Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain.

For patients with low back pain, skeletal muscle relaxants are often initiated after failure of first-line analgesics. However, these medications (reviewed in this article) are controversial alternatives that carry risks of adverse effects and increased cost.

Learning Through Experience: Analyzing the Impact of Short Study Abroad Programs from the Students' Own Words.

OBJECTIVE: The purpose of this study was to determine what students participating in short study abroad program (SSAP) elective courses learned during their experiences and if they satisfied the course learning objectives. METHODS: University of Florida College of Pharmacy students who participated in an SSAP to Scandinavia in the years 2014, 2016, 2017, and 2018 wrote digital journals describing their experiences. This study used inductive and deductive thematic analysis to analyze the journals and identify codes and themes. RESULTS: Four cohorts with a total of 39 student journals were analyzed leading to 11 themes being identified. Example themes included Differences in Pharmacy Practice, Differences in Pharmacy Law/Processes, Differences in Pharmacy Education/Training, and History/Culture. These themes were then mapped to the course objectives, and all course objectives were deemed to be fulfilled. CONCLUSION: Students participating in one College's SSAPs over 4 years through their own words demonstrated a better understanding of health care, pharmacy, and culture as it exists in one or more foreign countries and were able to meet the course objectives.

Potential benefits of warfarin monitoring by a clinical pharmacist in a long term care facility.

The primary objective of this study was to determine whether warfarin therapy monitoring by a pharmacist would benefit a long-term care facility, by maintaining patients within therapeutic INR range more consistently than the current practice of physician monitoring.Secondary objectives included whether adverse events resulting from non-therapeutic INR levels differed significantly between groups and whether pharmacist interventions resulted in decreased overall costs to the facility. A retrospective chart review was conducted on all patients treated with warfarin for a minimum of 14 days within a Long-Term Care (LTC) facility to compare Time within Therapeutic Range (TTR) between staff treated patients versus pharmacist treated patients. A total of 552 INRs were obtained for all patients during the study period: 499 (90.4%) under staff supervision and 53 (9.6%) under clinical pharmacist supervision. Of the 499 tests performed by the River Garden staff, 203 were within the desired range, compared with 29 of the 53 tests performed by the clinical pharmacist being in range. For the primary endpoint, a total of 1483 INRs were imputed, corresponding to the number of days between true INR measurements. INRs attributable to clinic staff management were within the therapeutic range 47.1% of the time, whereas INRs attributable to clinical pharmacist management were within the therapeutic range 58.7% of the time (P < 0.0001 for the comparison). Warfarin can be effectively monitored by a clinical pharmacist and routinely lead to appropriate INR levels in the nursing home setting, while potentially saving the facility healthcare dollars.

A review of abuse-deterrent opioids for chronic nonmalignant pain.

Chronic nonmalignant pain, which affects millions of people, is the most common reason patients seek medical care. Both current and potential opioid analgesics are discussed, along with new technologies used to prevent abuse.

Fulfilling Educational Competencies through Global Pharmacy Experiences.

Many Colleges of Pharmacy in the United States offer international education and practice experiences to their students. Multiple publications have described these offerings and related them back to the CAPE 2013 Outcomes. This article describes the multiple international programs offered by one College of Pharmacy, including international Advanced Pharmacy Practice Experiences, Short Study Abroad Programs, and International Health Outreach Trips. The article also details the relevant competencies associated with these international experiences.

A Simulated Approach to Fostering Competency in End-of-Life Care Among Pharmacy Students.

Objective. To determine if pharmacy students participating in simulation-based scenarios reported fewer learning needs about the transition from acute to end-of-life (EOL) care compared to students participating in solely case-based scenario delivery. Methods. Four end-of-life cases were developed for both paper-based case study and simulation delivery. Pharmacy students on three distant campuses were exposed to the case study approach while four teams of nine to ten pharmacy students were exposed to simulated versions of the same cases. A validated questionnaire was administered before and after exposure to assess end-of-life care learning needs. Results were analyzed following a Bonferroni-adjustment for multiple testing. Results. The case study groups produced similar pre/post changes on the questionnaire. After results were pooled and compared to the simulation only group, significantly higher changes in pre/post scores were found for the simulation group. Conclusion. Pharmacy students exposed to simulated EOL scenarios experienced significantly reduced learning needs following the scenarios, unlike their classroom-based counterparts.

Using interprofessional medication management simulations to impact student attitudes toward teamwork to prevent medication errors.

BACKGROUND: We developed and implemented a project incorporating ACPE Standard 11 and all Core IPEC competencies at a public University located at a medical center. The project was a collaboration between the colleges of nursing, pharmacy, and medicine at a distance campus location. INTERPROFESSIONAL EDUCATION ACTIVITY: Our Interprofessional Education Activity, which targeted all three elements of ACPE Standard 11, provided TeamSTEPPS® training followed by four medical error simulations. A debriefing took place after each scenario within a team as well as with all four groups following each simulation session. The Teamwork Attitudes Questionnaire (TTAQ) was used to evaluate the activity. DISCUSSION: Findings from our interprofessional education activity indicate that while students entered the activity already perceiving teamwork as a positive aspect of safe care delivery, significant improvement in attitudes post training toward specific team constructs was seen across all five domains. The project helped inform the structure of a replication of this effort that is currently underway, with a focus on embedding it in the curricula of all three programs (medicine, pharmacy, and nursing) across campuses. IMPLICATIONS: In summary, working collaboratively in a team while being exposed to a series of medication management scenarios enhances teamwork attitudes as well as potentially improving performance. Based on the positive initial results, plans have begun to extend the experience to other campuses and include a wider group of students.

Teaching End-of-Life Care Using Interprofessional Simulation.

BACKGROUND: Competency in end-of-life (EOL) care is a growing expectation for health professions students. This study assessed the impact of four EOL care scenarios, using high-fidelity simulation, on the perceived learning needs and attitudes of pharmacy and nursing students. METHOD: On three campuses, pharmacy students (N = 158) were exposed to standard paper EOL case scenarios, while a fourth campus exposed eight graduate nursing and 37 graduate pharmacy students to simulated versions of the same cases. RESULTS: The paper-based groups produced similar pre-post changes on the End of Life Professional Caregiver Survey. Results were pooled and compared with the simulation-only group, revealing significantly higher changes in pre-post scores for the simulation group. CONCLUSION: Students participating in the simulation group showed some significant differences in attitudes toward EOL care, compared with students in the classroom setting. [J Nurs Educ. 2017;56(4):205-210.].

A review of the treatment of type 2 diabetes in children.

The incidence of type 2 diabetes and obesity in children and adolescents has risen at staggering rates. Studies have shown that treating type 2 diabetes with oral medications in children may be more difficult than treating in adults. Compounding this problem is the fact that most of the medications available for treating type 2 diabetes have not been studied in children. Recently, the American Diabetes Association and the Pediatric Endocrine Society have collaborated to create a guideline for the treatment of type 2 diabetes in children. Similar to the treatment of adults with type 2 diabetes, metformin remains the mainstay of therapy along with diet and exercise. Adjunctive therapy should be based on the limited clinical evidence available as well as on patient preference. In order to avoid detrimental microvascular and macrovascular complications, patients, clinicians, and family members should work together to ensure adequate treatment of type 2 diabetes in children.

Redesign of a pediatric pharmacotherapy elective course to accommodate budget reductions.

OBJECTIVE: To redesign a pediatric elective pharmacotherapy course and determine whether the redesign resulted in changes in outcome measures. DESIGN: Active learning activities were moved to an online format. Prerecorded lectures continued to be used. Peer evaluation was incorporated to give the students more feedback on their performance. ASSESSMENT; Presentation grades, average examination grades, course grades, and evaluation scores from each student who completed University course evaluations were documented for students during the 2 semesters before and the 2 semesters after the course redesign. Although for undetermined reasons a drop in examination grades occurred after the course redesign, no significant differences in presentation grades, final grades, or course evaluation grades occurred. CONCLUSIONS: A strategic course redesign successfully reduced the costs and faculty time required to offer an elective course viewed as essential to the curriculum, allowing the course to be continued in the face of state budget cuts.

Self-assessment in pharmacy and health science education and professional practice.

Self-assessment is an important skill necessary for continued development of a health care professional from student pharmacist throughout their professional career. This paper reviews the literature on student and practitioner self-assessment and whether this skill can be improved upon. Although self-assessment appears to be a skill that can be improved, both students and professionals continue to have difficulty with accurate self-assessment. Experts' external assessment of students should remain the primary method of testing skills and knowledge until self-assessment strategies improve. While self-assessment is important to lifelong learning, external assessment is also important for practitioners' continuing professional development.

Comparing self-reported burnout of pharmacy students on the founding campus with those at distance campuses.

OBJECTIVES: To compare burnout among students: (1) assigned to the founding campus and those assigned to distance campuses and (2) in different academic years of the curriculum. The third objective was to determine the relative ability of each factor to predict burnout among pharmacy students. METHODS: Students in Gainesville (founding campus) and the Jacksonville, Orlando, and St. Petersburg distance campuses were surveyed using the Maslach Burnout Inventory. Internet-based survey methods were used to evaluate the emotional exhaustion, personal accomplishment, and depersonalization domains. Students responded using a Likert-type scale (1 = do not feel this way to 7 = feel this extremely strongly). RESULTS: Among 18 items, 8 significant differences were revealed. Within the emotional exhaustion domain, Gainesville students responded that they were more likely to "feel fatigued in the morning" (p < 0.001), "burned out" (p = 0.001), "used up" (p = 0.02), "frustrated" (p = 0.02), and "emotionally drained" (p < 0.02) compared to the distance students. Gainesville students had the highest average score on the item "I feel as though I treat my student colleagues impersonally" (p = 0.02). Academic year was the best predictor of burnout. Campus assignment was significant for emotional exhaustion, with the highest levels occurring on the founding campus. CONCLUSIONS: With few exceptions, students at the founding campus in Gainesville reported more emotional burnout than students attending classes at the distance campuses.

Type 2 diabetes in children: a growing epidemic.

In the pediatric population, type 2 diabetes has become a growing concern. A correlation appears to exist among type 2 diabetes in children, obesity, and a sedentary lifestyle. If obesity and diabetes are left untreated, conditions such as cardiovascular disease, nephropathy, and retinopathy may result as well. These conditions indicate the incredible strain on the health care system caused by diabetes and obesity. This strain may be eased by logical treatments such as exercise and healthy eating habits for the child and family. However, these lifestyle changes are not always effective in controlling blood sugar. When lifestyle changes do not yield positive results, the clinician must decide which (if any) pharmacological treatments are safe to use in the pediatric population. Orlistat and sibutramine have been studied in children as treatments for obesity and appear to be safe and effective for this population. Metformin and insulin are among the medications approved to treat diabetes in children and adolescents. Healthcare practitioners must play a role in educating parents and their children about the effects of obesity on the development of diseases like diabetes, as well as various therapies used to manage diabetes. In addition, healthcare practitioners can assist patients and their parents in understanding the benefits and risks of medications used in the treatment of the disease, assistance that may result in them making informed decisions regarding their overall health.