The design, implementation and evaluation of hybrid cancer clinic simulations: Escaping the norm.

INTRODUCTION: Simulation and gamification are two popular educational tools utilized to enhance student learning and engagement. This study aimed to evaluate the effectiveness of integrating a hybrid cancer clinic simulation into the curricula for third-year pharmacy (P3) students. METHODS: This prospective, single-arm pilot study incorporated a mixed-method learning activity involving patient simulation and escape room elements. Two cancer clinic simulations were developed by faculty members. For each clinic, students were randomly divided into 6 groups and tasked with completing a series of Pharmacist Patient Care Process (PPCP) activities involving patient actors. The PPCP activities were interwoven with engaging puzzles and games to simulate an escape room. Student learning and retention was measured by pre- and post-simulation quizzes and course level exams. A perceptions survey was administered after each simulation activity. RESULTS: Thirty-six students participated in both cancer clinic simulations, with 100% completing all aspects of the study. Mean student quiz scores improved from 61.4% to 81.7% (p < 0.0001) and 52.6% to 81.8% (p < 0.0001) following the first and second simulations, respectively. Exam performance improved for 16 out of 19 exam questions, with a significant increase in 4 questions (p < 0.05). Students overwhelmingly agreed that the cancer clinic simulations 1) reinforced knowledge, 2) facilitated PPCP, 3) improved their ability to make chemotherapeutic recommendations, 4) enhanced problem-solving skills, and 5) encouraged collaboration. CONCLUSION: This innovative hybrid simulation enhanced oncology-related knowledge and supported an interactive environment that improved student confidence and teamwork. Students enjoyed the simulations and recommended continuation for all future cohorts.

Gluten, Inflammation, and Neurodegeneration.

Growing evidence supports a potential link between dietary gluten intake and neurodegenerative disease in susceptible populations. Observational data supporting this link are described along with interventional study data evaluating the effects of restricting gluten from the diet in patients with neurologic disorders. Suggested underlying mechanisms between gluten intake and neurodegeneration are discussed.

Delirium and Its Pharmacological Causes in Older People, Part Three.

Delirium is a syndrome that can arise from many causes or underlying conditions, and though it has been reported in younger patients, it is more prevalent in older people, though it can occur in other age groups as well. Identifying delirium is challenging in older people because of the coexistence of underlying dementia or depression, which may further complicate the presentation. Drug-induced delirium is one of the major causes of delirium, and evaluation of this potential cause or contribution is an important component of the evaluation process, since it can lead to poor patient outcomes. Part one of this three part series reviewed the epidemiology, pathophysiology, evaluation, diagnostic process, and causes of delirium in older people. Parts two and three continued to review the pharmacological classes of medications that cause or contribute to delirium in older people.

Delirium and Its Pharmacological Causes in Older People, Part 1.

Delirium is a syndrome that can arise from many causes or underlying conditions, and though it has been reported in younger patients, it is more prevalent in older people, though it can occur in other age groups as well. Identifying delirium is challenging in older people because of the coexistence of underlying dementia or depression, which may further complicate the presentation. Drug-induced delirium is one of the major causes of delirium, and evaluation of this potential cause or contribution is an important component of the evaluation process, since it can lead to poor patient outcomes. This article will review the epidemiology, pathophysiology, evaluation, diagnostic process, and causes of delirium in older people, with a focus on the pharmacological causes.

Delirium and its Pharmacological Causes in Older People, Part Two.

Delirium is a syndrome that can arise from many causes or underlying conditions, and though it has been reported in younger patients, it is more prevalent in older people, though it can occur in other age groups as well. Identifying delirium is challenging in older people because of the coexistence of underlying dementia or depression, which may further complicate the presentation. Drug-induced delirium is one of the major causes of delirium, and evaluation of this potential cause or contribution is an important component of the evaluation process, since it can lead to poor patient outcomes. Part one of this three part series reviewed the epidemiology, pathophysiology, evaluation, diagnostic process, and causes of delirium in older people, with a focus on the pharmacological causes. Part two of this series continues to review drugs and drug classes that can cause or contribute to delirium in older people.

An initial environmental scan of APPE readiness assessment.

INTRODUCTION: Standards 2016 require schools/colleges of pharmacy (s/cop) to assess students' readiness to enter advanced pharmacy practice experiences (APPEs). However, literature describing how schools are meeting this standard is limited. The purpose of this study was to conduct an environmental scan to describe how s/cop assess student readiness to enter APPEs. METHODS: A web-based survey was distributed to assessment leads at United States s/cop, regardless of accreditation status. Respondents answered questions related to their current approach to assessing student APPE readiness, existence of intentional assessment plans, competencies used, assessment methods, benchmarks, and remediation strategies. Aggregate data were analyzed using descriptive statistics. RESULTS: Fifty-two S/COP (36.1%) responded. The majority (90.1%) were fully accredited schools. Most respondents have an intentional APPE readiness plan (73.5%), although the duration since implementation varied. There was no consensus among schools on which competencies informed APPE readiness with 67.3% listing Center for the Advancement of Pharmacy Education (CAPE) 2013 outcomes, 61.2% Guidance for Standards 2016 Appendix A, 53.1% pre-APPE domains (Standards 2007), and 30.6% Entrustable Professional Activities. Twenty-eight S/COP (57.1%) reported having individual student-level data to assess student APPE readiness. The most common methods for validating student APPE readiness were preceptor (48.9%) and student (44.9%) surveys. CONCLUSIONS: This environmental scan begins to identify trends in how S/COP is approaching the assessment of student readiness to begin APPEs. Further research is needed to identify best practices and practical methods to ensure compliance with current accreditation standards.

Parkinson's Disease and Its Management: Part 5: Treatment of Nonmotor Complications.

Most patients with Parkinson's disease experience nonmotor complications, broadly classified as either neuropsychiatric presentations or autonomic disorders. Despite the prevalence of these nonmotor features, treatment options for them are limited.

Parkinson's Disease and Its Management: Part 4: Treatment of Motor Complications.

Parkinson's motor complications include wearing-off, a delayed or absent response to carbidopa/levodopa therapy, freezing of gait, dyskinesias, and dystonias. Treatment may include medication adjustments, such as increased dopaminergic stimulation.

Parkinson's Disease and Its Management: Part 3: Nondopaminergic and Nonpharmacological Treatment Options.

This installment of a five-part series reviews the role of nondopaminergic pharmacotherapies and adjunctive options-such as monoamine oxidase type B inhibitors, catechol-O-methyltransferase inhibitors, and anticholinergic agents-in managing Parkinson's disease. Nonpharmacological treatments are also explored.

Part 2: Introduction to the Pharmacotherapy of Parkinson's Disease, With a Focus on the Use of Dopaminergic Agents.

This second of five articles reviews Parkinson's disease pharmacotherapy, focusing on dopaminergic agents such as levodopa/carbidopa and dopamine receptor agonists.

Parkinson's Disease and Its Management: Part 1: Disease Entity, Risk Factors, Pathophysiology, Clinical Presentation, and Diagnosis.

This article-the first of a five-part series-discusses possible causes, symptoms, diagnosis, and goals for treatment of Parkinson's disease. Identifying diseases that have similar presentations is an important component of the diagnostic process.

Design and implementation of a laboratory-based drug design and synthesis advanced pharmacy practice experience.

OBJECTIVE: To provide students with an opportunity to participate in medicinal chemistry research within the doctor of pharmacy (PharmD) curriculum. DESIGN: We designed and implemented a 3-course sequence in drug design or drug synthesis for pharmacy students consisting of a 1-month advanced elective followed by two 1-month research advanced pharmacy practice experiences (APPEs). To maximize student involvement, this 3-course sequence was offered to third-year and fourth-year students twice per calendar year. ASSESSMENT: Students were evaluated based on their commitment to the project's success, productivity, and professionalism. Students also evaluated the course sequence using a 14-item course evaluation rubric. Student feedback was overwhelmingly positive. Students found the experience to be a valuable component of their pharmacy curriculum. CONCLUSION: We successfully designed and implemented a 3-course research sequence that allows PharmD students in the traditional 4-year program to participate in drug design and synthesis research. Students report the sequence enhanced their critical-thinking and problem-solving skills and helped them develop as independent learners. Based on the success achieved with this sequence, efforts are underway to develop research APPEs in other areas of the pharmaceutical sciences.

Medicinal chemistry and the pharmacy curriculum.

The origins and advancements of pharmacy, medicinal chemistry, and drug discovery are interwoven in nature. Medicinal chemistry provides pharmacy students with a thorough understanding of drug mechanisms of action, structure-activity relationships (SAR), acid-base and physicochemical properties, and absorption, distribution, metabolism, excretion, and toxicity (ADMET) profiles. A comprehensive understanding of the chemical basis of drug action equips pharmacy students with the ability to answer rationally the "why" and "how" questions related to drug action and it sets the pharmacist apart as the chemical expert among health care professionals. By imparting an exclusive knowledge base, medicinal chemistry plays a vital role in providing critical thinking and evidence-based problem-solving skills to pharmacy students, enabling them to make optimal patient-specific therapeutic decisions. This review highlights the parallel nature of the history of pharmacy and medicinal chemistry, as well as the key elements of medicinal chemistry and drug discovery that make it an indispensable component of the pharmacy curriculum.

Inhibition of choline uptake by N-cyclohexylcholine, a high affinity ligand for the choline transporter at the blood-brain barrier.

The blood-brain barrier (BBB) choline transporter (CHT) may have utility as a drug delivery vector for drugs that act in the central nervous system. Previous studies suggested the importance of hydrophobic moieties on the cationic nitrogen of choline for improved affinity for this transporter. In a pilot study, we therefore designed five novel N-cycloalkyl derivatives of choline, one of which showed promising inhibition properties. This choline analogue had a cyclohexyl (UMBB-5) moiety substituting one of the methyl groups attached to the cationic nitrogen in choline. In situ experimental data were obtained from in situ rat brain perfusion studies. The binding affinity for the BBB-choline transporter found for UMBB-5 was K(i)=1.9 microM. Comparative molecular field analysis (CoMFA) suggested that the cyclohexyl moiety orientates towards a steric favourable area. Taken together, the results of these in situ and in silico studies provide further evidence or restrictions that occur with binding to this brain drug delivery vector.

Opioid receptor-like 1 (ORL1) molecular "road map" to understanding ligand interaction and selectivity.

The opioid receptor-like 1 (ORL1) system has attracted a lot of attention owing to its diverse physiological role and by its close structural proximity toward the classical opioid receptors. Even though they share a close sequence similarity, the ligand recognition pattern for the ORL1 receptor and the classical opioid receptors remains highly distinct. In addition, functional diversification observed between the ORL1 receptor system and classical opioid receptors clearly indicates that subtle changes in the structural makeup of a receptor are enough to delineate them. A clear understanding of the structural requirements for ligand selectivity by classical opioid receptors and identification of a common "opioid binding pocket" has not been achieved yet. At this juncture, the ORL1 receptor system presents itself as a potential tool in the quest for elucidating critical elements directing ligand selectivity. The current paper is a compilation of several site-directed mutagenesis studies conducted on the ORL1 receptor system. The mutagenesis studies concentrated on the transmembrane domain residues are reported with the changes observed in terms of both binding and functional activation of the receptor. Given the critical role played by this G-protein coupled receptor, molecular level understanding of this ORL1 receptor system would aid in rational design and development of agonists and antagonists with multiple therapeutic applications.

Solution-phase parallel synthesis of spirohydantoins.

Spirohydantoins are considered privileged structures, making them attractive for the preparation of compound libraries with the potential for diverse biological activity. However, very few modifications of this scaffold have been reported to date. The spirohydantoin template was elaborated into a library of 168 compounds through a two-step solution-phase parallel synthesis starting from various N-substituted piperidinones. The Strecker reaction was employed to generate alpha-amino nitriles from aniline and TMSCN (or KCN). Subsequent reaction of the anilido nitrogen with a diverse set of isocyanates, followed by refluxing under acidic conditions, afforded the title library in high yield and purity.