Reducing Student Workload Through Curricular Efficiency.

OBJECTIVE: This integrative review will examine the current literature assessing student workload, outcomes of increased workload and cognitive load, and approaches to evaluate and reduce student workload. Recommendations to better inform curriculum planning efforts will be presented along with a call to action to address the dilemma of student workload and curricular efficiency efforts. FINDINGS: Literature supports that perceptions of heavy workload can influence students' approach to learning and lead to the adoption of surface learning rather than a deep approach that involves higher-order processing and critical thinking. Additionally, ongoing evidence suggests that workload expansion affects student well-being and potential burnout in professional programs, and specifically that students perceive workload as directly related to their well-being and satisfaction. Intentional planning by faculty and programs can address this issue through streamlining classroom content, reducing lecture time, and modifying preclass work to allow for efficient learning. Even if the curriculum is lecture-based, workload perceptions can be affected by developing clearer guidance to set expectations for learners, intentionality in classroom design, and creating opportunities for student engagement. SUMMARY: Cognitive overload is multifactorial and complicated, given the increased standards of professional education accreditation and licensure requirements. As the Academy deliberately considers methods to improve curricular efficiency, there is an opportunity to focus on curriculum delivery with an appropriate balance of breadth and depth of instruction to ensure effective assessment and cognitive load.

Reflections on work-life integration post-pandemic: A perspective from pharmacy practice faculty.

INTRODUCTION: The effects of COVID-19 will have a lasting impact on how work is conducted moving forward. Prior to the pandemic, work-life integration and well-being were priorities for many organizations, including pharmacy. The disruption associated with the COVID-19 pandemic pushed businesses and organizations worldwide into an era of agility and flexibility previously unknown to the majority of workplaces. PERSPECTIVE: Increased remote work has presented both increased challenges (e.g., engagement) and opportunities (e.g., productivity). After a year of experience, this shift in the nature of how work is done has provided an opportunity to reimagine how and where work will be conducted in the future. IMPLICATIONS: Schools and colleges of pharmacy have an opportunity to re-evaluate how academic and practice responsibilities are accomplished in regards to work life-integration and management of concurrent work and family responsibilities. Administration and faculty should foster a culture of transparency on this topic to collaboratively incorporate methods that better facilitate work-life integration moving forward.

Embarking as "Captain of the Ship" for the Curriculum Committee.

This commentary examines the curriculum chair's responsibilities and discusses considerations when assuming this role, using a "captain of the ship" metaphor. From knowing the crew to managing a diverse set of responsibilities, the path to becoming an effective chair is challenging and each captain's stripe must be earned. Advice is provided to assist with understanding the curriculum and governance processes, as well as the chair's various roles and professional development. The need for leadership and management is also emphasized.

Antibiotic Approvals in the Last Decade: Are We Keeping Up With Resistance?

OBJECTIVE: To review the spectrum of activity, efficacy, safety, and role in therapy of all antibiotics and related biologics approved by the Food and Drug Administration (FDA) in the last decade. DATA SOURCES: A literature search was performed using PubMed and Google Scholar (2010 to end May 2021) with the search terms' name of the antibiotic or the biologic. Data were also obtained from the prescribing information, FDA, and ClinicalTrials.gov websites. STUDY SELECTION: All relevant English-language, late phase clinical trials assessing the safety and efficacy of the identified drugs were included. Review articles and references of retrieved articles were evaluated for relevant data. DATA SYNTHESIS: Antibiotic resistance is a public health crisis, and antibiotic development is imperative to outpace the ability of bacteria to develop resistance. Only 17 new systemic antibiotics and 1 related biologic have been approved by the FDA since 2010. Among these drugs, 14 were approved for common bacterial infections, 1 was approved for Clostridioides difficile infection (CDI), 1 was licensed to prevent CDI recurrence, and 2 were approved for drug-resistant tuberculosis. Very few antibiotics are in clinical development. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: The arrival of these new antibiotics was welcomed with great enthusiasm, particularly when they met previously unmet medical needs. Unfortunately, the majority of them represent modifications to existing chemical structures rather than new drug classes. Despite the availability of these antibiotics, managing patients with deep-seated infections and those with extensively resistant gram-negative organisms remains challenging. CONCLUSIONS: The number of new antibiotics and their indications are not keeping up with resistance and the needs of the patients.

A Systematic Review of Newer Antidiabetic Agents in the Treatment of Nonalcoholic Fatty Liver Disease.

OBJECTIVE: To evaluate glucagon-like peptide 1 receptor agonists (GLP-1 RAs), dipeptidyl-peptidase IV (DPP-4) inhibitors, and sodium-glucose cotransporter 2 (SGLT) inhibitors to treat nondiabetic and type 2 diabetes mellitus (T2DM) nonalcoholic fatty liver disease (NAFLD) as it relates to improvement in hepatosteatosis (HS) or steatohepatitis (SH). DATA SOURCES: MEDLINE and CINAHL were searched from inception through May 1, 2020. Search terms included nonalcoholic steatohepatitis, nonalcoholic fatty liver disease, fatty liver, dipeptidyl-peptidase IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose transporter 2 inhibitors. STUDY SELECTION AND DATA EXTRACTION: Full-text observational and randomized controlled studies in English were included. Patients diagnosed with NAFLD, treated with GLP-1 RAs, DPP-4 inhibitors, and SGLT2 inhibitors, with measures to evaluate HS or SH were evaluated. DATA SYNTHESIS: Eight GLP-1 RA trials were reviewed; 7 GLP-1 RA trials showed improvement in HS. Two studies demonstrated improvement in liver histology in patients with SH. Seven SGLT2 inhibitor studies were reviewed; 6 studies demonstrated improvements in NAFLD. Five studies showed improvements in HS, whereas 1 displayed improvement in liver histology in NASH. Six studies that included DPP-4 inhibitors were evaluated, and only 2 demonstrated improvement in NASH. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Based on evidence reviewed, GLP-1 RAs and SGLT2 inhibitors decreased HS and SH in NAFLD patients, whereas DPP-4 inhibitor therapy was not effective for patients with HS. CONCLUSIONS: Based on study data utilizing imaging studies and biopsy results, GLP-1 RAs or SGLT2 inhibitors can benefit NAFLD T2DM patients. Clinical trials with larger patient populations may augment these results.

A Systematic Review on the Use of Sacubitril/Valsartan Initiated Prior to Discharge in Hospitalized Patients With Heart Failure.

OBJECTIVE: Systematically review the evidence of sacubitril/valsartan initiated in the hospital setting prior to discharge in patients with acute decompensated heart failure (HF). DATA SOURCES: A literature search using keywords related to sacubitril/valsartan, HF, and inpatient use was performed using MEDLINE, CINAHL, and Google Scholar from inception through May 8, 2020. STUDY SELECTION AND DATA EXTRACTION: Eligible studies included patients initiated on sacubitril/valsartan while inpatient and reported efficacy and safety outcomes. DATA SYNTHESIS: A total of 10 articles were included for study review, of which 9 were full text and 1 was a conference poster. Key outcomes of interest were related to tolerability, N-terminal proB-type natriuretic peptide (NT-proBNP), functional capacity, target dose attainment, or rehospitalization rates. NT-proBNP levels were improved in 4 trials, and the results of functional capacity were mixed based on 2 studies. Rehospitalization rates were reported as secondary outcomes, and only 1 large study showed numerical and statistical improvement. The most frequent dose initiated prior to discharge was sacubitril/valsartan 24/26 mg twice daily. Hypotension was the most commonly reported adverse drug reaction and was commonly cited as a reason for not tolerating inpatient initiation with sacubitril/valsartan therapy. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Inpatient initiation of sacubitril/valsartan may improve surrogate and clinical outcomes after hemodynamic stabilization. Clinicians should consider patient-specific factors to ensure that benefits outweigh the risks and monitor for hypotension when initiated prior to hospital discharge. CONCLUSION: Initiating inpatient treatment with sacubitril/valsartan after hemodynamic stabilization is reasonable based on available evidence.

Amikacin Liposome Inhalation Suspension for Mycobacterium avium Complex Lung Disease.

OBJECTIVE: To review the pharmacology, pharmacokinetics, pharmacodynamics, clinical efficacy, safety, administration, and role of amikacin liposome inhalation suspension (ALIS) in treatment of Mycobacterium avium complex (MAC) lung disease.
DATA SOURCES: A PubMed search using the terms "amikacin inhaled," "nebulized," and "liposome suspension" was performed. Selected infectious diseaseconference posters were also examined for relevant information. In addition, pertinent guidelines were reviewed.
STUDY SELECTION/DATA EXTRACTION: Guidelines for the management of nontuberculous mycobacterial infections from the American Thoracic Society/ Infectious Diseases Society of America and the British Thoracic Society were used to summarize guidelinebased therapy (GBT). A phase II and a phase III clinical trial were reviewed to evaluate the role of ALIS in the treatment of MAC lung disease.
DATA SYNTHESIS: ALIS is a new formulation of inhaled amikacin (AMK) indicated for the treatment of MAC lung disease refractory to GBT in adults who are not candidates for intravenous AMK. An ongoing clinical trial has demonstrated that once-daily ALIS plus GBT results in higher rates of culture conversion compared with GBT alone by month 6 among patients with a mean age of 65 years. The most common adverse reactions associated with ALIS were dysphonia, cough, bronchospasm, hemoptysis, and ototoxicity. Nephrotoxicity was uncommon.
CONCLUSION: ALIS has been shown to increase culture conversion rates when added to GBT in adults with difficult-to-treat MAC lung disease. ALIS is associated with high rates of pulmonary and auditory adverse reactions and a low risk of renal adverse reactions. ALIS may be an attractive treatment option for older adults who are at high risk for nephrotoxicity.

Evaluation of pharmacy resident perceived impact of natural disaster on stress during pharmacy residency training.

INTRODUCTION: Natural disasters present unique challenges for healthcare training programs. Limited literature has been published regarding the impact of natural disasters on pharmacy residency training. The objective of this study was to determine the degree of perceived impact natural disasters have on pharmacy resident stress and which factors contribute to any perceived change in stress. METHODS: A cross-sectional study was conducted via a survey distributed to pharmacy residents whose program was located in an area potentially affected by natural disaster in the first six months of the 2017-2018 resident year. A modified Likert scale utilizing a 10-point scale was used to assess resident stress. Potential sources of stress were assessed via multiple-choice questions. The primary outcome was the degree of change in resident perceived stress compared to baseline during and after the natural disaster. RESULTS: One hundred twenty-nine pharmacy residents completed the survey. Stress increased from baseline during the natural disaster and remained elevated after compared to baseline. Main sources of stress were increased residency workload, natural disaster preparation and recovery, and concerns regarding friends and family. Half of residents reported their residency program did not have an established natural disaster policy in place. CONCLUSIONS: Improved planning and communication regarding workload expectations may minimize stress among residents balancing increased personal responsibilities during times of natural disaster.

Practical Approaches to Integrate the Topic of Drug Shortages Within Doctor of Pharmacy Curricula.

Drug shortages have a significant impact on the health care system. As concerns grow over this topic, the health care community continues to explore strategies for reducing its impact on patient care. Exposure during the pharmacy curriculum will prepare students to engage and be at the forefront of this issue. Pharmacy educators should evaluate if opportunities exist to incorporate discussions or activities related to drug shortages. Integration of this content can occur throughout the curriculum as introductory or reinforcement topics in courses related to social/administrative/behavioral sciences, informatics, drug information, case studies, pharmacotherapy, law, and ethics. Applying this topic can be done during pharmacy practice experiences and interprofessional activities. Addressing this topic intentionally and developing strategies to promote optimal care in patients amid drug shortages begins with educating pharmacy students about this issue and developing their problem-solving skills.

Baloxavir: A Novel Single-Dose Oral Antiviral for the Treatment of Influenza.

OBJECTIVE: To review the pharmacology, pharmacokinetics, pharmacodynamics, clinical efficacy, tolerability, dosing, and administration of baloxavir marboxil (BXM), as well as its place in the treatment of influenza.
DATA SOURCES: A search of PubMed and Google Scholar using the terms "baloxavir" and "S-033188" was performed. The manufacturer's website was also reviewed to further identify relevant information.
STUDY SELECTION/DATA EXTRACTION: All Englishlanguage articles from January 2008 to December 2018 appearing in these searches were reviewed for relevance to this paper. In addition, their bibliographies were reviewed to identify any articles not identified in the searches.
DATA SYNTHESIS: BXM is a selective cap-dependent endonuclease inhibitor approved by the Food and Drug Administration for the treatment of acute uncomplicated influenza in adults and adolescents 12 years of age and older who weigh at least 40 kg. Clinical trials demonstrated that BXM was associated with a significantly shorter time to alleviation of influenza symptoms compared with placebo when taken within 48 hours of symptom onset. The time to alleviation of symptoms was similar with BXM and oseltamivir. The most common adverse reactions associated with BXM were diarrhea, bronchitis, nausea, nasopharyngitis, and headache. BXM is administered orally as a single-dose of 40 mg or 80 mg, depending on body weight. No dosage adjustment is needed in patients with mild-to-moderate hepatic or renal impairment.
CONCLUSION: BXM has been proven safe and effective in the treatment of acute uncomplicated influenza in patients 12 years of age and older when administered within 48 hours of symptom onset.

Critical Appraisal of Biomedical Literature With a Succinct Journal Club Template: The ROOTs Format.

Journal clubs are a valuable tool to assist pharmacists in the evaluation of biomedical literature and to promote adoption of evidence-based practices. The concise ROOTs (relevance, observe validity, obtain clinically significant results, and translate results to clinical practice) method was developed to help simplify and provide structure to any journal club process. Although there are a variety of recommended practices on how to conduct journal clubs using a variety of questions and checklists, many are cumbersome and difficult to complete and present in less than 30 minutes. The concise ROOTs journal club format may be beneficial for clinicians to help them develop an efficient and consistent means to appraise evidence in clinical practice. A sample completed ROOTs template, utilizing the 2015 IMPROVE-IT trial, is provided to further assist in utilizing the template.

Useful resources for members serving on a curriculum committee in schools and colleges of pharmacy.

The curriculum committee has an important role in the design and delivery of a Doctor of Pharmacy program. The primary purpose of this article is to identify relevant resources for members to utilize to be active participants in a school or college of pharmacy curriculum committee. The resources presented are focused around the following seven key curricular management concepts: orientation to curriculum, syllabus review, teaching methods, curriculum review, interprofessional education, student workload, and policy development, as these are common agenda items for a committee meeting. Several curricular resources used by other health care disciplines were included to promote collaboration with interprofessional education activities. Awareness of such resources may benefit members to achieve optimal educational outcomes for the program.

Evidence-based strategies to reduce intravenous immunoglobulin-induced headaches.

OBJECTIVE: To review the literature evaluating pharmacotherapeutic and nonpharmacotherapeutic options available to reduce migraines or headaches associated with intravenous immunoglobulin (IVIG) treatment. DATA SOURCES: A search of MEDLINE (1946 to February 2015) and other secondary resources was performed using the terms immunoglobulin, immune globulin, intravenous immunoglobulins, migraine, and headache. Other relevant articles referenced from the MEDLINE search were also utilized. STUDY SELECTION AND DATA EXTRACTION: Data sources were limited to English language clinical trials and case studies. In all, 6 clinical studies and 2 case reports met the criteria. DATA SYNTHESIS: Headaches or migraines are common adverse effects associated with the administration of IVIG. We evaluated 6 clinical studies and 2 case reports discussing this adverse event in patients treated with IVIG. Strategies used were hydration, switching to an alternate IVIG product, decreased infusion rates, or treating with oral analgesics, opioids, propranolol, sumatriptan, or dihydroergotamines before, during, or after the IVIG infusion. Overall, the majority of patients experienced improvement in headache symptoms, suggesting benefit, after using the various strategies discussed. However, the evidence is limited to case reports and clinical studies with small sample sizes that do not directly measure cause and effect of headache resolution and therapy given in those treated with IVIG. CONCLUSIONS: An individualized treatment plan consisting of a pharmacotherapy or nonpharmacotherapy strategy used in the literature should be recommended after careful consideration of the patient's condition, specific IVIG product used, history of migraine, and previously failed and successful therapies.

Dornase Alfa for Non-Cystic Fibrosis Pediatric Pulmonary Atelectasis.

OBJECTIVE: To review the literature evaluating the efficacy of dornase alfa for non-cystic fibrosis pediatric patients with pulmonary atelectasis. DATA SOURCES: Articles were retrieved after a search of MEDLINE/PubMed (1946 to April 2014), and International Pharmaceutical Abstracts (1970-April 2014) was performed using the terms dornase alfa, recombinant human deoxyribonuclease, pulmonary, persistent, and atelectasis. Other relevant articles referenced from the MEDLINE search were also utilized. STUDY SELECTION AND DATA EXTRACTION: Data sources were limited to English language clinical trials and case studies including only children; 8 clinical trials and 12 case reports met the criteria. DATA SYNTHESIS: Dornase alfa is used as an off-label treatment option for pulmonary atelectasis because limited treatment modalities exist after conventional therapy has failed. We evaluated 8 clinical trials and 12 case reports involving this pediatric population with varying primary diagnoses. The majority of patients experienced improvement in atelectasis, suggesting benefit after receiving treatment with dornase alfa. However, the outcomes were possibly confounded by those receiving combination therapies, varying primary diagnoses, and varying end points evaluated. Dornase alfa was overall well tolerated, with only a few patients experiencing worsening atelectasis posttreatment. CONCLUSIONS: Dornase alfa may be considered as a therapeutic option in non-cystic fibrosis pediatric patients with pulmonary atelectasis, who require treatment intervention when conventional therapy is unsuccessful.

Risk of hypotension with concomitant use of calcium-channel blockers and macrolide antibiotics.

PURPOSE: The literature describing the risk of hypotension in patients receiving concomitant therapy with a calcium-channel blocker (CCB) and a macrolide antibiotic is reviewed. SUMMARY: A literature search was conducted to identify studies and reports describing significant drug interactions between CCBs and macrolide antibiotics resulting in hypotension. One retrospective clinical trial, one pharmacokinetics study, and five case reports were found using MEDLINE. While both dihydropyridine and nondihydropyridine CCBs are cytochrome P-450 isoenzyme 3A4 (CYP3A4) substrates, verapamil was the CCB implicated in three of the five case reports. Based on currently available literature, it is unknown whether the risk of clinically significant hypotension is higher for patients receiving nondihydropyridine CCBs; however, due to the drugs' effects on the coronary arteries, there is the potential for more-serious cardiac complications with these agents. Both erythromycin and clarithromycin have been shown to prolong the Q-T interval, an effect that appears to increase when these drugs are given with CYP3A4 inhibitors. The potential for Q-T interval prolongation by both erythromycin and clarithromycin may increase the risk of clinically relevant hypotension and even shock in patients taking CCBs, in particular nondihydropyridines. CONCLUSION: Potentially significant hypotension and shock may occur when macrolide antibiotics, particularly erythromycin and clarithromycin, are administered concomitantly with CCBs. The frequency of hypotension as a result of concomitant CCB and macrolide administration appears to be small, but the risk of adverse effects and the severity of the effects appear to be greater for those patients who are older and in those with multiple comorbidities.