Development and validation of a performance-based palliative care assessment tool for student pharmacists.

INTRODUCTION: Integration of hospice and palliative care principles within pharmacy curricula is essential to fill the need of pharmacist training in this growing specialty. A formalized assessment tool to evaluate skill development does not exist for student pharmacists specific to palliative care. The objective of this study was to develop a valid and reliable, palliative care-focused, performance-based assessment tool for student pharmacists. METHODS: Eight academic palliative care (PC) pharmacists were recruited for the workgroup to perform domain development, validation, tool creation, and reliability testing for this performance-based assessment tool. Hospice and palliative care clinical pharmacist entrustable professional activities (EPAs) served as the framework. Content validity testing utilized content validity index and scale universal agreement (S-CVI/UA) to determine level of agreement for activities included in the tool. Student volunteers completed a standardized patient case and workgroup members served as raters during the reliability testing phase. Interrater reliability was measured through calculation of Fleiss Kappa scores for each activity. RESULTS: Out of 14 EPAs, nine were deemed "essential" to include in the tool. Thirty-four supporting activities for the nine essential EPAs were drafted. Two rounds of content validity testing were necessary to achieve S-CVI/UA of 0.9593. Consensus was reached from workgroup members for activities deemed necessary to include in the tool after questionnaire distribution utilizing a Fleiss Kappa cutoff >0.6. CONCLUSIONS: This validated tool will afford colleges and schools of pharmacy with PC curricula an opportunity to assess student achievement of PC-specific skills and evaluate curricular effectiveness.

Safe and Appropriate Use of Methadone in Hospice and Palliative Care: Expert Consensus White Paper.

Methadone has several unique characteristics that make it an attractive option for pain relief in serious illness, but the safety of methadone has been called into question after reports of a disproportionate increase in opioid-induced deaths in recent years. The American Pain Society, College on Problems of Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize methadone safety and efficacy, but guidelines for the end-of-life scenario have not yet been developed. A panel of 15 interprofessional hospice and palliative care experts from the U.S. and Canada convened in February 2015 to evaluate the American Pain Society methadone recommendations for applicability in the hospice and palliative care setting. The goal was to develop guidelines for safe and effective management of methadone therapy in hospice and palliative care. This article represents the consensus opinion of the hospice and palliative care experts for methadone use at end of life, including guidance on appropriate candidates for methadone, detail in dosing, titration, and monitoring of patients' response to methadone therapy.

Safety, efficacy, and durability of laparoscopic adjustable gastric banding in a single surgeon U.S. community practice.

BACKGROUND: Although laparoscopic adjustable gastric banding (LAGB) has been increasing in popularity, controversy is ongoing in regard to its efficacy, safety and durability. Particular concern exists now that this technique is being adapted in the community setting. We report a single surgeon's experience of LAGB in a community practice serving a medium-size Midwest town in the United States. METHODS: From March 30, 2004 to December 2, 2009, 442 patients underwent LAGB (77% women; mean age 47 years, range 18-71; mean body mass index 47 kg/m(2), range 35-78). The maximal number of primary procedures performed in a 12-month period was 105. Follow-up information was available for 94% of patients. RESULTS: The perioperative mortality rate was 0%. The average percentage of excess weight loss was 27% at 6 months (n = 384), 38% at 12 months (n = 301), 44% at 18 months (n = 260), 48% at 24 months (n = 190), 51% at 36 months (n = 135), 58% at 48 months (n = 66), and 60% at 60 months (n = 31). By 60 months, 10% had failed to lose ≥25% of their excess body weight. The explantation rate was 1.8%. Gastric prolapse occurred in 2.0% of patients and erosion in 0.4% of patients. CONCLUSION: LAGB can be done safely in a community setting with acceptable weight loss and low failure rates. LAGB is less technical than other procedures; however, the results depend heavily on meticulous long-term follow-up. We have proposed a strategy that has been effective in the community setting.