Creating a win-win: A novel layered learning approach for assessing first-year pharmacy students' communication skills.

BACKGROUND AND PURPOSE: Individualized assessment of students in skills-based courses is essential for practice readiness, however recruiting evaluators is challenging. Our school of pharmacy offers a teaching certificate program for postgraduate year one pharmacy residents (PGY1 residents; PGY1s) which requires completion of a teaching experience. The longitudinal layered learning assessment experience (LLLAE) was designed to meet instructional needs for individualized assessment of first-year pharmacy students' communication skills and provide a meaningful teaching opportunity for PGY1s. This manuscript describes the implementation and evaluates the impact of the LLLAE. EDUCATIONAL ACTIVITY AND SETTING: PGY1s were invited to participate in the yearlong LLLAE. Faculty developed PGY1s' skills through training sessions, direct observation, and debrief sessions. PGY1s evaluated students and provided feedback using pre-defined criteria during 3 summative assessments (capstones). Capstones were common pharmacy practice scenarios in which students interact with an actor serving as a standardized patient or provider. PGY1s completed an end-of-year survey to self-rate their improvement in evaluating students, providing feedback, and confidence. FINDINGS: Twenty-two PGY1s participated in the LLLAE over 2 years. They evaluated 73.2% of total capstone interactions. The end-of-year survey was completed by 20 PGY1s (90.9% response rate). All respondents indicated improvement in their skills to evaluate students, ability to provide feedback, and confidence. Scores were 4 or 5 (scale of 1 to 5) across all measures. Key contributors fostering improvement were the training and debrief sessions, faculty feedback, pre-defined criteria, and multiple practice opportunities. SUMMARY: This novel layered learning approach was a win-win for faculty and PGY1s. The approach improved feasibility for faculty to continue individualized student assessment while mentoring early career pharmacists. PGY1s gained an opportunity to contribute to student growth, learn from experienced faculty, and develop skills for practice. Additionally, students benefited from individualized feedback.

Risk Factors and Clinical Outcomes of Candidemia Associated With Severe COVID-19.

COVID-19 can cause serious illness requiring multimodal treatment and is associated with secondary infections. Studies have suggested an increased risk of fungal infections, including candidemia following severe COVID-19 though understanding of risk factors and clinical outcomes remains unclear. OBJECTIVES: To describe clinical characteristics, outcomes and risk factors of candidemia among patients hospitalized with severe COVID-19. DESIGN SETTING AND PARTICIPANTS: A multicenter, case-control study of patients with severe COVID-19 was conducted to evaluate risk factors and clinical outcomes in patients who developed candidemia between August 2020 and August 2021. MAIN OUTCOMES AND MEASURES: Chart review evaluating institutional and patient demographics, clinical and mycological characteristics, concomitant interventions (antibiotics, immunosuppressive agents, parenteral nutrition, degree of oxygen support, mechanical ventilation, surgery), treatment regimens, and outcomes (length of stay and discharge disposition). RESULTS: A total of 275 patients were enrolled in the study, including 91 patients with severe COVID-19 and subsequent candidemia and 184 with severe COVID-19 without candidemia. Most patients received antibiotics prior to candidemia episode (93%), while approximately one-quarter of patients received biologic for COVID-19. In-hospital mortality was significantly higher in the cases compared with the controls (68% vs 40%; p < 0.01). Candida albicans was the most common (53%), followed by C. glabrata (19%). Use of central lines, biologic, and paralytics were independent risk factors for candidemia. CONCLUSIONS AND RELEVANCE: Candidemia following COVID-19 infection is a concern that requires clinical consideration and patient monitoring. Risk factors for the development of candidemia in the setting of COVID-19 infection are largely consistent with traditional risk factors for candidemia in hospitalized patients.

Real-World Observational Review of Andexanet Alfa Prescribing and Utilization Outcomes at a Community Teaching Hospital.

OBJECTIVES: Andexanet alfa is the first approved antidote in the management of life-threatening bleeds in patients treated with Xa inhibitors. The ANNEXA-4 study was successful in reducing factor Xa levels during time of administration but lacked correlation to improved patient outcomes. Given its novel mechanism of action, U.S. boxed warning, cost of up to $58,000 per dose, and limited efficacy data compared with standard of care, hospitals are faced with a dilemma with its addition to formulary and process for ensuring optimized use. The objective of this study was to evaluate adherence to institution restriction criteria and the clinical outcomes of treatment for patients for whom andexanet alfa is requested. DESIGN: Retrospective cohort study of andexanet alfa requests within a 12-month time period. SETTING: A 600-bed community teaching hospital. PATIENTS: Patients whom pharmacists received request for dispensing andexanet alfa. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Quality outcomes reviewed compliance to restriction criteria. Clinical outcomes evaluated use of adjunctive blood products, ICU length of stay, hospital length of stay, and hospital mortality. Safety outcomes evaluated incidence of thrombotic events.Andexanet alfa was requested for 16 patients from November 2018 to November 2019. It was administered in nine patients, with compliance to restriction criteria of 66.6%, average ICU length of stay 5.6 days, hospital length of stay 8.6 days, hospital mortality in 44.4%, and thrombotic events in 33.3%. Orders were rejected in seven patients with compliance to restriction criteria of 100%, ICU length of stay 3.2 days, hospital length of stay 5.5 days, hospital mortality in 14%, and thrombotic events in 14%. CONCLUSIONS: A greater rate of adverse effects and mortality was identified with the use of andexanet alfa compared with clinical trials. This is potentially due to its use in a more severely ill patient population and lack of adherence to restriction criteria.