A Systematic Review of Escape Room Gaming in Pharmacy Education.

OBJECTIVES: The objectives of this review were to review the current literature on escape rooms in pharmacy education, determine their impact on educational outcomes, and identify areas for future research. FINDINGS: A literature search retrieved 14 reports, of which 10 studies met all of the study criteria. The majority of the studies used the escape room to review previously taught content (90%). More than half the studies (60%) assessed a change in a student's knowledge. One study testing a broad content area found a decrease in the before and after knowledge assessment from 70% to 67%, while other studies found before and after content knowledge increase. On average, 5.8 faculty facilitators and 33 h were needed for each activity. SUMMARY: This review suggests that pharmacy students enjoy escape rooms and perceive that it helps in their clinical knowledge and teamwork skills. Additionally, there is a potential that it can demonstrate an increase in content knowledge, particularly escape rooms that had a singular content focus. Faculty planning on implementing an escape room activity should give strong consideration to the preparation, delivery/logistics, and content.

A Systematic Review of Weight-Based Metoprolol for Acute Atrial Fibrillation with Rapid Ventricular Rate.

Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in the emergency department (ED) and when patients present in acute AF with rapid ventricular rate (RVR), it can result in significant morbidity and mortality. Primary treatment modalities are aimed at rate control with the two most common agents being intravenous metoprolol and diltiazem. Some evidence suggests that diltiazem may be more effective at controlling rate in these patients; however, the dosing strategies, pharmacologic differences, and study designs may play a role in the observation of these differences. The purpose of this article is to review the evidence for using weight-based metoprolol in the treatment of AF with RVR. The vast majority of studies comparing metoprolol and diltiazem for the treatment of acute AF with RVR compare a flat dose of metoprolol to a weight-based dose of diltiazem. Following a comprehensive review, only two studies have compared a weight-based dosing strategy of intravenous (IV) metoprolol versus IV diltiazem for this disease state. Overall, the two studies only contained 94 patients and failed to meet power. Beyond differing dosing strategies, differences in pharmacokinetics between the two medications (like the onset of action and metabolism) could have played a role in the differences observed in the studies. Further studies are warranted to provide better guidance on which agent should be used in the treatment of acute AF with RVR.

Qualitative Analysis of Pharmacy Students' Self-identified Preconceptions Regarding the Term Clinical Pharmacy.

Objective. To evaluate third-year pharmacy students' self-identified preconceptions regarding the term clinical pharmacy as defined by the American College of Clinical Pharmacy (ACCP).Methods. Third-year pharmacy students were led in a multipart activity focused on evaluating their preconceptions about the term clinical pharmacy after exposure to the unabridged definition published by ACCP. Students were asked to identify two preconceptions they had before the activity that were dispelled after reading the article. Thematic coding was used to identify semantic themes and generate summaries of student perceptions.Results. Three hundred twenty-two third-year pharmacy students' assignment data was coded to reveal six major themes about their preconceptions related to the term clinical pharmacy: setting, required training, job responsibilities, scope within the health care system, job environment (physical, emotional, financial), and limited knowledge about clinical pharmacy. Consistencies in thought were found within two of these themes, namely setting and required training. Significant variance was seen in the remaining four themes, specifically regarding types of activities performed, job environment, the scope of practice, and impact in the health care system.Conclusion. Third-year pharmacy students' preconceptions about clinical pharmacy were related to the exclusivity of where it can be practiced and the need for additional training as a requirement. However, high variability was seen in the majority of the remaining themes, illustrating an inconsistent view of what clinical pharmacy is and the need for intentional focus on professional identity formation within the pharmacy curriculum.

Drug-Induced Hyperthermia Review.

Humans maintain core body temperature via a complicated system of physiologic mechanisms that counteract heat/cold fluctuations from metabolism, exertion, and the environment. Overextension of these mechanisms or disruption of body temperature homeostasis leads to bodily dysfunction, culminating in a syndrome analogous to exertional heat stroke (EHS). The inability of this thermoregulatory process to maintain the body temperature is caused by either thermal stress or certain drugs. EHS is a syndrome characterized by hyperthermia and the activation of systemic inflammation. Several drug-induced hyperthermic syndromes may resemble EHS and share common mechanisms. The purpose of this article is to review the current literature and compare exertional heat stroke (EHS) to three of the most widely studied drug-induced hyperthermic syndromes: malignant hyperthermia (MH), neuroleptic malignant syndrome (NMS), and serotonin syndrome (SS). Drugs and drug classes that have been implicated in these conditions include amphetamines, diuretics, cocaine, antipsychotics, metoclopramide, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and many more. Observations suggest that severe or fulminant cases of drug-induced hyperthermia may evolve into an inflammatory syndrome best described as heat stroke. Their underlying mechanisms, symptoms, and treatment approaches will be reviewed to assist in accurate diagnosis, which will impact the management of potentially life-threatening complications.

Student perceptions of non-technical skills development during advanced pharmacy practice experiences.

INTRODUCTION: In today's workforce, non-technical skills (NTS) are essential in determining an employee's ability to fit into an organization. However, it is unknown whether pharmacy students consider these skills essential to their future work or believe they are sufficiently trained. Therefore, this study evaluated student perceptions of the value of NTS as a pharmacist and their satisfaction with NTS training. METHODS: A 45-item survey was distributed to 111 fourth-year pharmacy students at Texas A&M College of Pharmacy in March 2019. Given the diverse nature of NTS, this study collected student perceptions about the 2016 Accreditation Council for Pharmacy Education Standard 4 Key Elements: self-awareness, leadership, innovation, and professionalism. Results were analyzed utilizing descriptive statistics. RESULTS: Approximately 84% (n = 93) of students completed the survey. More students perceived professionalism as an important skill to have, followed by leadership, self-awareness, and innovation. Similar results were shown with students' satisfaction with NTS training. Also, results highlighted that students' satisfaction level with their NTS training and their belief regarding their strengths relied on two factors: the number of advanced pharmacy practice experiences (APPEs) where NTS training occurred and the amount of time spent practicing the NTS. CONCLUSION: These data add to the existing literature to support NTS training in experiential pharmacy education. While APPEs should not be the only setting where these skills are practiced in the curriculum, our study's findings may further guide curricular priorities and assessment strategies for NTS in the experiential setting.

Review of Medical Therapies for the Management of Pulmonary Embolism.

Traditionally, the management of patients with pulmonary embolism has been accomplished with anticoagulant treatment with parenteral heparins and oral vitamin K antagonists. Although the administration of heparins and oral vitamin K antagonists still plays a role in pulmonary embolism management, the use of these therapies are limited due to other options now available. This is due to their toxicity profile, clearance limitations, and many interactions with other medications and nutrients. The emergence of direct oral anticoagulation therapies has led to more options now being available to manage pulmonary embolism in inpatient and outpatient settings conveniently. These oral therapeutic options have opened up opportunities for safe and effective pulmonary embolism management, as more evidence and research is now available about reversal agents and monitoring parameters. The evolution of the pharmacological management of pulmonary embolism has provided us with better understanding regarding the selection of anticoagulants. There is also a better understanding and employment of anticoagulants in pulmonary embolism in special populations, such as patients with liver failure, renal failure, malignancy, and COVID-19.

Risk of Bleeding in Patients on Full-Dose Enoxaparin With Venous Thromboembolism and Selective Serotonin Reuptake Inhibitors.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are very commonly prescribed agents that are also potent antiplatelet agents. OBJECTIVE: This study was designed compare the rate of major bleeding events between patients who were treated with low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) on SSRIs and those not on chronic SSRI therapy. METHODS: This was a retrospective cohort study of 575 patients with a primary or secondary diagnosis of an acute VTE initiated on full-dose enoxaparin with or without an SSRI between October 1, 2009, and October 1, 2014, in a 443-bed, single tertiary care referral county teaching hospital. RESULTS: No significant difference was found in the incidence of major bleeding in the SSRI versus non-SSRI group (19.6% vs 17.0%, P = 0.548). Ad hoc analysis demonstrated an elevated risk of major bleeding in patients on escitalopram compared with those on any of the other SSRIs (46.2% vs 15.2%, P = 0.018). Multivariate analysis demonstrated that escitalopram use-OR (95% CI) = 18.85 (1.84-193.6)-was associated with increased major bleeding, and acid suppressive therapy-0.24 (0.07-0.90); P = 0.014-was associated with decreased major bleeding in patients reporting alcohol use. CONCLUSION: No difference was found in the incidence of major bleeding in patients on LMWH and SSRIs versus those on LMWH but not on SSRIs. However, ad hoc findings showed a significantly higher rate of major bleeding events in patients who received escitalopram and alcohol among patients on full-dose enoxaparin for VTE. These findings merit further exploration.