AACP faculty affairs standing committee report of strategies for faculty self-advocacy and promotion.

OBJECTIVES: The 2020-2021 American Association of Colleges of Pharmacy Faculty Affairs Standing Committee (FASC) was charged with identifying how faculty can self-advocate and promote themselves in a social influence context. FINDINGS: The FASC identified social influence and persuasion theories and strategies that can be used by faculty to initiate self-advocacy discussions and collaborations. Social influence and persuasion theories can provide a framework for research and scholarship or for beginning discussions regarding self-advocacy. SUMMARY: This FASC report describes the Committee charge, background information, and an overview of social influence theories and how these theories can be applied in academic pharmacy. The report concludes with a summary of issues for follow-up to the Committee's work.

Evaluation of the efficacy and safety of direct oral anticoagulants in the treatment of portal vein thrombosis.

OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of direct oral anticoagulants vs. warfarin for portal vein thrombosis treatment. METHODS: This was a single-center, retrospective study. Adult patients initiated on a direct oral anticoagulant or warfarin for treatment of a new portal vein thrombosis were included. The primary failure outcome was the absolute difference in recurrent thromboembolic events 90 days following initiation of a direct oral anticoagulant vs. warfarin. The primary safety outcome was the absolute difference in bleeding events 90 days following initiation of a direct oral anticoagulant vs. warfarin. Descriptive statistics, Fisher's exact, and Student's t-tests were utilized as appropriate. RESULTS: Thirty-three patients were included. Thirteen (39.4%) patients received direct oral anticoagulants, and 20 (60.6%) received warfarin. None of the patients receiving direct oral anticoagulants experienced a primary failure event compared to four receiving warfarin (P < 0.001). None of the patients receiving direct oral anticoagulants experienced a primary safety event vs. one receiving warfarin (P < 0.001). CONCLUSION: Direct oral anticoagulants appear to be effective and safe in the treatment of portal vein thrombosis and in preventing recurrent thromboembolic events. Future studies with larger sample sizes are warranted to confirm direct oral anticoagulants' efficacy in portal vein thrombosis.

Development of coupled patient care experience courses to enhance patient care skills in the ambulatory and acute care settings.

BACKGROUND AND PURPOSE: Providing opportunities to allow pharmacy students to apply clinical skills is essential to ensure that they are comfortable and competent to perform these skills during advanced pharmacy practice experiences (APPEs) and in practice. We describe unique coupled courses that require students to apply clinical skills during real patient encounters and simulation activities in the ambulatory and acute care setting to ensure that they are ready for APPEs. EDUCATIONAL ACTIVITY AND SETTING: New required courses were developed at West Virginia University School of Pharmacy that focused on teaching and reinforcing patient care skills in the ambulatory and acute care settings. Both courses were designed to provide students with multiple opportunities to offer supervised patient care and to become more comfortable and confident in their patient care skills. FINDINGS: The coupled courses were well-received by students. Feedback indicated that students felt more comfortable in these patient care settings and in performing patient care activities as a result of these courses. SUMMARY: These coupled courses offered multiple opportunities for students to practice patient care skills and gain valuable experience participating in activities that increased their confidence and competence at being integral members of the healthcare team. The interactions with real patients, simulated patient scenarios, standardized patients, and other members of the healthcare team helped students advance communication skills, clinical skills, and ability to identify and resolve medication-related problems in preparation for APPEs.

Antibiotic de-escalation on internal medicine services with rounding pharmacists compared to services without.

Background Antimicrobial stewardship programs ensure antibiotic therapy is used appropriately and includes de-escalation when clinical status or culture data indicates broad-spectrum agents are no longer needed. Although the impact of infectious diseases clinical pharmacists has been well documented, there is limited research evaluating the impact of adult internal medicine clinical pharmacists on broad-spectrum antibiotic de-escalation while rounding on internal medicine teams. Objective To determine if broad-spectrum antibiotics were de-escalated more regularly and more rapidly in patients on internal medicine services with a rounding pharmacist at the bedside compared to internal medicine services without rounding pharmacists. Setting A single 700 bed academic medical center in the United States of America. Method This was a prospective observational cohort chart review. Main outcome measure The primary endpoint was appropriate broad-spectrum antibiotic de-escalation within 72 h or upon return of culture results. Result A total of 64 patients were included in this study with 39 in the pharmacist group and 25 in the no pharmacist group. De-escalation occurred in 35/39 patients on services with pharmacists and in 13/25 patients on services without pharmacists (p = 0.001). In terms of mean days of broad-spectrum antibiotic therapy, services with rounding pharmacists saw patients on Methicillin-resistant Staphylococcus aureus coverage for an average of 2.12 days of their duration of therapy compared to 2.8 days in those without pharmacists (p = 0.821). Services with rounding pharmacists saw patients on Pseudomonas aeruginosa coverage for 2 days of their length of stay compared to 3 days in those without pharmacists (0.398). Conclusion This data shows that broad-spectrum antibiotics were de-escalated more frequently on medicine services with rounding pharmacists compared to services without pharmacists.

Intentional Interprofessional Experiential Education.

The experiential component of a doctor of pharmacy curricula is an ideal, yet underutilized vehicle to advance interprofessional education (IPE) initiatives. To date, most experiential-based IPE initiatives occur in a naturally occurring, non-deliberate fashion. The American Association of Colleges of Pharmacy (AACP) Experiential Education Section formed the Task Force on Intentional Interprofessional Education in Experiential Education in academic year 2015-2016 to explore the issue. This commentary describes the work of the task force, including the following elements: defining intentional interprofessional experiential education as "the explicit effort by preceptors and practice sites to create/foster educational opportunities or activities designed specifically to achieve interprofessional educational competencies;" conducting a systematic literature review to identify examples of intentional interprofessional experiential education in the published literature; surveying faculty with oversight of experiential education programs and preceptors within those programs; and generating recommendations to stakeholders including AACP, pharmacy schools, and experiential education administrators.

Retrospective cross-sectional pilot study of rifaximin dosing for the prevention of recurrent hepatic encephalopathy.

Standard treatment for hepatic encephalopathy (HE) includes medications that reduce ammonia and bacterial translocation in the gut. Rifaximin can be used off-label for the reduction of overt HE. The study purpose was to determine efficacy of traditional rifaximin dosing (400 mg three times daily) compared with newer dosing (550 mg twice daily) via readmission rates for the prevention of recurrent HE. This was a retrospective, observational, cross-sectional pilot study conducted in a tertiary medical center. A total of 226 patients 18-89 years of age with documentation of HE via ICD-9 code who started rifaximin therapy while inpatient between April 2009 and June 2014 were evaluated. Data collected included rifaximin dosing, other medications used to treat HE, duration of therapy, time to readmission, and various laboratory values. There were no differences in readmission rates at 30 days, 60 days, or 6 months between treatment groups. Additionally, there was no difference in the odds of readmission between the treatment groups (OR = 0.77, 95% CI: [0.201, 4.365], P = 0.718). Patients had a low overall probability of readmission over the observational period. Based on average wholesale price data, the cost for a 9-day supply of rifaximin for the 400-mg dosing regimen is $952.56 versus $605.16 for the 550-mg dosing regimen. The rifaximin 550-mg dosing strategy should be utilized in hospitalized patients for the prevention of recurrent HE as there was no difference in readmission rate or time to readmission between dosing groups. The 550-mg regimen had a lower acquisition cost for a 9-day duration of treatment in the studied institution.

Worsening renal function in patients with baseline renal impairment treated with intravenous voriconazole: A systematic review.

The objective of this paper was to review the risk of worsening renal function in patients with pre-existing renal impairment receiving intravenous voriconazole (IVV). Controversy exists regarding the cause and risk of renal dysfunction in patients treated with IVV. Whilst some studies implicate renally excreted cyclodextrin, a pharmaceutical formulation stabiliser, as the cause of renal dysfunction following voriconazole administration, others provide contradicting evidence. Here we analyse the available literature to gain an insight into the significance of renal toxicity in patients treated with IVV. PubMed was searched for relevant studies to December 2014. To account for publication bias, abstracts from the Interscience Conference on Antimicrobial Agents and Chemotherapy, the Infectious Diseases Society of America/ID Week, and the European Congress of Clinical Microbiology and Infectious Diseases from 2008-2014 were reviewed. Bibliographies of all identified articles were reviewed and cross-referenced for additional sources. Seven retrospective studies were identified for inclusion in the review; no prospective studies were identified. Based on the available evidence, we conclude that there is no strong evidence suggesting an increased incidence of worsening renal function with IVV use. No study thus far has provided direct conclusive evidence for cellular and physiological renal toxicity due to IVV at clinically prevalent doses.

Teaching and learning curriculum programs: recommendations for postgraduate pharmacy experiences in education.

PURPOSE: Recommendations for the development and support of teaching and learning curriculum (TLC) experiences within postgraduate pharmacy training programs are discussed. SUMMARY: Recent attention has turned toward meeting teaching- and learning-related educational outcomes through a programmatic process during the first or second year of postgraduate education. These programs are usually coordinated by schools and colleges of pharmacy and often referred to as "teaching certificate programs," though no national standards or regulation of these programs currently exists. In an effort to describe the landscape of these programs and to develop a framework for their basic design and content, the American Association of Colleges of Pharmacy Pharmacy Practice Section's Task Force on Student Engagement and Involvement, with input from the American Society of Health-System Pharmacists, reviewed evidence from the literature and conference proceedings and considered author experience and expertise over a two-year period. The members of the task force created and reached consensus on a policy statement and 12 recommendations to guide the development of best practices of TLC programs. The recommendations address topics such as the value of TLC programs, program content, teaching and learning experiences, feedback for participants, the development of a teaching portfolio, the provision of adequate resources for TLC programs, programmatic assessment and improvement, program transparency, and accreditation. CONCLUSION: TLC programs provide postgraduate participants with valuable knowledge and skills in teaching applicable to the practitioner and academician. Postgraduate programs should be transparent to candidates and seek to ensure the best experiences for participants through systematic program implementation and assessments.

Role of doxycycline in Clostridium difficile infection acquisition.

OBJECTIVE: To evaluate and review the literature surrounding the potential protective benefit of tetracyclines, particularly doxycycline, in reducing Clostridium difficile infection (CDI) acquisition. DATA SOURCES: MEDLINE/PubMed, Google Scholar, and International Pharmaceutical Abstracts were searched through January 2014 using the search terms doxycycline, tetracycline, and Clostridium difficile. STUDY SELECTION AND DATA EXTRACTION: Relevant studies, case reports, and review articles were screened for inclusion. Bibliographies of articles were extensively reviewed for additional sources. DATA SYNTHESIS: Doxycycline is a second-generation tetracycline antibiotic indicated for use in a variety of clinical syndromes and has activity against aerobic Gram-positive and -negative, anaerobic, and atypical bacteria as well as protozoan parasites. Although not used therapeutically to treat CDI, doxycycline may prevent or attenuate the virulence factors of toxigenic C difficile. Current literature does not indicate an increased risk of development of CDI with doxycycline use. In 3 retrospective studies, the use of doxycycline was associated with a protective effect. CONCLUSIONS: Doxycycline has been shown to have potential protective effects against the development of CDI. Although further randomized placebo-controlled studies are needed, available data suggest that the use of doxycycline in place of alternative antimicrobials, when appropriate, may be a useful antimicrobial stewardship strategy aimed at reducing the incidence of CDI.

Ecallantide for treatment of acute attacks of hereditary angioedema.

PURPOSE: The pharmacology, pharmacokinetics, efficacy, safety, dosage, administration, adverse effects, and place in therapy of ecallantide, a kallikrein inhibitor for the treatment of hereditary angioedema (HAE), are reviewed. SUMMARY: Ecallantide is the first member of the kallikrein inhibitor class approved for the treatment of acute attacks of HAE. Ecallantide works by binding to kallikrein, preventing the conversion of kininogen to bradykinin, which reduces vascular permeability, thus reducing the swelling associated with acute attacks of HAE. Ecallantide has been studied for the treatment of HAE in three Phase II studies and two Phase III studies. These studies were collectively known as the EDEMA (Evaluation of DX-88's Effect in Mitigating Angioedema) studies. Phase III clinical trials found that ecallantide is superior to placebo in ameliorating patient symptoms associated with acute attacks of HAE at any anatomical site. Ecallantide has a favorable safety profile, with the most common adverse effects being gastrointestinal effects, headache, and injection site reactions. The most severe adverse effects of ecallantide are the risk of anaphylaxis and the possible development of antiecallantide antibodies. A risk evaluation and mitigation strategy program has been approved by the Food and Drug Administration to help ensure the safety and efficacy of ecallantide use. The recommended dose is 30 mg given as three separate subcutaneous injections. CONCLUSION: Ecallantide is a novel agent approved for the treatment of acute attacks of HAE at any anatomical site. It is one of only three medications approved for this indication in the United States, presents a unique mechanism of action, and appears to be safe and effective when used for its labeled indication.

Cost minimization analysis comparing enteral N-acetylcysteine to intravenous acetylcysteine in the management of acute acetaminophen toxicity.

CONTEXT: Acetaminophen poisoning is one of the most common exposures and causes of poisoning-related fatalities as reported to U.S. poison information centers. Acetylcysteine is indicated for the antidotal treatment of acetaminophen poisoning to prevent or minimize acetaminophen-related hepatotoxicity. Available as either an enteral or intravenous (IV) formulation, both forms of acetylcysteine have been proven to be efficacious. Because of the differences in the acquisition costs and the length of treatment, it is unclear which treatment route is the most cost-effective. OBJECTIVE: The purpose of this study was to compare the total hospitalization charges associated with patients who received either enteral or IV acetylcysteine therapy. MATERIALS AND METHODS: A retrospective, IRB-approved cohort study of patients treated with either enteral or IV acetylcysteine at a university-related hospital for the treatment of acute acetaminophen overdose was conducted. Patients included were over 18 years of age, admitted during the 5-year periods of 1996-2000 (enteral) and 2004-2008 (IV), had an ICD-9 discharge diagnosis for acetaminophen overdose, had no transplant history, and were admitted within 24 h of the overdose. The primary endpoint was the total cost associated with the hospital stay. The Consumer Price Index (CPI) inflation calculator from the U.S. Bureau of Labor Statistics was used to adjust all monetary values to 2008 dollars. RESULTS: Of a total of 1,647 patients, 261 met the inclusion criteria with 70 patients being treated with enteral acetylcysteine and 191 patients treated with IV acetylcysteine. The associated cost was greater in the enteral group than in the IV group ($18,287.63 vs. $7,607.82; p < 0.001). The average length of stay was longer in the enteral group compared to the IV group (7 days vs. 4 days; p < 0.001). CONCLUSIONS: Patients who were treated with IV acetylcysteine had a decreased length of stay and cost of hospitalization compared with those patients who were treated with enteral acetylcysteine.