Grit, Subjective Happiness, Satisfaction With Life, and Academic Resilience Among Pharmacy and Physical Therapy Students at Two Universities.

OBJECTIVE: The primary objective of this study was to compare grit, subjective happiness, satisfaction with life, and academic resilience among pharmacy and occupational therapy/physical therapy (OT/PT) students at 2 distinct universities using the short grit scale, subjective happiness scale (SHS), satisfaction with life scale (SWLS), and the academic resilience scale (ARS-30). METHODS: In January 2019, investigators administered an online survey to students at 2 universities using a cross-sectional, voluntary, anonymous survey design using grit scale, SHS, SWLS, and ARS-30. Descriptive statistics, t tests, a 2-way analysis of variance, Pearson correlation, and regression analyses were used to examine the relationship between these scores. RESULTS: There were 227 respondents who consented to participate in the study and completed all 4 surveys. The overall response rate for pharmacy students was 44% and 43% for OT/PT students, with most pharmacy and OT/PT students in the 19-25-year range. Grit scores did not differ between pharmacy students and OT/PT students, while SHS scores were significantly higher in OT/PT students. Subjective happiness was higher in the private university, with young, female students at the private university reporting higher SHS scores. Although the grit score was not correlated with SWLS, SHS, or ARS-30 scores, the SWLS was correlated with SHS. The SHS was a strong predictor of academic resilience in both OT/PT and pharmacy students. CONCLUSION: Subjective happiness and satisfaction with life were found to be strong predictors of academic resilience among pharmacy students. Colleges of pharmacy may consider administering the SHS and/or SWLS at baseline and annually to measure well-being.

Perspectives of Professionalism, Self-Awareness, Leadership, and Innovation and Entrepreneurship From Experiential Education Preceptors.

OBJECTIVE: The objectives of this study were to (1) quantify the perceived importance of and comfort with the Accreditation Council for Pharmacy Education Standard 4 (ACPE-S4) key elements, (2) describe how preceptors promote and assess key elements, and (3) describe preceptor perceptions of student key element skill demonstration. METHODS: This study used a cross-sectional electronic survey to assess experiential education preceptors' perceptions of ACPE-S4 key elements. The survey consisted of 2 item categories, with 5 and 15 items included to collect information on preceptor demographics and ACPE-S4 key elements, respectively. Surveys were distributed to 451 introductory and advanced rotation preceptors. Frequencies and means were reported for quantitative survey items, open-ended survey responses were analyzed using a general interpretivist approach. RESULTS: In total, 242 surveys were completed for a response rate of 54%. Most respondents identified as female (54.5%) and precepted community pharmacy rotations (28.5%). ACPE-S4 key elements, in order of most to least important, were professionalism, self-awareness, leadership, and innovation and entrepreneurship. Respondents varied in their conceptualization of key elements, with multiple activities used for skill demonstration and assessments. Qualitative analysis identified 2 themes: "Variation in preceptor fluency with S4 key elements" and "Communication as a means to demonstrate and evaluate ACPE-S4 key element skills." CONCLUSION: Variation among preceptors in conceptualization, learning activities, and comfort in assessment for ACPE-S4 key elements highlights the need for support and resources to assist preceptors in developing activities and assessments for skills reflective of ACPE-S4 key elements. Preceptors commonly relied on vulnerable communication with students to assess key element skills, identifying a potential target for assessment and preceptor development. Pharmacy programs, in addition to the Academy, could benefit from using assessments already offered by preceptors. Finally, explicit evaluation criteria may help to guide skill acquisition and facilitate consistent assessment of key element skills.

AACP faculty affairs standing committee report of strategies for faculty self-advocacy and promotion.

OBJECTIVES: The 2020-2021 American Association of Colleges of Pharmacy Faculty Affairs Standing Committee (FASC) was charged with identifying how faculty can self-advocate and promote themselves in a social influence context. FINDINGS: The FASC identified social influence and persuasion theories and strategies that can be used by faculty to initiate self-advocacy discussions and collaborations. Social influence and persuasion theories can provide a framework for research and scholarship or for beginning discussions regarding self-advocacy. SUMMARY: This FASC report describes the Committee charge, background information, and an overview of social influence theories and how these theories can be applied in academic pharmacy. The report concludes with a summary of issues for follow-up to the Committee's work.

A Qualitative Exploration of ACPE Standard 4 Key Elements From the Perspective of Student Pharmacists.

OBJECTIVE: Attitudes and skills reflecting the Accreditation Council for Pharmacy Education Standard 4 (ACPE-S4) remain an important component of pharmacy education. The objectives of this study were (1) explore student perspectives on the importance of ACPE-S4 key elements, and (2) identify experiences that students described as supporting ACPE-S4 attitude and skill development. METHODS: This was a qualitative study using focus groups and dyadic interviews with student pharmacists to collect data on ACPE-S4 key element importance and skill acquisition. A general inductive qualitative approach was used to analyze data, with 2 study authors independently reviewing all transcripts and assigning codes to text segments. Authors then met to discuss coding, iteratively organize coded segments into categories and subcategories, and select representative quotes. RESULTS: Overall, 3 focus groups and 3 dyadic interviews were conducted with a total of 20 students. Students ranked professionalism and self-awareness as the 2 most important key elements. From qualitative analysis, 4 categories and 10 subcategories of educational activities, programs, and experiences were identified as follows: Mentorship (Identifying a Mentor, Formal Mentorship Programs), Curriculum (Practice Lab, Professional Development Course, Interprofessional Education, Experiential Education), Cocurriculum (Organizational Involvement, Volunteer Hours), and Opportunities Outside Academic Setting (Work, Conferences, and Innovative Pharmacy Practices). CONCLUSION: Participants articulated several opportunities for developing the skills and attitudes reflecting ACPE-S4 key elements. Incorporating student input into ACPE-S4 attitude and skill development may help pharmacy programs consider how to design, refine, and implement initiatives and experiences to help students develop skills across ACPE-S4 focus areas.

Lessons From Using Design Thinking to Develop the 2021 AACP Teachers' Seminar.

Objective. To describe and evaluate how a design thinking approach aided the creation of the 2021 American Association of Colleges of Pharmacy (AACP) Teachers' Seminar.Methods. The design thinking framework (ie, inspiration, ideation, and implementation) was used to structure the seminar development process from July 2020 to July 2021. Nine committee members engaged in a persona activity (ie, inspiration), a brainstorming activity (ie, ideation), and a prototyping activity (ie, implementation) to create a user-centered learning experience. Twenty-five small group facilitators were then recruited to create and deliver breakout session content. After the seminar, the team was invited to debrief their experience in a focus group and an electronic survey to evaluate the perceived impact of using design thinking in the planning process.Results. Twenty-one (62%) of the 34 committee members and small group facilitators attended the focus group, and 28 (82%) completed the electronic survey. Most agreed that design thinking was a useful approach to support the Teachers' Seminar, and they were generally positive about the experience. There was a significant increase in self-reported creative self-efficacy for coming up with novel ideas, ability to solve problems, and helping expand others' ideas. Team members identified positive attributes about the seminar and planning process as well as areas for improvement. Team members also acknowledged challenges and potential solutions for professional organizations and program developers to consider when creating user-centered experiences.Conclusion. Design thinking can be a useful framework for seminar planning and implementation to create engaging, meaningful, and valuable educator development experiences.

Student Perceptions of an Interprofessional Short Course Designed to Increase Awareness of Human Trafficking.

Human trafficking is a global problem with significant impacts on victims' physical and emotional health. Many health care professionals lack human trafficking knowledge, leading to missed opportunities for intervention. This cross-sectional study used evaluation data from a short course on human trafficking to evaluate the course's perceived impact on students. Closed-ended questions were analyzed descriptively while open-ended questions were analyzed using qualitative content analysis. A total of 241 students across eight professions/disciplines completed the evaluation. The vast majority indicated course content was valuable, applicable to their future practice, and recognized interprofessional teamwork is needed to address human trafficking. Despite course effectiveness, there remains a need to continue expanding interprofessional engagement and examining the longitudinal impact of this educational effort.

Accommodating Pharmacy Students With Physical Disabilities During the Experiential Learning Curricula.

Accommodating pharmacy students with physical disabilities during the experiential learning portion of the Doctor of Pharmacy (PharmD) curriculum can present unique challenges for pharmacy schools. The available literature regarding accommodations for pharmacy students in the experiential learning environment is sparse, leaving programs with little guidance. This commentary from the Big Ten Academic Alliance calls on the Academy to create a community of shared resources and best practice examples and offers practical suggestions for accommodating pharmacy students with mobility, vision, and auditory disabilities during introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs).

Impact of Interprofessional Telehealth Case Activities on Students' Perceptions of Their Collaborative Care Abilities.

Objective. To describe the development, implementation, and assessment of simulated interprofessional education (IPE) telehealth case activities. Methods. Faculty from pharmacy and physician assistant schools developed interprofessional cases covering topics addressed in both curricula and designed for specific levels of learners. Using a telehealth format, pharmacy students were paired with physician assistant students and met at specified times in a virtual room. Faculty representing both professions assessed students as they discussed a patient case, determined a diagnosis, and collaborated to develop appropriate treatment options. Pre-experience and post-experience data and student reflections were collected. Results. Pharmacy students' responses to items on the Team Skills Scale (TSS) completed after participating in four IPE telehealth case activities indicated positive changes. Mean total TSS scores significantly improved from pre-experience 62.3 (SD 8.4) to post-experience 72.6 (SD 5.7). Quantitative evaluation of student teams' participation in an interprofessional activity was assessed using the Creighton Interprofessional Collaborative Evaluation (C-ICE) instrument and the average score was 90%. Theme analysis was performed on student reflections and the most prominent themes identified were satisfaction from interacting with other health care professionals, increased confidence in clinical decision-making ability, and affirmation that IPE telehealth cases should be included in each year of the curriculum. Conclusion. Implementation of interprofessional cases using telehealth technology is an effective way for pharmacy schools to incorporate IPE into their curriculum. Students reported improved self-perception of interprofessional competence and attitudes toward interprofessional collaboration after participating in IPE telehealth cases.

Nonchemotherapy drug-induced neutropenia and agranulocytosis: could medications be the culprit?

Drug-induced agranulocytosis is a severe complication that has been implicated with most classes of medications. Medications such as clozapine, trimethoprim-sulfamethoxazole and methimazole have been more commonly associated with agranulocytosis than other agents. Although the pathogenesis isn't fully elucidated, it appears to be two-fold with a direct toxicity to the myeloid cell line and immune-mediated destruction. Patients may be asymptomatic at the time neutropenia is discovered or may present with more severe complications such as sepsis. In approximately 5% of cases drug-induced agranulocytosis may be fatal. Management of drug-induced agranulocytosis includes the immediate discontinuation of the offending medication, initiation of broad-spectrum antibiotics and consideration of the use of granulocyte colony-stimulating factors in high-risk patients.

Improving adherence to oral cancer therapy in clinical practice.

Adherence to oral chemotherapy regimens maximizes their effectiveness and minimizes any potential toxicities. Factors specifically related to the treatment, patient, and health care provider may influence medication adherence. Treatment-related factors include the complexity of the regimen, the cost of therapy, the possibility of side effects, and the delay in treatment benefits. Meanwhile, patients may not have an adequate support system or an understanding of the need for the medication, and providers may not fully succeed in communicating the importance of adherence and the types of side effects that may occur. Nonadherence may lead to an increased risk of toxicity, decreased effectiveness, and increased utilization of health care resources. Although various methods for measuring adherence are available, self-reporting is the most widely used. Studies describing adherence in a broad range of cancers are reviewed. Treatment of chronic myeloid leukemia has been revolutionized by the development of oral tyrosine kinase inhibitors that are highly effective in managing the disease when taken consistently. However, nonadherence is relatively common and can lead to reduced rates of response and increased medical costs. Similar effects of nonadherence on outcome and cost have also been observed in patients with various other hematologic malignancies and solid tumors. Interventions to improve adherence to oral chemotherapy regimens include communication about the importance of adherence and the potential consequences of nonadherence, simplification of the patient's medication schedule (if possible), and inclusion of a caregiver or family member in the conversation. Written materials should always be provided to accompany verbal instructions. This review summarizes factors influencing medication adherence, impact of nonadherence on patient outcomes, methods for measuring adherence, previous studies of nonadherence in patients with cancer, common barriers to access, and interventions to improve adherence in the community setting.

An oncology pharmacy practice elective course for third-year pharmacy students.

Objective. To develop and implement a 1-credit-hour oncology pharmacy practice elective course for third-year pharmacy students and assess its impact on examination scores in a required pharmacotherapeutics course.Design. Major topics were identified to focus on therapeutic management and supportive care of the oncology patient. Psychosocial topics were incorporated to help pharmacy students better relate to oncology patients.Assessment. Learning was assessed by means of 2 computer-based examinations, weekly reflection posts, and a completed oncology service-learning project and reflection paper. Students enrolled in the course achieved higher pharmacotherapeutics oncology section examination scores than students who had not taken the course. Also, this course increased students' interest in oncology pharmacy.Conclusion. The oncology pharmacy elective course has received overwhelmingly positive feedback from students and student enrollment continues to grow. We will continue to offer this course to future practitioners.

Pazopanib for the treatment of metastatic renal cell carcinoma.

BACKGROUND: Renal cell carcinoma (RCC) is the most common cancer in the kidneys. Until 2005, treatment options were limited to immunotherapy. Since that time, there have been numerous targeted therapy agents approved with improved efficacy toward RCC. Pazopanib is a multi-tyrosine kinase inhibitor that was approved by the US Food and Drug Administration in October 2009 and by the European Medicines Agency in June 2010 for the treatment of metastatic RCC. OBJECTIVE: The objective of this report was to review pazopanib's mechanism of action; pharmacologic, pharmacokinetic, and dynamic properties; potential drug interactions; and the results of clinical trials evaluating efficacy and tolerability associated with pazopanib for the treatment of RCC. METHODS: MEDLINE, International Pharmaceutical Abstracts, and Web of Science were searched for English-only clinical trials and therapeutic reviews (publication dates: 2000-January 1, 2012). Abstracts from the 2000 to 2011 meetings of the American Society of Clinical Oncology were searched for an updated safety profile and tolerability data of pazopanib in RCC. References from relevant articles were reviewed. Key search terms included pazopanib, Votrient, GW786034, renal cell carcinoma, adverse events, pharmacology, pharmacokinetic, and clinical trial. RESULTS: Two clinical trials met the inclusion criteria for the use of pazopanib in RCC (a Phase II and a Phase III trial). Pazopanib is an inhibitor of numerous tyrosine kinases, including vascular endothelial growth factor receptor and platelet-derived growth factor receptors. It is involved in inhibiting signaling pathways, angiogenesis, and cell proliferation. Pazopanib was approved by the US Food and Drug Administration and the European Medicines Agency at the dose of 800 mg daily. Peak concentrations are achieved within 2 to 4 hours of this dose with a mean t(½) of 35 hours. The pharmacokinetic properties of pazopanib are affected by food as well as by crushing the tablet. A 2-fold increase in AUC was seen when pazopanib was administered with a high-fat meal as well as when crushing the tablet. Thus, pazopanib should be administered on an empty stomach at least 1 hour before or 2 hours after a meal. Pazopanib is primarily metabolized by cytochrome P-450 3A4, and caution should be used with concomitant administration of cytochrome P-450 inducers and/or inhibitors. In a Phase III trial of pazopanib in metastatic RCC, pazopanib reportedly improved progression-free survival from a median of 4.2 to 9.2 months compared with placebo (P < 0.0001). The most common adverse effects of pazopanib were hypertension, hair depigmentation, diarrhea, nausea, anorexia, and vomiting. Many of the grade 3/4 toxicities were hepatic in nature, with elevations occurring in aspartate aminotransferase, alanine aminotransferase, and bilirubin. CONCLUSIONS: Pazopanib is reportedly effective in the treatment of metastatic RCC. Although there are currently no direct comparisons between pazopanib and other tyrosine kinase inhibitors, the data suggest that pazopanib may be a first-line option in the treatment of RCC. The only Phase III trial of pazopanib suggests improvement of progression-free survival in RCC as well as tolerability in the selected population.

Fatal hepatic and renal toxicity as a complication of trabectedin therapy for radiation-induced sarcoma.

Trabectedin therapy was prescribed for a patient with radiation-induced sarcoma. Two doses of trabectedin were given before therapy was discontinued with the patient experiencing renal and liver failure. Despite discontinuing trabectedin the patient continued to experience increases in liver transaminases, bilirubin, blood urea nitrogen, and serum creatinine. Hemodialysis was initiated with no improvement. With all other causes being ruled out, trabectedin likely caused hepatic and renal failure leading to death in this patient. Recent literature suggests that patients may benefit from prophylactic dexamethasone as a means of reducing hepatic toxicity.

Implementation of a safety program for handling hazardous drugs in a community hospital.

PURPOSE: The implementation of a safety program for handling hazardous drugs in a community hospital is described. SUMMARY: A committee of representatives of the departments of pharmacy, nursing, human resources, safety, radiology, performance improvement, employee health, and environmental services and members of the hospital administration was formed to formally address the management of hazardous drugs in a community, not-for-profit, adult hospital in Omaha, Nebraska. Published guidelines and regulations were reviewed to determine the hospital's compliance with the handling of hazardous drugs. A knowledge deficit regarding the risk and severity of occupational exposure to hazardous drugs was identified. A formal education plan was immediately implemented providing inservice education to all staff who may come into contact with hazardous drugs. Each drug was electronically tagged in the hospital computer system. The nitrile gloves used in the pharmacy were switched to a brand tested for resistance to chemotherapy drug permeation. The use of personal protective equipment for all health care workers who may come into contact with hazardous drugs was also instituted. Waste stream management was addressed, and a new waste stream was identifed and implemented to address chemicals regulated by the Resource Conservation Recovery Act. Nursing, pharmacy, and housekeeping personnel were extensively educated on the different waste streams and the importance of segregating waste at the point of use. All gloves for housekeeping and laundry service staff were replaced with hazardous-drug-rated nitrile gloves. CONCLUSION: A gap analysis allowed a multidisciplinary team to establish a safety program for managing hazardous drugs in a community hospital.

Temozolomide-induced desquamative skin rash in a patient with metastatic melanoma.

Temozolomide is an oral alkylating agent used in the treatment of metastatic melanoma. Commonly reported adverse effects of the drug include nausea and vomiting, constipation, headache, and fatigue, as well as myelosuppression, which may be dose limiting. Few reports have described dermatologic adverse effects such as rash and pruritus, and, to our knowledge, none have discussed the seriousness or extensiveness of the rash. We describe a 37-year-old woman who was receiving temozolomide for treatment of metastatic melanoma. After 6 weeks of therapy, the patient developed an unexplained fever. The drug was discontinued, and the fever resolved within 2 days. Temozolomide was restarted 2 months later; the patient again developed a fever. This time the fever was accompanied by a diffuse erythematous skin rash that progressed to an extensive, full-body, desquamative skin rash. The rash was treated with moisturizing cream along with intravenous and topical corticosteroids and antibiotics. Due to the severity of the rash, temozolomide was permanently discontinued. Even after its discontinuation, the patient experienced the rash on a long-term basis, with periodic exacerbations. However, none were as severe as the first rash. The patient's metastatic disease remained stable for the next 2 years. According to the Naranjo adverse drug reaction probability scale, the likelihood that temozolomide was responsible for the adverse drug reaction of fever was probable (score of 6). Clinicians should be aware that an erythematous and exfoliative rash may be induced by temozolomide, and be familiar with the pharmacologic and supportive measures necessary for its treatment.