freedom from Torture developed remote telephone assessments to provide interim medico-legal reports, ensuring people could obtain medical evidence to support their asylum claim. METHOD: To audit this new way of working, feedback was collected from the doctors, interpreters, individuals being assessed, and senior medical and legal staff who reviewed the reports. This paper presents findings from the first 20 assessments. RESULTS: Individuals assessed reported that the doctor developed good rapport, but in 35% of assessments reported that there were some experiences they felt unable to disclose. In 70% of assessments, doctors felt that rapport was not as good compared to face-to-face. In the majority of assessments, doctors were unable to gain a full account of the torture or its impact. They reported feeling cautious about pressing for more information on the telephone, mindful of individuals' vulnerability and the difficulty of providing support remotely. Nevertheless, in 85% of assessments doctors felt able to assess the consistency of the account of torture with the psychological findings, in accordance with the Istanbul Protocol (United Nations, 2004). Factors that hindered the assessment included the inability to observe body language, the person's ill health, and confidentiality concerns. CONCLUSION: This research indicates that psychological medico-legal reports can safely be produced by telephone assessment, but are more likely to be incomplete in terms of both full disclosure of torture experiences and psychological assessment. The limitations underline the need for a follow-up face-to-face assessment to expand the psychological assessment as well as undertake a physical assessment.

An Exploratory Study Using Visual Thinking Strategies to Improve Undergraduate Students' Observational Skills.

Objective. To describe a teaching approach that incorporated visual thinking strategies (VTS) into an existing health humanities course and measure the effects on the observation skills of undergraduate health professions students. Methods. Visual thinking strategies were used to introduce students to a variety of health-related topics. Each week a facilitated 15-minute discussion was held about a work of art related to the day's topic. Pre- and post-course assessments were administered in which students were shown three images and asked to describe what they observed in each image. Student responses were evaluated using deductive content analysis with two different categorization matrices. The assessments also included six Likert-style questions. Results. For matrix one, the most frequent type of observation was naming or identifying something. Growth between pre- and post-course assessments occurred in the following categories: what is happening, how it looks, and where it is located. The number of student observations for two of the three images increased. The majority of students indicated that the use of this visual art exercise was an enjoyable learning experience. Conclusion. In future studies, a larger sample size and inclusion of a control group could better demonstrate the meaningful impact of VTS on developing students' observational skills.

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.

PharmD graduates' perceptions of the impact of a teaching specialization.

INTRODUCTION: The purpose of this study was to evaluate graduates' perceptions of the impact of a teaching (education) specialization and identify aspects of the specialization that could be enhanced. METHODS: A 20-item online survey was emailed to graduates of the education specialization at Southern Illinois University Edwardsville School of Pharmacy. Data was analyzed using descriptive statistics. Regression analysis was used to examine (1) association between overall self-rated competence on abilities and skills as a teacher and the number of types of teaching experiences and (2) association between overall self-rated competence on abilities and skills as a teacher and history of holding a faculty position. Chi square was used to determine differences between the two cohorts in confidence areas. RESULTS: Fifty-six out of 69 alumni (81.2%) responded to the survey. Graduates reported high levels of confidence in most teaching abilities. There was a high level of agreement that the specialization enhanced motivation to teach. Regression analysis indicated statistically significant associations between self-rated competence on abilities and skills across a variety of teaching experiences (e.g., classroom lecturing, precepting, continuing education, staff training, lab instruction, facilitating small groups) and history of faculty employment. Enhanced skills in experiential education and teaching outside of academia were identified as further areas for development. CONCLUSION: The education specialization offered at Southern Illinois University Edwardsville School of Pharmacy may be an alternative entry level PharmD pathway for stimulating interest in academia. The majority of graduates agreed that they have applied the knowledge and skills to their careers.

A course for developing interprofessional skills in pre-professional honor students using humanities and media.

BACKGROUND AND PURPOSE: To design and implement an undergraduate honors course for pre-health professional students that develops interpersonal skills through use of a variety of humanities. EDUCATIONAL ACTIVITY AND SETTING: A three credit hour course in an honors seminar sequence was developed by pharmacy practice faculty and with input from faculty in mass communications, philosophy, applied communication studies and history. The course utilized a variety of media such as literature, film, and podcasts to foster student discussion about a variety of health-related topics. Topics included public health, stigmatization, portrayals of health care providers, patient experiences, health care ethics, aging, and death and dying. Students were assessed using pre-class assignments and reflective writings as well as a formal written and oral presentation on a selected health-related book. A quasi-experimental design was used to assess the impact of the course on desired course outcomes. FINDINGS: The first course offering was to 22 undergraduate pre-health professional honors students. Pre- and post-course surveys on students' perceptions and students' reflective writings revealed achievement of desired course outcomes. Post-course evaluations also revealed positive perceptions about the course. DISCUSSION: The design of this course provided an outlet for students to read and enjoy various forms of media, while also meeting its goal of exposing students to a variety of humanities. The course allowed students to think critically about various health care issues, and to begin to develop interpersonal skills. SUMMARY: The course could be adapted for pharmacy by developing affective domains of the Accreditation Council for Pharmacy Education (ACPE) Standards.

Dexmedetomidine infusion for analgesia up to 48 hours after lung surgery performed by lateral thoracotomy.

Patients undergoing a lateral thoracotomy for pulmonary resection have moderate to severe pain postoperatively that is often treated with opioids. Opioid side effects such as respiratory depression can be devastating in patients with already compromised respiratory function. This prospective double-blinded clinical trial examined the analgesic effects and safety of a dexmedetomidine infusion for postthoracotomy patients when administered on a telemetry nursing floor, 24 to 48 hours after surgery, to determine if the drug's known early opioid-sparing properties were maintained. Thirty-eight thoracotomy patients were administered dexmedetomidine intraoperatively and overnight postoperatively and then randomized to receive placebo or dexmedetomidine titrated from 0.1 to 0.5 µg·kg·h(-1) the day following surgery for up to 24 hours on a telemetry floor. Opioids via a patient-controlled analgesia pump were available for both groups, and vital signs including transcutaneous carbon dioxide, pulse oximetry, respiratory rate, and pain and sedation scores were monitored. The dexmedetomidine group used 41% less opioids but achieved pain scores equal to those of the placebo group. The mean heart rate and systolic blood pressure were lower in the dexmedetomidine group but sedation scores were better. The mean respiratory rate and oxygen saturation were similar in the two groups. Mild hypercarbia occurred in both groups, but periods of significant respiratory depression were noted only in the placebo group. Significant hypotension was noted in one patient in the dexmedetomidine group in conjunction with concomitant administration of a beta-blocker agent. The placebo group reported a higher number of opioid-related adverse events. In conclusion, the known opioid-sparing properties of dexmedetomidine in the immediate postoperative period are maintained over 48 hours.

Sedation levels during propofol administration for outpatient colonoscopies.

The levels of sedation required for patients to comfortably undergo colonoscopy with propofol were examined. One hundred patients undergoing colonoscopy with propofol were enrolled. In addition to standard-of-care monitoring, sedation level was monitored with the Patient State Index (PSI) obtained from a brain function monitor, transcutaneous carbon dioxide (tcpCO2) was monitored with the TCM TOSCA monitor, and end-tidal carbon dioxide was monitored via nasal cannula. The Ramsay Sedation Score (RSS) was also assessed and recorded. After baseline data were obtained from the first 40 consecutive patients enrolled in the study, the remaining 60 patients were randomized into two groups. In one group the PSI value was blinded from the anesthesiologist and in the second group the PSI was visible and the impact of this information on the management of the sedation was analyzed. Overall 96% of patients reached levels of deep sedation and 89% reached levels of general anesthesia. When comparing the blinded to PSI versus unblinded groups, the blinded group had a significantly lower PSI and higher RSS and tcpCO2, indicating the blinded group was maintained at a deeper sedation level with more respiratory compromise than the unblinded group. Patients undergoing colonoscopy under propofol sedation delivered by a bolus technique are frequently taken to levels of general anesthesia and are at risk for respiratory depression, airway obstruction, and hemodynamic compromise.