Implementation of longitudinal thematic course design across four institutions.

INTRODUCTION: The objective of this study was to describe thematic course design utilized in pharmacy courses at four different institutions. Best practices and lessons learned are shared. METHODS: Four institutions independently incorporated a longitudinal Harry Potter (HP) theme into their courses. Faculty collaborated to share course experiences and determine similar concepts present at all four institutions. A mixed-methods approach was used to analyze available data. Thematic analysis was used for qualitative course evaluation comments. Quantitative course evaluation data from two institutions was also analyzed. RESULTS: Similar concepts identified as important elements of longitudinal thematic course design included creation of new groups, incorporation of thematic activities (e.g., adding HP characters to patient cases), and gamification. Qualitative analysis of student course evaluation comments found three emerging themes: increased student engagement, enjoyment of thematic course design, and appreciation for the gaming aspect. Quantitative course evaluation data demonstrated that students liked the HP theme to facilitate learning and it increased student engagement in the course. CONCLUSIONS: A thematic course design at four institutions was well received by students and potentially increased student engagement with the course material longitudinally.

Factors Influencing Provider and Patient Choice of P2Y12 Inhibitor Therapy.

BACKGROUND: Clopidogrel is the most commonly prescribed P2Y12 inhibitor for acute coronary syndrome (ACS) or stent placement, though ticagrelor or prasugrel may be preferred. Medication-related factors may influence selection of therapy. OBJECTIVES: To determine which factors most greatly influence cardiology-provider and patient selection of P2Y12 inhibitor to guide shared-decision making (SDM). METHODS: Single-center study assessed survey responses from 32 cardiology-providers who prescribed and 105 patients who received clopidogrel, prasugrel, or ticagrelor for ACS or stent placement. Respondents ranked factors influencing P2Y12 inhibitor selection and reported preference of therapy. Patients reported experience with shared decision-making process. RESULTS: Cardiology-providers ranked risk of bleeding, comfort/experience, and cost as most influential. Patients ranked risk of drug interaction, adverse effects, and reduction in myocardial infarction as most influential. Significant differences between cardiology-providers and patients were found for 5 of 8 factors. Cardiology-providers ranked once daily administration (p = 0.01), risk of bleeding (p = 0.002), and cost (p < 0.001) as more important than patients. Patients ranked risk of adverse effects (p = 0.007) and drug interactions (p = 0.005) as more important than cardiology-providers. Cardiology-providers prescribed ticagrelor 42.3% of the time following ACS, though 78.1% ranked it as their preferred agent. Patients were prescribed ticagrelor 9.3% of the time, though 55.7% ranked it as their preferred agent. Use of SDM was reported by 21.6% of patients and 88.5% were unaware that multiple P2Y12 inhibitors existed. CONCLUSION: Significant differences exist between cardiology-providers and patients regarding factors influencing P2Y12 inhibitor selection, specifically safety-related factors, once daily administration, and cost. Most patients were not involved in SDM.

A clinical focus on the use of extended-duration thromboprophylaxis in medically ill patients.

PURPOSE: This review describes and analyzes literature to provide recommendations for use of extended-duration thromboprophylaxis (EDT) in medically ill patients. SUMMARY: Guidelines recommend pharmacologic thromboprophylaxis for patients at increased thrombosis risk during hospitalization and recommend against extending thromboprophylaxis beyond hospitalization. Despite these recommendations, observational data demonstrate that venous thromboembolism (VTE) risk persists following hospital discharge. A MEDLINE literature search was performed to identify original research evaluating the safety and efficacy of EDT. Eight meta-analyses and 5 randomized controlled trials-each varying in the agents studied (enoxaparin, rivaroxaban, apixaban, and betrixaban)-were selected for inclusion. Collectively, the evaluated data demonstrates that EDT reduces the incidence of VTE at the expense of increasing the risk of major bleeding and without providing mortality reduction. Variations in enrollment criteria, differences in EDT strategies, and uncertainty regarding proper patient selection limit the applicability of EDT in practice. Rivaroxaban and betrixaban gained Food and Drug Administration (FDA) approval on the basis of results of the APEX and MARINER trials and a post hoc analysis of the MAGELLEN trial results. Although a number of agents are FDA approved for use in EDT, clinicians must carefully weigh the risks vs benefits of EDT with these agents until studies demonstrate a more favorable risk-benefit profile. CONCLUSION: Evidence to support EDT in medically ill patients is inconclusive and has highlighted the need for an individualized approach. The reviewed evidence supports guideline recommendations from both the American College of Chest Physicians and the American Society of Hematology that recommend against routine use of EDT in the majority of medically ill patients. Future studies are needed to optimize the risk-benefit profile of EDT and to ensure proper patient selection.

Management of Direct-Acting Oral Anticoagulants Surrounding Dental Procedures With Low-to-Moderate Risk of Bleeding.

The purpose of this article is to review the available evidence regarding how to safely manage direct-acting oral anticoagulant (DOAC) therapy in patients requiring dental procedures with low-to-moderate risk of bleeding. A literature search was performed using MEDLINE and PubMed. Each author performed an independent search to ensure all pertinent articles were identified. The reference sections of each article were also reviewed. Pertinent articles were evaluated by each author for inclusion. Articles were eligible for inclusion if the participants were taking DOAC therapy surrounding a dental procedure known to have low-to-moderate risk of bleeding. Studies could be prospective or retrospective and included case reports, case series, and clinical trials. Articles were excluded if they assessed dental procedures known to carry a high risk of bleeding or were review articles. Twenty-five articles were identified, 5 of which met inclusion criteria including 2 case series, 1 retrospective study, and 2 prospective trials. Variation in the management of DOAC therapy surrounding these procedures was found. Among patients undergoing low-to-moderate risk dental procedures while receiving DOAC therapy, bleeding rates were low regardless of whether the DOAC was held or continued surrounding the procedure. Documented bleeding was mild and easily controlled by local hemostatic measures. Patients can safely continue DOAC therapy surrounding these dental procedures.