Assessing learning gains of pharmacy students in communications, ways of thinking, and intercultural skills through self-assessment.

BACKGROUND AND PURPOSE: Intercultural and Global Health Issues was developed to address learning outcomes in communication, ways of thinking, intercultural personal skills, and intercultural knowledge. The aim of this study was to assess learning gains of pharmacy students through self-assessment. EDUCATIONAL ACTIVITY AND SETTING: Course design, learning outcomes, objectives, and activities were created to meet the expected educational outcomes. A revised rubric was created from the American Association of Colleges and Universities (AACU) Valid Assessment of Learning in Undergraduate Education rubrics on Intercultural knowledge, Information literacy, and Creative thinking. Students completed self-assessments at the beginning and end of the course. Ward hierarchical clustering, paired sample t-tests, and independent t-tests analyzed multidimensional data in two clusters. FINDINGS: Cluster 1 (C1) students reported pre-course capstone performances for cultural self-awareness, problem solving, and access and use of information ethically and legally. Post-course scores for C1 students statistically increased for all AACU domains reaching capstone performances for intercultural competence, creative thinking, and information literacy. Cluster 2 (C2) students reported capstone performance levels for all AACU domains from the beginning to the end of the course. All students reported achievement of self-efficacy, creative thinking, and cultural competency at the end of the course. There was no statistically significant difference in course learning outcome scores for C1 and C2 students. SUMMARY: Students achieved embedded learning outcomes of ways of thinking, communication, interpersonal skills, and intercultural knowledge as demonstrated from self-assessments. Course activities aided students' demonstration of self-efficacy, creative thinking, and intercultural knowledge.

Therapeutic update on oral potassium exchange resin use in chronic kidney disease patients: a systematic review of randomized controlled clinical trials.

Hyperkalemia is a common electrolyte disorder in patients with chronic kidney disease (CKD) that increases in prevalence with the decline of glomerular fltration rate (GFR). Another risk of hyperkalemia is the use of renin-angiotensin-aldosterone system inhibitors (RAASi) and/or mineralocorticoid receptor antagonists (MRAs) in managing CKD and proteinuria. The treatment of chronic hyperkalemia is challenging especially for outpatients. Treatment options for hyperkalemia include the potassium exchange resins of which two new potassium binders, Patiromer Sorbitex Calcium, and Sodium Zirconium Cyclosilicate (SZC) have demonstrated their clinical efficacy in reducing serum potassium with a positive safety profile. The old potassium exchange resin sodium polystyrene sulfonate (Kayexalate™) has some negative side effects including colonic necrosis, hypomagnesemia, and hypernatremia. In this review and literature search, we compare the available oral potassium exchange resins, highlight their advantages and disadvantages and comment on efficacy and safety parameters specifically in CKD patients.

Tenapanor: A new treatment option for hyperphosphatemia in end stage kidney disease.

PURPOSE: This narrative review explores the currently published studies that have evaluated tenapanor for the treatment of hyperphosphatemia in end-stage kidney disease (ESKD) patients on hemodialysis. This medication's new phosphate lowering mechanism of action reduces intestinal phosphate absorption predominantly through reduction of passive paracellular phosphate flux by inhibition of the sodium/hydrogen exporter isoform 3 (NHE3). Tenapanor additionally prevents active transcellular phosphate absorption compensation by decreasing the expression of sodium phosphorus 2b transport protein (NaPi2b). METHODS: A comprehensive search of the literature was conducted using PubMed and ClinicalTrials.gov search engines. The search term "tenapanor hyperphosphatemia" was used for study retrieval. Results were limited to studies published in the English language and excluded review articles. Human, animal, and in vitro studies were included. No date range was specified. RESULTS: A total of 11 primary studies were identified and included in this review, the largest human study of which enrolled 236 patients. Each study is presented in table format along with measured end points. CONCLUSIONS: Tenapanor is the first drug in its class that lowers hyperphosphatemia in ESKD patients through a novel mechanism of action involving paracellular inactive transport. Although more studies are needed, early results indicate that tenapanor may have a place in managing hyperphosphatemia in ESKD patients both as monotherapy and as an adjunct to existing phosphate binder therapy.

Accommodating Pharmacy Students With Physical Disabilities During the Experiential Learning Curricula.

Accommodating pharmacy students with physical disabilities during the experiential learning portion of the Doctor of Pharmacy (PharmD) curriculum can present unique challenges for pharmacy schools. The available literature regarding accommodations for pharmacy students in the experiential learning environment is sparse, leaving programs with little guidance. This commentary from the Big Ten Academic Alliance calls on the Academy to create a community of shared resources and best practice examples and offers practical suggestions for accommodating pharmacy students with mobility, vision, and auditory disabilities during introductory pharmacy practice experiences (IPPEs) and advanced pharmacy practice experiences (APPEs).

Ergocalciferol Versus Cholecalciferol in Non-Dialysis Dependent Chronic Kidney Disease Patients: A Small Retrospective Cohort Study.

PURPOSE: The purpose of this retrospective cohort study was to measure the difference between cholecalciferol and ergocalciferol in their ability to effect vitamin D, parathyroid hormone (PTH), calcium, and phosphorous serum concentrations in patients with stage 3 or 4 chronic kidney disease. METHODS: This was a retrospective cohort study conducted within a single-center ambulatory nephrology clinic. Patients eligible for the study were identified through medical records displaying each patient's initiation on either ergocalciferol or cholecalciferol from 2013 to 2016. Patients' baseline vitamin D, PTH, calcium, and phosphorous serum concentrations were taken prior to treatment initiation, and patients were reassessed with a second measurement within 12 months of therapy. RESULTS: Out of 149 eligible patients, 110 were excluded. There were 33 patients included on cholecalciferol and 6 patients on ergocalciferol. A significant difference was observed in the percent change of phosphorous serum concentrations from baseline following drug administration (p=0.03). The mean changes from baseline to final serum phosphorous concentrations (mg/dL) were 0.12 and -0.3 for cholecalciferol and ergocalciferol, respectively. There was no significant difference in vitamin D (14.9, 15.1, p=0.97), PTH (5.6, 2.3, p=0.72), or calcium (0.05, -0.17, p=0.08) serum concentrations between cholecalciferol and ergocalciferol, respectively. There was a statistically significant increase in the mean change in serum phosphorous concentrations within the cholecalciferol group compared to the ergocalciferol group. CONCLUSION: In this small pilot study, cholecalciferol treatment appeared to increase serum phosphorous concentrations compared to ergocalciferol. These observations may warrant further large-scale studies that are appropriately powered to validate such findings.

Use of Paricalcitol as Adjunctive Therapy to Renin-Angiotensin-Aldosterone System Inhibition for Diabetic Nephropathy: A Systematic Review of the Literature.

PURPOSE: Diabetic nephropathy (DN) is a major complication of diabetes. Paricalcitol is a vitamin D analog that is typically used for secondary hyperparathyroidism in patients with chronic kidney disease but may have some beneficial effect on DN. This review evaluates the effect of paricalcitol in combination with renin-angiotensin-aldosterone system inhibitor therapy in managing DN. METHODS: A literature search was conducted of PubMed and ClinicalTrials.gov. Limits were set to include only clinical trials in humans written in English. The search terms used were paricalcitol and diabetic nephropathy. The following outcomes of kidney function and damage as well as adverse drug events were assessed and included: 24-h urine albumin excretion, serum phosphorus and calcium concentrations, urinary albumin excretion rates, estimated glomerular filtration rate, and markers of inflammation and endothelial function. FINDINGS: Four studies with a total of 389 patients were identified for review through the process described above. Two of the 6 studies provide evidence of the effect of paricalcitol on DN by way of reduction in urine albumin to creatinine ratio and urinary albumin excretion rate when compared with placebo. One study reported an increase in serum phosphorous, 1 study observed a decrease in estimated glomerular filtration rate, and 1 study reported no effect on inflammatory markers or endothelial function. IMPLICATIONS: The number of clinical trials examining the effect of paricalcitol in DN is small. The studies that have been completed enrolled <300 patients. Paricalcitol can reduce protein in the urine, but there is no compelling evidence that it preserves kidney function.

Cost Savings and Clinical Interventions Made by PharmD Students During APPE Rotations at Federally Qualified Health Centers.

PharmD students make significant clinical interventions during their last year of training in clinical rotations at a variety of practice sites. These interventions ranged from performing dosage adjustments to preventing adverse drug reactions and saved $92,803 dollars in the Federally Qualified Health Center practice sites that were included in this study over a 1-year period of time. The following study examines the types of interventions made and their associated cost savings.

Grading trends and evaluation of student performance across advanced pharmacy practice experiences (APPE) in the Big Ten Academic Alliance (The GRAPPES study).

INTRODUCTION: With over a third of the doctor of pharmacy curriculum relying on experiential education (EE), it is critical that students are assessed and graded in accordance with their actual performance. The objective of this paper is to review advanced pharmacy practice experience (APPE) grading across the Big Ten Academic Alliance to describe how APPE grading occurs at these institutions and highlight differences in approach and outcomes. METHODS: Experiential directors/deans were asked to import de-identified data (e.g., APPE curriculum, midpoint and final evaluation score and grade, number of preceptors, number of students, number of years of pharmacy school, total hours of APPEs offered, number and duration of APPEs per year, grading scale information). A chi-square test including pairwise comparisons with a Bonferroni p-value adjustment for multiple comparisons was performed. RESULTS: Seven college/schools submitted data from over 3600 students between 2012-2015. The distribution of letter grades differed significantly across all colleges/schools in 2012-2013, 2013-2014 and 2014-2015 (p < 0.0001). Similarly, the distribution of letter grades by rotation type varied significantly for all colleges/schools (p < 0.0001). Students in acute care, ambulatory care, and other patient care rotation types were less likely to obtain an "A" and more likely to obtain a "B" compared to students in other rotation types. CONCLUSIONS: When letter grades are used for APPEs, the trend suggests over 95% of students receive an "A" or "B" grade. Final grades varied by rotation type with more "B" grades observed in patient care rotations than "A" grades over the three-year period.

Preceptor perceptions of block scheduling and institutional track programs to prepare APPE students for residency or hospital careers.

INTRODUCTION: Butler University College of Pharmacy and Health Sciences (BUCOPHS) and Purdue University College of Pharmacy (PUCOP) created Block Scheduling and Institutional Track programs with the goal of better preparing students interested in pursuing postgraduate residency and/or a career in institutional practice. While informal feedback has been positive from both students and preceptors, more formalized feedback was sought. The objective of this study was to determine whether preceptors perceived additional benefits in precepting students selected through Block Scheduling and Institutional Track programs compared to students scheduled on rotations through a traditional preference or optimization process. METHODS: A 12-item electronic survey instrument was sent to BUCOPHS and PUCOP preceptors who had precepted block-scheduled and/or institutional track students in the 2014-15 and 2015-16 academic years. RESULTS: The majority of preceptors (71.4%) felt that the time they spent orienting block and institutional track students was less or significantly less when compared to orienting traditionally scheduled students. Seventy-three percent (73.2%) of preceptors reported that block-scheduled and institutional track students were more or significantly more prepared for residency positions than traditional students. The majority of preceptors (93%) indicated they would recommend block scheduling or an institutional track to other practice sites. Reported benefits to the preceptor included additional time to dedicate to patient care, additional time to complete projects and initiatives for the pharmacy department, and publishable research produced from student projects mentored. CONCLUSION: Preceptors perceived benefits in precepting block-scheduled and institutional track students compared to traditionally scheduled rotation students.

Hydralazine-associated Amenorrhea in a Premenopausal Patient With Chronic Kidney Disease: A Case Report and Review of Literature.

PURPOSE: Several antihypertensive medications have been associated with various forms of sexual dysfunction. We present a case report of a premenopausal patient with hydralazine-associated amenorrhea. METHODS: The Naranjo adverse drug reaction probability scale was used to assess causality. We also performed a literature search on PubMed to find publications that report hydralazine-associated amenorrhea. RESULTS: The Naranjo scale generated a score of 6, suggesting a probable relationship between amenorrhea and hydralazine therapy. No publications associating hydralazine with amenorrhea were identified. IMPLICATIONS: A probable relationship exists between hydralazine and the development of amenorrhea.

Integrating parts of the APhA Career Pathway Evaluation Program for pharmacy professionals into a career development lab.

BACKGROUND AND PURPOSE: To use parts of the APhA Career Pathway Evaluation Program for Pharmacy Professionals in a career development laboratory designed to provide students with relevant information that will help them prepare for successful careers across the profession of pharmacy. EDUCATIONAL ACTIVITY AND SETTING: Students enrolled in the second professional year of pharmacy school participated in an interactive three-hour career development laboratory. Students completed the APhA Career Pathway Evaluation Program for Pharmacy Professionals Online Assessment Tool prior to the laboratory. In class, the students were randomized into eight groups. Two career profiles were assigned to each group for discussion during a thirty-minute brainstorming session. The groups reported their knowledge for each career profile to the entire class, and the instructors supplemented the discussion with details and more specific information about each profile. FINDINGS: Two years of data were collected (n=300 students). One hundred and twenty four (41.3%) students responded to the voluntary post-laboratory survey questions. Overall, students rated the career pathway activities favorably with an average score of 8.13 out of 10. After participation in the discussion, 74 (59.7%) respondents indicated their career interests had been impacted. SUMMARY: This career development laboratory is one example of how the APhA Career Pathway Evaluation Program for Pharmacy Professionals can be effectively incorporated into the PharmD curriculum in order to help students explore the various career options they might not have otherwise discovered on their own.

A Review of Ferric Pyrophosphate Citrate (Triferic) Use in Hemodialysis Patients.

PURPOSE: The objective of this short review is to evaluate the efficacy of ferric pyrophosphate citrate and to determine its place in therapy based on the current published literature. METHODS: A literature search was conducted and pared down to yield 4 placebo controlled Phase II and III clinically relevant trials. FINDINGS: Ferric pyrophosphate citrate is a new intradialytic iron supplementation product that has been found to reduce the dose of erythropoiesis-stimulating agents and intravenous iron supplementation and to increase serum ferritin concentrations. IMPLICATIONS: This agent may be administered to patients with stage 5 chronic kidney disease receiving hemodialysis as a new iron supplementation option to maintain hemoglobin, transferrin saturation, and ferritin concentrations.

Can Pentoxifylline be used as Adjunct Therapy to ACE Inhibitors and ARBs in Preserving Kidney Function?

PURPOSE: To determine if there is sufficient evidence to recommend the addition of pentoxifylline to standard ACE inhibitor and ARB therapy in chronic kidney disease patients to reduce proteinuria and preserve kidney function.  METHODS: A search of the literature was conducted using the PubMed.gov and ClinicalTrials.gov search engines and the search terms "pentoxifylline renoprotection", "pentoxifylline CKD", and "pentoxifylline nephropathy". RESULTS were limited to studies in human subjects and published in the English language. No date range was specified. Studies focused on the effects of pentoxifylline on drug induced nephropathy were excluded.  RESULTS: Nine relevant articles were retrieved and evaluated. The two main populations studied were patients with chronic kidney disease (CKD) and patients with CKD and comorbid type 2 diabetes. Six of the nine studies reported a significant reduction in proteinuria in pentoxifylline treated patients. Four studies reported a significant change in estimated glomerular filtration rate (eGFR).  CONCLUSION: Addition of pentoxifylline to ACE inhibitor and ARB therapy may improve proteinuria in CKD patients. There is conflicting evidence as to whether pentoxifylline will improve kidney function as measured by eGFR. KEY WORDS: pentoxifylline renoprotection, pentoxifylline CKD , pentoxifylline nephropathy.This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

Using institutional track programs and block scheduling to help students prepare for postgraduate residency training.

PURPOSE: The development and implementation of institutional track programs and block scheduling to help students prepare for postgraduate residency training are described. SUMMARY: Institutional track and block scheduling models were implemented into advanced pharmacy practice experience rotations to provide students with several of these experiences at the same practice site. Students at Purdue University College of Pharmacy (PUCOP) and Butler University College of Pharmacy and Health Sciences (BUCOPHS) can apply for an institutional track or block schedule. The application process for the institutional track and block scheduling programs provides students with an opportunity to refine written and oral skills that are necessary for residency applications and interviews, since the process mimics that of the ASHP Resident Matching Program. Students are frequently provided with mentors to assist in the residency or fellowship preparation, curriculum vitae or cover letter design, and career planning. Students at the site may also be paired with pharmacy residents enrolled in blocked rotations to serve as mentors. The top students are matched with a practice site and then assigned to five consecutive patient care rotations. Since 2011, a total of 71 students have participated in institutional tracks at PUCOP or block scheduling at BUCOPHS. Most institutional track students (83%) and block scheduling students (81%) were successful in matching to residency programs or hospital pharmacy positions after graduation. CONCLUSION: Block scheduling and institutional track programs were offered to students at two colleges of pharmacy interested in pursuing postgraduate residency training. Most institutional track students and block scheduling students successfully matched to residency programs or hospital pharmacy positions after graduation.

A review of sucroferric oxyhydroxide for the treatment of hyperphosphatemia in patients receiving dialysis.

PURPOSE: Sucroferric oxyhydroxide is the newest phosphate binder to receive US Food and Drug Administration approval for patients on dialysis. The purpose of this review is to critically evaluate the studies that have been conducted with this medication and determine where it may fit in the clinician's overall treatment plan for hyperphosphatemia in patients with chronic kidney disease. METHODS: Literature searches were performed in the PubMed database and www.ClinicalTrials.gov using the search terms sucroferric oxyhydroxide, and PA21 phosphate binder. Limits were set to include only clinical trials performed in human subjects. FINDINGS: Four completed clinical trials and 3 ongoing studies were identified. Completed clinical trials included Phase I, Phase II, and Phase III studies that all demonstrated the ability of sucroferric oxyhydroxide to lower serum phosphorus concentrations. One study compared sucroferric oxyhydroxide with sevelamer and reported no statistically significant difference in serum phosphorus-lowering ability. The ongoing trials are evaluating sucroferric oxyhydroxide for long term use, in peritoneal dialysis patients, and compared with calcium-based phosphate binders. IMPLICATIONS: Sucroferric oxyhydroxide is an effective phosphate binder for chronic kidney disease patients receiving hemodialysis and may offer an advantage in terms of pill burden. Gastrointestinal side effects are similar to those of current phosphate binders. Advantages of other phosphate binders (ie, the lipid- and uric acid-lowering abilities of sevelamer) may outweigh the pill burden benefits of sucroferric oxyhydroxide.

Cost savings associated with pharmacy student interventions during APPEs.

OBJECTIVE: To quantify the impact of pharmacy students' clinical interventions in terms of number and cost savings throughout advanced pharmacy practice experiences (APPEs) using a Web-based documentation program. METHODS: Five hundred eighty doctor of pharmacy (PharmD) students completing ten 4-week APPEs during the final year of the curriculum were asked to document all clinical interventions they made using a Web-based documentation tool. Data were collected over 4 academic years. RESULTS: The total number of interventions made was 59,613, the total dollars saved was $8,583,681, and the average savings per intervention was $148. The top 3 categories of interventions made by students were identifying dosing issues, conducting chart reviews, and recommending appropriate therapy. The top 3 intervention types made by students that resulted in the most dollars saved per intervention were identifying potential allergic reactions, identifying drug interactions, and resolving contraindications. CONCLUSIONS: Pharmacy students made important and cost-effective clinical interventions during their APPEs that resulted in significant savings. Documentation programs can track the number, type, and value of the interventions that pharmacy students are making.

Evaluating the Use of Bortezomib and Eculizumab in Desensitization of Transplant Patients.

Objective: To systematically review the existing literature concerning the utilization of bortezomib and eculizumab to determine if there is enough evidence to warrant their routine use in desensitization protocols for high-risk transplant candidates. Data Sources: PubMed, Google Scholar, and ClinicalTrials.gov were searched using the terms bortezomib, eculizumab, desensitization, transplant, highly-sensitized, pre-sensitized, and antibody-mediated rejection (AMR). The articles included were published between January 2009 and August 2012. Study Selection and Data Extraction: All English-language articles involving human subjects were assessed for inclusion. The search included articles evaluating the use of these agents in desensitization and the prevention of AMR, but excluded articles investigating these drugs in the treatment of established AMR. Data Synthesis: Highly sensitized transplant candidates are at an increased risk of developing AMR after transplant; desensitization potentially reduces this risk. The addition of bortezomib and eculizumab to current desensitization protocols may enhance outcomes. The bortezomib search produced 3 efficacy trials, 1 safety trial, 2 in-progress trials, 14 patient cases from 8 published case reports, and 3 efficacy study abstracts. Conclusions: Much of the available literature assessing the efficacy of bortezomib and eculizumab for use in desensitization exists as restricted clinical trials and incomplete case reports. Bortezomib and eculizumab appear to be potentially effective additions to current desensitization protocols. However, we are unable to determine at this time whether these agents improve the most clinically relevant outcome of successful transplantation. Further well-designed clinical trials are needed to determine their true clinical efficacy in highly sensitized transplant candidates.

Pilot testing of checklists to discern adverse drug reactions and adverse drug events.

OBJECTIVES: To estimate the prevalence of patient-reported adverse drug events (ADEs)/adverse drug reactions (ADRs) in the community pharmacy setting and determine the prevalence relative to pharmacist judgment. DATA SOURCES: The 2009 version of the Pharmacy Times top 200 drugs was used to identify the prescription medications most commonly used within the ambulatory population during 2008. All ADEs/ADRs for each medication were obtained by combining the ADEs/ADRs listed in Drug Facts and Comparisons, Lexi-Comp, and Micromedex. METHODS: Checklists for each pharmacologic class within the top 200 medications (n = 51) were developed, with questions about the five most common ADEs/ADRs in each class. Ten community pharmacies administered the checklists. Patients requesting a prescription refill for a medication listed in the top 200 were asked to complete a class-specific checklist to determine ADEs/ADRs experienced in the previous 4 weeks. Upon completion, pharmacists engaged in routine counseling procedures, including a discussion of patient-reported ADEs/ADRs. Pharmacists indicated if they believed, based on their clinical judgment, whether the ADE/ADR reported was related to the medication. RESULTS: 2,057 checklists were completed, with a total of 10,285 potential ADEs/ADRs. Patients reported 2,185 ADEs/ADRs (21.24%), with 755 (7.3%) definitively confirmed by the pharmacist as being related to their medication. CONCLUSION: Use of these checklists resulted in the identification of previously unrecognized ADEs/ADRs in the community setting. Routine use of these short, patient-completed checklists may assist pharmacists in earlier identification of ADEs/ADRs, which can have a positive impact on patient safety across settings.

Nicotinic acid and nicotinamide: a review of their use for hyperphosphatemia in dialysis patients.

Phosphate binders have traditionally been used to treat hyperphosphatemia, a common complication in patients with end stage renal disease (ESRD). New evidence suggests that nicotinic acid and its metabolites may effectively decrease phosphorus absorption in the gastrointestinal tract, thereby reducing serum phosphorus concentrations. We conducted a literature search to identify studies of patients with ESRD on dialysis that evaluated the role of niacin and related compounds in decreasing serum phosphorus levels. We searched PubMed using the search terms niacin, nicotinic acid, niacinamide, nicotinamide and hyperphosphatemia. Limits were set to include only those articles published since 2002, conducted in human subjects, and written in the English language. Review articles captured through this process were mined for references to other primary literature that may not have been returned through the initial search. All studies were included if they met the search criteria and were conducted in patients with ESRD who received either hemodialysis or peritoneal dialysis. To identify current, ongoing studies, another search was conducted through clinicaltrials.gov. Among the seven studies that met our exclusion criteria, three used nicotinic acid as the therapeutic intervention and four used nicotinamide. Both nicotinic acid and nicotinamide were effective in significantly reducing serum phosphorus concentrations in patients with ESRD on either hemodialysis or peritoneal dialysis. Additional, large-scale studies that assess the appropriate dose as well as long-term safety and efficacy are recommended before clinicians can confirm their place in therapy.