Interventions to Facilitate Return to Work after Stroke: A Systematic Review.

PURPOSE: To gather knowledge about effective return to work interventions for survivors of stroke. METHODS: A database search was conducted in MEDLINE, CINAHL, PsycINFO, Scopus, and Web of Science using keywords and medical subject headings. Studies were included if they met the following criteria: (i) studies published in English since the year 2000; (ii) adult patients aged 18-65 with a primary diagnosis of stroke; (iii) working pre-stroke; and (iv) intervention in which one of the primary outcomes is return to work. The methodological quality of included studies was assessed and the evidence synthesised. RESULTS: Twelve studies were included, of which three were randomised controlled trials, four were retrospective studies, one was a cohort study, one was an explorative longitudinal study, one was a pre-post treatment observation study and two were pilot studies. The employment rate at follow-up ranged from 7% to 75.6%. Overall, there was limited published evidence regarding the effectiveness of interventions to promote return to work for this population, and it was unclear if return to pre-stroke work was the goal. CONCLUSION: A lack of large, controlled trials, variations in follow-up time and the definitions of return to work accounted for the large range of employment rates at follow-up. There is limited published high-quality evidence regarding the effectiveness of interventions to promote return to work in working-age survivors of stroke.

Pembrolizumab-induced Toxic Epidermal Necrolysis in a Patient with Metastatic Esophageal Adenocarcinoma.

Adverse cutaneous reactions associated with the immune checkpoint inhibitor (ICI) pembrolizumab are well documented, yet life-threatening reactions such as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) are infrequent.1,2 We present a case of pembrolizumab-induced TEN in a patient with metastatic esophageal adenocarcinoma who was successfully treated with cyclosporine and systemic corticosteroids.

A mixed-method longitudinal study of an interprofessional education course.

The purpose of this mixed-method longitudinal study was to understand how health professional students' perceptions of their professional flexibility, role interdependence, and reflection on their process of working together change over time as a result of participating in an interprofessional education course. Data were collected from students enrolled in an interprofessional service-learning course each year from Fall 2014 to 2018 via online surveys at four assessment points and through qualitative reflection papers that served as course assignments. The 14-week course consisted of both didactic instruction and an experiential component whereby students conducted a service-learning activity in interprofessional teams. Quantitative findings demonstrate that students experienced a significant quadratic growth trajectory in reflection on process and a significant linear growth trajectory in professional flexibility. Students reported experiencing non-significant changes in role interdependence. Qualitative data, however, suggest student learning across all three domains. This study has implications for interprofessional educational initiatives aimed at promoting students' interprofessional competencies.

An academic-community interprofessional telehealth online training partnership: Impact on students and providers.

Telehealth can be used to improve rural communities' access to specialized healthcare services and ameliorate rural care barriers. Use of telehealth quickly increased with the COVID-19 pandemic, and universities shifted to online instruction for the safety of students and faculty. This rapid uptake of telehealth and online instruction has created an urgent need for examples of online training for health professional students in telehealth. Participants for this study included 44 students enrolled in an interprofessional online mental health telehealth course and four health care professionals from rural clinics. Qualitative data were collected and analyzed from students and providers. Four primary themes were identified: student benefits from the IPE telehealth course, patient benefits, clinic benefits, and technological challenges. Student subthemes included learning skills needed for telehealth, improving team skills, learning about professional roles and responsibilities, and understanding rural health needs. Clinic benefits included improving telehealth readiness. This study presents an early example of online interprofessional mental health telehealth training using an academic-community partnership. Our pilot findings suggest that this course experience resulted in positive benefits for students and rural clinic providers.

Advancing Pharmacy Education and Workforce Development Amid the COVID-19 Pandemic: Report of the 2020-2021 AACP Academic Affairs Committee.

EXECUTIVE SUMMARY The 2020-2021 Academic Affairs Committee was charged to (1) Read all six reports from the 2019-20 AACP standing committees to identify elements of these reports that are relevant to your committee's work this year; (2) Determine what changes made in colleges and schools of pharmacy during the COVID-19 pandemic should be continued to advance pharmacy education; (3) Develop a realistic model for colleges and schools of pharmacy to share resources to meet the curricular needs of member schools; (4) Create strategies by which colleges and schools of pharmacy can meet current and future workforce development needs particularly in light of the changes in healthcare delivery as a result of the COVID-19 pandemic; (5) Identify salient activities for the Center To Accelerate Pharmacy Practice Transformation and Academic Innovation (CTAP) for consideration by the AACP Strategic Planning Committee and AACP staff. This report provides an overview of changes made in schools and colleges of pharmacy implemented in response to the COVID-19 pandemic that may be continued to advance pharmacy education; a realistic model for colleges and schools of pharmacy to share resources to meet the curricular needs of member schools; and strategies by which schools and colleges of pharmacy can meet current and future workforce development needs, particularly in light of the changes in healthcare delivery as a result of the COVID-19 pandemic. The committee is proposing one policy statement for consideration by the 2021 AACP House of Delegates, four suggestions for consideration by schools and colleges of pharmacy (including two endorsements for suggestions from the 2020-21 Argus Commission), and one recommendation for consideration by AACP for CTAP to implement and oversee.

Two cases of congenital dermatomyofibroma.

We present two infants with histologically confirmed congenital dermatomyofibromas. Congenital cases are rare with only one prior case reporting presence since birth. Given the benign nature of the lesions and propensity of dermatomyofibromas to resolve without intervention in young male patients, no additional treatments were pursued.

Adaptive kinship: Jane Rule's domestic geographies of care.

Focusing on two of Jane Rule's novels, The Young in One Another's Arms and Memory Board, this essay treats them as a resource for rethinking the relationship between queerness, kinship, and domesticity. Rather than a fully agential idea of queer kinship-the familiar model of "families we choose"-Rule grounds her model of kinship in shared domestic experience, and in slow and mutual adaptation. Her vision of kinship is profoundly relational, and never homonormative; it is also grounded in the lived experience of disability. For Rule, adaptation is both an interpersonal process and a material one: her novels take place in houses that are adapted to accommodate physical and intellectual disabilities, non-monogamous romantic relationships, communal child-rearing, transient populations, and other unconventional communities of care. Adaptive kinship is a way of opposing state rule, the ideology of genetic lineage, and the hegemony of the couple form. Rule's groups of people, which usually include characters queered by race, disability, citizenship, and other forms of difference in addition to sexuality, become families not because they share a legal or genetic tie or because they have chosen each other, but because they have shared and shaped a domestic space.

Recommendations for integration of foundational and clinical sciences throughout the pharmacy curriculum.

INTRODUCTION: Pharmacy faculty have the often difficult task of translating and incorporating existing concepts and advances from the foundational sciences into the clinical sciences and practice. This commentary focuses on content integration as a curricular and educational strategy, outcomes data from integration, and recommendations for programs employing or considering curricular integration. COMMENTARY: Integration of foundational and clinical sciences across the curriculum has been emphasized in accreditation standards but met with mixed reactions by faculty across different disciplines in the academy. Many pharmacy programs have already incorporated some level of integration in didactic courses. However, most report coordination of curricular delivery rather than higher levels of integration in which different disciplines work together to design and deliver instructional materials across the entire curriculum. IMPLICATIONS: Curricular integration models should be optimized to minimize or eliminate the risks of marginalization of foundational sciences in pharmacy curricula. A significant problem in implementing curricular integration is determining the appropriate balance between foundational and clinical sciences. Well-designed curricular integration with ongoing reinforcement that builds in complexity over time could enhance knowledge retention, critical thinking abilities, and clinical decision making. Further research is needed into the outcomes achieved from various integrated curricular approaches in pharmacy education.

Survey of residency program directors' perceptions of nontraditional pharmacy residency applicants.

PURPOSE: The attitudes and expectations of residency program directors (RPDs) regarding nontraditional residency applicants (NTAs) were evaluated. METHODS: This was a cross-sectional, survey-based study targeting RPDs of American Society of Health-System Pharmacists-accredited residency programs. A 14-question survey requesting information related to demographics, perceptions of NTAs compared with traditional applicants, advantages and disadvantages of NTAs, and advice for NTAs was administered electronically to RPDs. The primary outcome of this study was to determine RPDs' perceptions of NTAs as suitable residency candidates. The secondary outcome evaluated the rate of NTA acceptance into residency programs and a qualitative assessment of RPDs' advice for NTAs. RESULTS: Of the 1,414 RPDs contacted to participate, 328 (23%) completed the survey. RPDs were primarily affiliated with postgraduate year 1 pharmacy practice (52%) or postgraduate year 2 specialty residencies (30%), and 35% reported having an NTA in their program. Most respondents (87%) reported that NTAs are given equal consideration relative to traditional residency applicants. RPDs rated work experience as the most important quality of an NTA, followed closely by the ability to work with others and teachability. Most (277 [85%]) RPDs agreed that NTAs should possess experiences beyond work experience, such as research, leadership, and community service. The biggest concern regarding NTAs was significant time since graduation prior to application. CONCLUSION: The majority of RPDs did not perceive NTAs differently from traditional applicants in the selection process of prospective candidates.

Examining collaborative leadership through interprofessional education: findings from a mixed methods study.

Collaborative leadership is essential as recent trends in healthcare service delivery necessitate interprofessional collaboration and care. Interprofessional education (IPE) efforts, therefore, have to prepare students for this type of leadership. The purpose of this study was to understand how students' perceptions of leadership change as a result of embedding a collaborative leadership model, the Social Change Model (SCM) of leadership, in an IPE course. Data were collected from 30 students participating in an interprofessional course through two interprofessional course reflections, pre/post leadership posters and poster reflections, and a pre/post survey. Results from paired sample t-tests suggested students significantly improved in their perceptions of leadership efficacy. These data also indicated improvements to the three group-level values of the SCM: collaboration, common purpose, and controversy with civility. Findings from the qualitative data suggest that students learned to view leadership as more of a team effort than the actions of a single individual and as more of a process than a role. Findings also revealed the benefits and challenges of using a visual process of poster development as a way of examining students' changes in perceptions of leadership over the course of the semester. Implications are discussed in relationship to the utility of the SCM in promoting students' shifts in conceptualizations of leadership that emphasizes collaboration and helps prepare students to engage in these ways within interprofessional teams in their practice.

Evaluating the perceived impact of an interprofessional childhood obesity course on competencies for collaborative practice.

Interprofessional education (IPE) is needed to prepare health professional students to address the complexities of childhood obesity in practice. This mixed-method study sought to evaluate the perceived impact of a childhood obesity IPE intervention on health professional students' collaborative competency development within two domains: roles/responsibilities and teams/teamwork. Fourteen health professional students participated in this mixed-methods study. Quantitative data were collected through pre/post surveys, while qualitative data were collected through reflection assignments. Survey findings indicated that students reported significant increases in growth within both interprofessional competency domains. Qualitative data elaborated on the types of learning students experienced relative to each domain. Implications of this study for research and practice related to IPE to address complex health issues, such as childhood obesity, are shared.

Sensitizing Future Health Professionals to Determinants of Childhood Obesity.

Long-term solutions to the childhood obesity epidemic will require concerted interdisciplinary efforts that are sensitive to both individual and social determinants of health. The Junior Doctors of Health© (JDOH) program involves interprofessional education (IPE) with university students from health science fields (e.g., medicine, pharmacy, social work, public health) who deliver an interactive program in teams to at-risk school-aged youth. The purpose of this study was to assess the impact of participation in the JDOH IPE program on university students' beliefs about childhood obesity. Fifty-three of the 71 health sciences students enrolled in the JDOH IPE program between 2011 and 2013 participated in this study. Pre- and post-surveys assessed students' beliefs about the importance, causes of, and responsibility for reducing childhood obesity with both closed- and open-ended questions. In 2013, quantitative data were analyzed using Wilcoxon matched-pairs signed-rank tests and qualitative data were analyzed through open coding to identify emergent themes. Results indicate that after participation in the JDOH IPE program, students' identification of social and environmental causes of childhood obesity increased significantly. Further, students' ranking of the importance of obesity was initially higher than those of different issues typically portrayed as social or environmental (e.g., youth violence) but it was similarly ranked after participation in JDOH. This suggests a greater sensitivity to social and environmental challenges faced by youth. Findings suggest that IPE experiences that bring clinical and community-oriented health professions together to engage with disadvantaged youth foster sensitivity to the complexities of childhood obesity in low-income settings.