Implementation and evaluation of an interprofessional prescription writing workshop with a simulated electronic prescribing activity for preclerkship medical students.

BACKGROUND: Prescription writing skills are essential for physician practice. This study describes the development and implementation of a curricular intervention focused on improving the knowledge and confidence of preclerkship medical students' prescription writing practices utilizing an interprofessional education model, with a focus on electronic prescribing. METHODS: Medicine and Pharmacy Faculty from a large, urban university collaborated to develop the content of the workshop and a simulation platform was used for the e-prescribing activity. Second-year medical students attended a mandatory in-person workshop facilitated by fourth-year pharmacy students. A pre and post knowledge test and confidence survey were used to assess students' knowledge, confidence, and satisfaction. Outcomes from the knowledge test were evaluated with paired-samples proportions tests, and confidence survey data was evaluated with paired t-tests and Wilcoxon signed-rank tests in a pre-post study design. RESULTS: Students demonstrated a significant increase in prescription writing knowledge and confidence after completing the workshop. On the pre-test, 7% of students (21/284) completed the electronic prescribing assessment correctly and 51% of students (149/295) completed it correctly on the post-test. All items on the confidence survey showed a significant increase in pre- versus post-survey comparisons (p < 0.001). CONCLUSIONS: This interprofessional prescription writing workshop facilitated by pharmacy students shows promise for improving the knowledge and confidence of prescription writing and electronic prescribing practices in preclerkship medical students.

An elective course on career opportunities for pharmacy students.

BACKGROUND AND PURPOSE: There is limited literature describing the outcomes of formal career guidance in pharmacy programs. This study assessed the course outcomes including students' satisfaction, achievement of the learning objectives and scoring on assignments. EDUCATIONAL ACTIVITY AND SETTING: A 1-credit elective course aims at providing second- and third-year professional pharmacy students (P2 and P3) to career guidance. The main topics address career planning and paths, communication skills, personal and professional development, leadership and entrepreneurship. Included are written assignments, oral group presentations and mock interviews. FINDINGS: Data on 303 students, including 279 P2 and 24 P3, between 2012 and 2021 were analyzed using course evaluations, direct assessment and scoring. Average evaluations ratings were consistently above 4 on a 5-point scale including the clarity of the course policies and procedures (4.61) and its objectives and requirements (4.59), organization (4.58), instructors' simulated questions, responses, discussion and openness to other viewpoints (4.57) and quality (4.5). Students found the experience to be interesting and relevant to pharmacy practice. All students scored above 70% on the course assignments. DISCUSSION: Students were satisfied with the course and gave high ratings to the course content, delivery and in meeting its learning objectives. They scored high on the different course assignments. These findings are similar to the results of other studies reporting students' satisfaction with career guidance. SUMMARY: The career opportunities course is popular among pharmacy students who consistently reported their satisfaction with its content, design and delivery.

A Qualitative Analysis of Community Participants' Experiences with a Virtual Interprofessional Team Visit (vIPTV) with Healthcare Students.

Healthcare students must develop essential interprofessional skills to provide efficient, safe, and effective patient-centered care. To ensure students receive the proper training to develop these skills, an interprofessional team visit (IPTV) program was established at a large urban university in 2011. The program involved teams of students from nine disciplines conducting home visits with community participants to provide patient-centered care and educational resources. During the COVID-19 pandemic, the IPTV program transitioned to a virtual delivery first piloted in 2020. The aims of this study were to evaluate the community participants' experiences with virtual IPTV (vIPTV), identify benefits and challenges related to transitioning from in-person to virtual delivery, and utilize participants' feedback to improve the IPTV program. Focus groups with 39 total participants were conducted in seven different sessions during December 2021 and January 2022. Qualitative analysis of the data showed that participants value the IPTV program, had positive experiences with the virtual delivery, and desire personalized interactions. Community participant's feedback can enhance virtual educational experiences for healthcare students' training.

A Qualitative Analysis of Older Adults' Views of Healthcare Provider Attributes and Communication Skills.

Understanding factors that improve patients' healthcare experiences are essential for healthcare providers (HCPs) caring for older adults (OAs). Previous data supports that effective patient-centered care leads to a better understanding of patients' experiences, values, and preferences. The aim of this study was to evaluate OAs views of HCPs attributes and communication skills to better understand patient's views about their HCP interactions. Qualitative analysis of the data revealed five key themes that emerged: professionalism, patient rapport, patient-centered care, empathy, and communication. Addressing and optimizing performance in these areas could improve patient experiences and support enhanced training for healthcare students.

Provision of Lifestyle Recommendations to Cancer Patients: Results of a Nationally Representative Survey of Hematologists/Oncologists.

Adopting a healthy lifestyle during cancer treatment enhances patients' outcomes. The purpose of this study is to evaluate the current practices and attitudes adopted by hematologists/oncologists on providing lifestyle recommendations to cancer patients. The secondary objective includes a correlation between the hematologists/oncologists' sociodemographic with their provision of lifestyle recommendations to their patients. This prospective, cross-sectional study surveyed Lebanese hematologists/oncologists in five major Lebanese governorates. The questionnaire collected information on participants' demographics and personal lifestyle choices as well as practices and perceptions related to lifestyle recommendations provided to cancer patients. A total of 40 hematologists/oncologists practicing in Lebanon completed the questionnaire with a response rate of 33.3%. The top three recommendations that hematologists/oncologists provided to their patients include quit smoking (95%), increase your physical activity (92.5%), and improve your nutrition/diet (85%). The mean number of recommendations provided per hematologist/oncologist was 3.88 (± 1.067). These discussions were consistently provided during clinical encounters with patients. The most frequently reported barriers hindering patient education on lifestyle recommendations included practitioners' lack of time and knowledge and patients' advanced stages of cancer and lack of interest in the topic. Hematologists/oncologists perceived these recommendations to be beneficial to patients' mental health and performance status, while few of them identified other benefits. Only one statistically significant correlation was identified between hematologists/oncologists' sociodemographic and providing the lifestyle recommendations to their patients. To achieve higher quality patient-centered care, communication gaps between hematologists/oncologists and cancer patients should be addressed, and solutions to identified barriers should be implemented.

Patient Perception of Acute Pain Management: Data from Three Tertiary Care Hospitals.

Introduction. The primary objectives of this study were to assess patients' description of their acute pain intensity; patients' attitude towards their pain management during hospitalization; and their overall satisfaction with pain treatment. Methodology. A cross-sectional questionnaire-based study was conducted between October 2014 and March 2015 in three medical centers in Lebanon. All participants' responses were reported using descriptive statistics. The association between categorical variables was evaluated using Pearson χ2 test or Fisher's exact test where the expected cell count was < 5. Results. A total of 119 women on the maternity services and 177 patients on the orthopedic services were surveyed. Around 50% of obstetric and 37% of orthopedic patients reported pain to be severe at its highest intensity. In maternity and orthopedic patients, respectively, unfavorable practices included pain not being assessed prior to pain medication administration (19.3% and 30.5%), having to wait for ≥30 minutes before getting the pain medication (14.2% and 11.3%), and pain score not being documented on medical chart (95% and 93.2%). Surprisingly, 94.1% of the maternity and 89.2% of orthopedic patients were satisfied to strongly satisfied with their pain management. Conclusion. Pre- and postoperative pain remain a prevalent problem that requires a consensus and joint efforts for improvement.

Physicians' Attitudes to Clinical Pain Management and Education: Survey from a Middle Eastern Country.

Despite promising initiatives to advance the practice of pain management in Middle Eastern countries, their pain care lags behind developed countries. The objectives of this study are to evaluate physicians' assessment of their own competency in pain management, to assess physicians' practice related to pain management, and to identify physician-related barriers to effective pain control. A cross-sectional survey was conducted in 3 teaching medical centers in Lebanon targeting the above-mentioned outcomes and assessing the impact of physicians' years in practice on the studied end-points. A total of 69 physicians were surveyed. Fifty-seven percent reported "very good to excellent" pain management skills; only 25% of them described the need for continuing professional development. When treating patients with pain, 52% of physicians refer to updated international guidelines, whereas 43% rely on their own judgment. Physicians were more likely to consult with another physician (65%) rather than a pharmacist (12%) when treating patients with pain. Fear of adverse effects of analgesics was the most commonly reported barrier (45%) to pain control among physicians from different career stages. Based on these survey findings, national pain management and practice policies are needed to optimize this area of deficiency in patient care.

Prescription Errors with Chemotherapy: Quality Improvement through Standardized Order Templates.

BACKGROUND: Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps. INITIAL ASSESSMENT: An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement. CHOICE OF SOLUTION: Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population. IMPLEMENTATION: The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers. EVALUATION: Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement. LESSONS LEARNED: Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.

Effects of Radiotherapy on the Risk of Developing Secondary Malignant Neoplasms in Hodgkin's Lymphoma Survivors.

Extended follow-up of Hodgkin lymphoma (HL) survivors indicates that these patients are at high risk of secondary malignant neoplasms (SMNs) contributing to increased morbidity and mortality. This study examined the characteristics of HL survivors who developed SMNs with the aim to report any correlation with radiotherapy (RT) dose. In this retrospective multi-center cohort study of HL patients treated between 1990 and 2011 at three major teaching hospitals in Lebanon, classification was into two groups including those treated with combined modality (RT and chemotherapy-CHT) and those treated with CHT alone. Approval from the University Institutional Review Board (IRB) was obtained. Of the 112 patients evaluated, 52.7% (59) received the combined modality while 47.3% (53) received CHT alone. There were 6 cases of SMNs in the combined modality cohort and 5 cases in the CHT cohort. The mean RT dose in the combined modality cohort was 34.5 Gray (Gy) (SD ± 5.3). A statistically significant increase (1.5 fold) in the risk of developing SMNs was observed among patients who received a dose higher than 41 Gy compared to a dose between 20 to 30 Gy (OR= 1.5; 95% confidence interval= 0.674 to 3.339, p=0.012). The risk of SMNs was not significantly higher among patients who received extended field compared to involved field RT (p=0.964). This study showed that the risk of developing SMNs is higher among patients treated with RT dose greater than 31 Gy, independent of the RT type used.

Mapping of the biomedical literature evaluation competencies based on pharmacy students' feedback.

BACKGROUND: This study aims to map the learned curriculum based on students' feedback regarding the biomedical literature evaluation competencies in a pharmacy curriculum, to evaluate teaching methods and to report students' longitudinal self-assessment of their achievement of related learning outcomes as they progress from didactic to experiential courses. METHODS: The biomedical literature evaluation competencies were mapped in three courses delivered during different pharmacy professional years (PPY): Drug Information and Literature Evaluation (PHA421) offered in the second PPY, Pharmacoeconomics (PHA557) and Professional Pharmacy Practice Experience-Hospital/Drug Information Services (PHA570) offered in the third PPY. A unified survey was developed to collect information from students at the beginning and completion of these courses. Survey results were then compared to school assessment data of identified courses for triangulation of findings. RESULTS: Listed student learning outcomes are consistently achieved through all three courses with more assertion from the students at the completion of the applied experiential course PHA 570 (>90 % agree or strongly agree). In terms of delivery methods, 84 % of students perceived the benefits of active learning methods in reinforcing acquired skills and increasing confidence in knowledge and critical thinking in a less stressful learning environment. Results shown at the end of each course indicate a favorable student response from one course to the next where almost all students replied with 'agree to strongly agree' to survey questions assessing their readiness to critically evaluating trials (72 %, 96 % and 92 %) in PHA421, PHA557 and PHA570, respectively. Study findings are in congruence with school assessment database of the selected courses. CONCLUSION: Formative assessment results demonstrated acquisition of required analytical skills, and completion of course learning outcomes as students progressed from introductory to advanced courses covering the biomedical literature component.

Mapping and assessment of personal and professional development skills in a pharmacy curriculum.

BACKGROUND: Health sciences programs are increasingly expanding their curricula to bridge foundational scientific knowledge with needed skills to practice and patient care. The primary objectives of this study are to 1) assess whether the personal and professional development (PPD) subdomains (self-assessment, leadership, innovation and entrepreneurship, and professionalism) are integrated in a pharmacy curriculum; and 2) identify any gaps related to the subdomains' learning objectives. METHODS: Four different mapping activities were completed to create a comprehensive mapping plan regarding the integration of the PPD subdomains in the curriculum. The first mapping activity entailed matching the school's program educational outcomes (PEOs) to these subdomains (Step 1). Mapping of the enacted curriculum by faculty (Step 2) and learned curriculum by students (Step 3) were also completed in order to evaluate the integration of these subdomains in the curriculum. Finally, Step 4 involved mapping of the assessed curriculum by analyzing the progress of students on PPD-related competencies using standardized scoring rubrics and the correlation between students' and facultys' assessments with regard to matching competencies. The Cochrane's Q test and the Cohen's kappa coefficient were used in the statistical analysis of parametric data. RESULTS: The subdomains were found to be woven across curricular, co-curricular, and extra-curricular activities based on the four different mapping activities. Faculty and students agreed that the PPD competencies are integrated in the curriculum; provided example courses, experiences and activities; and identified areas of further improvements. The completed mapping activities drove the development of action plans for remediation of identified gaps in the curriculum. CONCLUSION: Mapping activities showed the sequential integration of the PPD skills at different depths and breadths in the curriculum. This study provides an example to health sciences schools on the incorporation of the PPD skills in their curricular, co-curricular and extra-curricular activities as current accreditation standards have directed Pharmacy programs to integrate and enforce them in their curricula.

Amoxicillin/Clavulanic Acid-induced thrombocytopenia.

INTRODUCTION AND OBJECTIVE: Drug-induced thrombocytopenia is a common adverse effect reported in the literature. Typically patients present with a low platelet count with signs and symptoms ranging from bruising to bleeding, and major organ damage. Penicillin-induced thrombocytopenia previously reported in the literature is explained primarily through the hapten-dependent antibody process. The goal of this report is to present a case of an amoxicillin/clavulanic acid-induced thrombocytopenia. CASE PRESENTATION: A 23-year-old male presented to the emergency department with bruises on his arms and legs after completing a full course of amoxicillin/clavulanic acid of 625 mg twice a day for 5 days for tonsillitis. After several tests, the patient was diagnosed with thrombocytopenia induced by amoxicillin/clavulanic acid. The patient was treated with a corticosteroids taper regimen for 3 weeks. He was discharged after 3 days of inpatient treatment with instructions to avoid physical activity for 2 weeks. Two weeks post discharge, the follow-up showed that the platelet count had increased. DISCUSSION: Penicillin-induced thrombocytopenia has been previously reported in the inpatient setting where bleeding was observed. However, the patient in this case report presented with bruises on his arms and legs. The diagnosis was made by the process of elimination; not all possible tests were conducted. The patient was prescribed corticosteroids that are not indicated for drug-induced thrombocytopenia. The Naranjo scale showed that this is a probable adverse event of amoxicillin/clavulanic acid. CONCLUSION: This is a unique case where amoxicillin/clavulanic acid was reported to be a probable cause of thrombocytopenia in an outpatient setting without signs of bleeding and without concomitant medications.

Association of hypertension with coronary artery disease onset in the Lebanese population.

The onset of coronary artery disease (CAD) is influenced by cardiovascular risk factors that often occur in clusters and may build on one another. The objective of this study is to examine the relationship between hypertension and CAD age of onset in the Lebanese population. This retrospective analysis was performed on data extracted from Lebanese patients (n = 3,753). Logistic regression examined the association of hypertension with the age at CAD diagnosis after controlling for other traditional risk factors. The effect of antihypertensive drugs and lifestyle changes on the onset of CAD was also investigated. Results showed that hypertension is associated with late onset CAD (OR=0.656, 95% CI=0.504-0.853, p=0.001). Use of antihypertensive drugs showed a similar association with delayed CAD onset. When comparing age of onset in CAD patients with traditional risk factors such as hypertension, diabetes, hyperlipidemia, obesity, smoking and family history of CAD, the age of onset was significantly higher for patients with hypertension compared to those with any of the other risk factors studied (p < 0.001). In conclusion, hypertension and its treatment are associated with late coronary atherosclerotic manifestations in Lebanese population. This observation is currently under investigation to clarify its genetic and/or environmental mechanisms.

Pharmacist recognition of and adherence to medication-use policies and safety practices.

PURPOSE: Pharmacist recognition of and adherence to medication-use policies and safety practices were assessed. METHODS: Simulation testing was used to assess the performance of pharmacists in hypothetical scenarios simulating real-life situations. Fifty test case medication orders were developed, some requiring specific intervention and some requiring no special action. Orders were classified into four categories: those posing safety concerns n ( = 16), those with formulary and product standardization issues (n = 4), those with pharmacy and therapeutics (P&T) committee restrictions (n = 4), and those requiring no special action (n = 26). Potential barriers to compliance were identified by the project team and the orders categorized accordingly. The orders were processed by 25 pharmacists using a simulation testing procedure. Data were analyzed by pharmacists' demographics, order category, and perceived barriers to compliance. RESULTS: Pharmacists were correctly able to recognize 77.3% of test orders: 67.3% with safety concerns, 98.9% with formulary issues, and 98.5% with restrictions. Appropriate action was taken with 74.2% of test orders: 64.5% of safety orders, 96.6% of formulary orders, and 92.4% of restriction orders. There was no correlation between pharmacists' performance and demographic characteristics. The two barriers to correct response identified most often were ambiguous responsibility and low perceived level of importance. CONCLUSION: Pharmacists generally recognized and took appropriate action with simulated medication orders that contained problems related to formulary or P&T committee restrictions. They were less able to recognize and act appropriately on orders with safety-related problems. Ambiguous responsibility and low perceived importance were the most significant factors contributing to noncompliance with P&T committee policies and guidelines.

Factors influencing the magnitude and clinical significance of drug interactions between azole antifungals and select immunosuppressants.

The magnitude of drug interactions between azole antifungals and immunosuppressants is drug and patient specific and depends on the potency of the azole inhibitor involved, the resulting plasma concentrations of each drug, the drug formulation, and interpatient variability. Many factors contribute to variability in the magnitude and clinical significance of drug interactions between an immunosuppressant such as cyclosporine, tacrolimus, or sirolimus and an antifungal agent such as ketoconazole, fluconazole, itraconazole, voriconazole, or posaconazole. By bringing similarities and differences among these agents and their potential interactions to clinicians' attention, they can appreciate and apply these findings in a individualized patient approach rather than follow only the one-size-fits-all dosing recommendations suggested in many tertiary references. Differences in metabolism and in the inhibitory potency of cytochrome P450 3A4 and P-glycoprotein influence the onset, magnitude, and resolution of drug interactions and their potential effect on clinical outcomes. Important issues are the route of administration and the decision to preemptively adjust dosages versus intensive monitoring with subsequent dosage adjustments. We provide recommendations for the concomitant use of these agents, including suggestions regarding contraindicated combinations, those best avoided, and those requiring close monitoring of drug dosages and plasma concentrations.