Early Lead Extraction for Infected Implanted Cardiac Electronic Devices: JACC Review Topic of the Week.

Infection remains a serious complication associated with the cardiac implantable electronic devices (CIEDs), leading to substantial clinical and economic burden globally. This review assesses the burden of cardiac implantable electronic device infection (CIED-I), evidence for treatment recommendations, barriers to early diagnosis and appropriate therapy, and potential solutions. Multiple clinical practice guidelines recommended complete system and lead removal for CIED-I when appropriate. CIED extraction for infection has been consistently reported with high success, low complication, and very low mortality rates. Complete and early extraction was associated with significantly better clinical and economic outcome compared with no or late extraction. However, significant gaps in knowledge and poor recommendation compliance have been reported. Barriers to optimal management may include diagnostic delay, knowledge gaps, and limited access to expertise. A multipronged approach, including education of all stakeholders, a CIED-I alert system, and improving access to experts, could help bring paradigm shift in the treatment of this serious condition.

Exploring the Effect of Virtual Education on Student Pharmacists' Confidence toward APPE Readiness.

A drop in confidence in Advanced Pharmacy Practice Experience (APPE) readiness was observed in students in the Class of 2022 prior to starting APPEs. We aim to investigate potential causes of students' low confidence in APPE preparedness to provide solutions and to prevent this outcome with future students. We evaluated students' perceived confidence to start APPEs and compared this to curricular changes, employment obligations, and the impact of COVID-19 on delivery of the pre-APPE and APPE curriculum. Students' low confidence with APPE readiness was not indicative of the following factors: (1) delivery of the didactic curriculum, (2) students' performance in the didactic curriculum, or (3) number of summative assessments in key didactic courses. Rather, the low confidence perception may have been due to differences such as a fully remote didactic experience in the P3 year, more virtual Introductory Pharmacy Practice Experiences (IPPEs), a reduced course load in the P3 spring semester, and changes to a pre-APPE preparatory course compared to other class years. The students' self-reported midpoint scores during their first APPE block and preceptor's evaluations on their performance contrasted their pre-APPE perceptions. Frequent in-person and on-site skills assessments throughout the didactic curriculum seem to reinforce confidence before APPEs.

Assessment of the impact of co-curricular activities on achievement of Doctor of Pharmacy program outcomes.

INTRODUCTION: Co-curricular activities are recognized as an increasingly important aspect of pharmacy education. However, the impact of these activities on student learning is not well understood compared to that of curricular learning. The purpose of this study was to assess student-perceived progress in achieving program outcomes through voluntary co-curricular activities compared with learning of the same outcomes through mandatory curricular activities. METHODS: The study was performed over six semesters between fall 2017 and spring 2020 at the University of Southern California School of Pharmacy. Separate surveys were sent to all first- through third-year doctor of pharmacy students each semester to assess the impact of curricular and co-curricular activities on improvement in six program outcomes. Graduating student survey data were also mapped to learning outcomes to assess improvement of these outcomes upon graduation. RESULTS: Three main results emerged from these data. First, there was greater variation in the impact of co-curricular activities on different learning outcomes compared to the effect of curricular activities on the same outcomes. Second, co-curricular activities had a greater impact on "soft skills," including leadership and professionalism, compared to concrete knowledge in areas such as therapeutic mechanisms. Finally, the impact of co-curricular activities on most learning outcomes diminished with progression through the curriculum while the impact of curricular activities remained relatively constant. CONCLUSIONS: Student-perceived improvement in learning of program outcomes differs when based on co-curricular compared to curricular activities. These results show how these activities can complement each other in achievement of program outcomes.