A compliance assessment of midpoint formative assessments completed by APPE preceptors.

INTRODUCTION: Experiential pharmacy preceptors should provide formative and summative feedback during a learning experience. Preceptors are required to provide colleges and schools of pharmacy with assessments or evaluations of students' performance. Students and experiential programs value on-time completion of midpoint evaluations by preceptors. The objective of this study was to determine the number of on-time electronically documented formative midpoint evaluations completed by preceptors during advanced pharmacy practice experiences (APPEs). METHODS: Compliance rates of on-time electronically documented formative midpoint evaluations were reviewed by the Office of Experiential Education of a five-member consortium during the two-year study period prior to the adoption of Standards 2016. Pearson chi-square test and generalized linear models were used to determine if statistically significant differences were present. RESULTS: Average midpoint compliance rates for the two-year research period were 40.7% and 41% respectively. No statistical significance was noted comparing compliance rates for year one versus year two. However, statistical significance was present when comparing compliance rates between schools during year two. Feedback from students and preceptors pointed to the need for brief formal midpoint evaluations that require minimal time to complete, user friendly experiential management software, and methods for documenting verbal feedback through student self-reflection. CONCLUSIONS: Additional education and training to both affiliate and faculty preceptors on the importance of written formative feedback at midpoint is critical to remaining in compliance with Standards 2016.

Enteral nutrition in the chronic obstructive pulmonary disease (COPD) patient.

Chronic obstructive pulmonary disease (COPD) is a progressive, chronic disease, in which malnutrition can have an undesirable effect. Therefore, the patient's nutritional status is critical for optimizing outcomes in COPD. The initial nutrition assessment is focused on identifying calorically compromised COPD patients in order to provide them with appropriate nutrition. Nutritional intervention consists of oral supplementation and enteral nutrition to prevent weight loss and muscle mass depletion. Evaluation of nutritional status should include past medical history (medications, lung function, and exercise tolerance) and dietary history (patient's dietary habits, food choices, meal patterns, food allergy information, and malabsorption issues), in addition to physiological stress, visceral proteins, weight, fat-free mass, and body mass index. The current medical literature conflicts regarding the appropriate type of formulation to select for nutritional intervention, especially regarding the amount of calories from fat to provide COPD patients. This review article focuses on the enteral product formulations currently available, and how they are most appropriately utilized in patients with COPD.

Impact of advanced pharmacy practice experience placement changes in colleges and schools of pharmacy.

OBJECTIVE: To document the annual number of advanced pharmacy practice experience (APPE) placement changes for students across 5 colleges and schools of pharmacy, identify and compare initiating reasons, and estimate the associated administrative workload. METHODS: Data collection occurred from finalization of the 2008-2009 APPE assignments throughout the last date of the APPE schedule. Internet-based customized tracking forms were used to categorize the initiating reason for the placement change and the administrative time required per change (0 to 120 minutes). RESULTS: APPE placement changes per institution varied from 14% to 53% of total assignments. Reasons for changes were: administrator initiated (20%), student initiated (23%), and site/preceptor initiated (57%) Total administrative time required per change varied across institutions from 3,130 to 22,750 minutes, while the average time per reassignment was 42.5 minutes. CONCLUSION: APPE placements are subject to high instability. Significant differences exist between public and private colleges and schools of pharmacy as to the number and type of APPE reassignments made and associated workload estimates.

Consortium-based approach to an online preceptor development program.

OBJECTIVE: To describe the implementation process of a consortium-based preceptor development program and to review completion and assessment data over the first 27 months. DESIGN: Five 1-hour, Web-based preceptor development modules were developed using streaming media technologies. Modules were released using a password-protected Internet site and were free to consortium-affiliated preceptors. Preceptor's institutional affiliation, module completion dates, module assessments, and continuing education credits were recorded and made available to each institution. ASSESSMENT: Three hundred eighty-two preceptors completed 1489 modules. Fifty-six percent of preceptors were affiliated with more than 1 consortium institution. The number of participating preceptors per institution varied from 72 to 204. Sixty-five percent of preceptors completed all 5 modules. Preceptor satisfaction was high, with 93% agreeing with each course evaluation statement. Program cost per institution ranged from $12 to $35 per preceptor. CONCLUSIONS: A consortium-based approach to preceptor development is a convenient and effective means of providing required training.

Barriers to expanding advanced pharmacy practice experience site availability in an experiential education consortium.

OBJECTIVES: To compare 2006-2007 and projected 2010-2011 advanced pharmacy practice experience (APPE) availability and needs for 4 colleges and schools of pharmacy in Georgia and Alabama and to examine barriers and offer potential solutions to increase APPE site and preceptor availability. METHODS: Data on APPE needs and availability were gathered prospectively and evaluated relative to current and projected enrollment and planned programmatic changes. RESULTS: Combined 2006-2007 non-community APPE needs and availabilities were 3,590 and 4,427, respectively, with a surplus availability of 837. Combined projected 2010-2011 non-community APPEs were estimated at 4,309. Assuming 2006-2007 non-community availability remained unchanged, the surplus availability declined to 118. CONCLUSIONS: The need for quality experiential education represents a significant barrier and rate-limiting step to the matriculation of the increased numbers of pharmacists. Barriers to expanding APPE availability include: introductory pharmacy practice experience (IPPE) and APPE expansion, growth of new and existing pharmacy programs, financial instability of acute care facilities, and lack of preceptor development resources. Regional experiential education consortiums can provide a constructive approach to improve access to quality sites and preceptors through standardizing processes and leveraging resources.

Therapeutic potential of n-3 polyunsaturated fatty acids in disease.

PURPOSE: The potential therapeutic benefits of supplementation with n-3 polyunsaturated fatty acids (PUFAs) in various diseases are reviewed, and the antiinflammatory actions, activity, and potential drug interactions and adverse effects of n-3 PUFAs are discussed. SUMMARY: Fish oils are an excellent source of long-chain n-3 PUFAs, such as eicosapentaenoic acid and docosahexaenoic acid. After consumption, n-3 PUFAs can be incorporated into cell membranes and reduce the amount of arachidonic acid available for the synthesis of proinflammatory eicosanoids (e.g., prostaglandins, leukotrienes). Likewise, n-3 PUFAs can also reduce the production of inflammatory cytokines, such as tumor necrosis factor alpha, interleukin-1, and interleukin-6. Considerable research has been conducted to evaluate the potential therapeutic effects of fish oils in numerous conditions, including arthritis, coronary artery disease, inflammatory bowel disease, asthma, and sepsis, all of which have inflammation as a key component of their pathology. Additional investigations into the use of supplementation with fish oils in patients with neural injury, cancer, ocular diseases, and critical illness have recently been conducted. The most commonly reported adverse effects of fish oil supplements are a fishy aftertaste and gastrointestinal upset. When recommending an n-3 PUFA, clinicians should be aware of any possible adverse effect or drug interaction that, although not necessarily clinically significant, may occur, especially for patients who may be susceptible to increased bleeding (e.g., patients taking warfarin). CONCLUSION: The n-3 PUFAs have been shown to be efficacious in treating and preventing various diseases. The wide variation in dosages and formulations used in studies makes it difficult to recommend dosages for specific treatment goals.