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Curr Pharm Teach Learn ; 10(12): 1574-1578, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30527822


INTRODUCTION: Descriptions of SOAP note requirements and assessment methods used during advanced pharmacy practice experiences (APPEs) are limited in the literature. This study aimed to gather information from preceptors regarding SOAP note writing and assessment methods utilized during ambulatory care APPEs. METHODS: A survey was developed and distributed to ambulatory care preceptors with data collected via Qualtrics and analyzed using descriptive statistics, Fisher's exact test to assess the significance for associations between dependent and independent variables, and the Gamma test to assess dependent variables in grading habits and feedback types. RESULTS: The survey response rate was 62% with 75% of preceptors having students write SOAP notes during APPEs. A majority of preceptors (84%) do not formally grade SOAP notes with full-time faculty being more likely to grade and provide written feedback. Half of the preceptors perceived students as either prepared or very prepared to write SOAP notes but the majority felt that students struggle with the assessment portion of the note. There were significant differences between schools in the percentage of preceptors that formally grade SOAP notes, ranging from 2 to 45%. CONCLUSIONS: Preceptors' perception of student preparedness to write SOAP notes on ambulatory APPEs was similar, despite assessment methods varying widely.

Documentación/normas , Educación en Farmacia/normas , Percepción , Preceptoría/métodos , Atención Ambulatoria/métodos , Documentación/métodos , Educación en Farmacia/métodos , Evaluación Educacional/métodos , Retroalimentación , Humanos , Servicios Farmacéuticos , Encuestas y Cuestionarios
Am J Pharm Educ ; 82(9): 6725, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30559501


Objective. To develop and establish validity for a grading rubric to evaluate diabetes subjective, objective, assessment, plan (SOAP) note writing on primary care (PC) advanced pharmacy practice experiences (APPEs), and to assess reliability and student perceptions of the rubric. Methods. Ten PC APPE faculty members collaborated to develop a rubric to provide formative and summative feedback on three written SOAP notes per APPE student over a 10-month period. Correlation analyses were conducted between rubric scores and three criterion variables to assess criterion-related validity: APPE grades, Pharmaceutical Care Ability Profile Scores, and Global Impression Scores. Inter-rater and intra-rater reliability testing were completed using Cohen's kappa and Intraclass Correlation Coefficients (ICC). Student perceptions were assessed through an anonymous student survey. Results. Fifty-one students and 167 SOAP notes were evaluated using the final rubric. The mean score significantly increased from the first to second SOAP note and from the first to third SOAP note. Statistically significant positive correlations were found between final rubric scores and criterion variables. The ICC for inter-rater reliability was fair (.59) for final rubric scores and excellent for intra-rater reliability (.98 to1.00). Students responded that the rubric improved their ability (84.9%) and confidence (92.4%) to write SOAP notes. Conclusion. The rubric may be used to make valid decisions about students' SOAP note writing ability and may increase their confidence in this area. The use of the rubric allows for greater reliability among multiple graders, supporting grading consistency.

Documentación/normas , Evaluación Educacional/métodos , Educación en Farmacia/métodos , Docentes , Retroalimentación Formativa , Metas , Humanos , Reproducibilidad de los Resultados , Estudiantes de Farmacia , Escritura
Psychopharmacol Bull ; 44(2): 32-53, 2011 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-27738354


OBJECTIVES: This study evaluated the efficacy of ramelteon for insomnia in adult subjects with ADHD. EXPERIMENTAL DESIGN: For this randomized, double-blind, placebo-controlled crossover trial, 8 mg of ramelteon was given nightly, within three hours of bedtime, to ADHD-insomnia subjects confirmed by DSM-IV-TR, ADHD-RS, MINI, and clinical interview. All subjects underwent two weeks each of ramelteon and placebo. Objective sleep measures were obtained by actigraphy. Subjective measures included: the Epworth Sleepiness Scale (ESS) and ADHD-RS. PRINCIPAL OBSERVATIONS: Of 36 subjects entering the study, 58% met criteria for circadian rhythm sleep disorder (CRSD), delayed sleep phase type. During ramelteon period, mid-sleep time, an indicator of circadian phase, occurred significantly earlier, by ~45 minutes compared to placebo period. An association was noted between the magnitude of the sleep phase advance and the timing of ramelteon administration in relationship to sleep start time, but did not reach statistical significance; maximal efficacy was noted 1.5 hours before bedtime. Paradoxically, ramelteon marginally, but significantly increased sleep fragmentation and ESS scores compared to the placebo state. CONCLUSIONS: Ramelteon is efficacious in maintaining an earlier sleep/wake cycle in adults with ADHD and CRSD but can have paradoxical fragmenting effects on sleep and exacerbate daytime sleepiness. In the presence of a circadian rhythm disorder, the usual dosing and timing parameters for ramelteon need to be carefully considered.

Pharmacotherapy ; 30(9): 942-51, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20795849


Generalized anxiety disorder (GAD) is a common, chronic mental illness that has a significant burden on the patient's quality of life. Treatment for GAD routinely consists of monotherapy with a proven anxiolytic such as an antidepressant or benzodiazepine, but many patients do not respond fully to these drugs, and additional treatment may be needed. Therefore, we reviewed the safety and efficacy of atypical antipsychotics as adjunct therapy to standard GAD pharmacotherapy in patients deemed treatment resistant. We performed a literature search of the MEDLINE database for English-language articles published from January 1966-May 2009. Identified articles were evaluated, and only open-label trials and randomized controlled trials (RCTs) were included in the review. Relevant references from the articles were also evaluated. Only a few reports of large-scale RCTs that assessed an atypical antipsychotic for treatment-resistant GAD have been published. Articles were found for five of the eight currently available atypical antipsychotics, but not for asenapine, clozapine, and paliperidone. Several open-label trials and smaller RCTs support the need for further evaluation of aripiprazole and quetiapine for treatment-refractory GAD, although one quetiapine trial demonstrated negative results. There is disparate data for risperidone, with one open-label trial and one small RCT showing positive results and one large RCT showing negative results. One open-label trial of ziprasidone and one RCT of olanzapine both showed beneficial effects of the drugs. Adverse effects were specific to each agent, with weight gain being the most common, but many studies did not monitor systematically for lipid level, weight, or glucose level changes. Although data suggest efficacy regarding the use of atypical antipsychotics for augmentation of treatment-refractory GAD, more rigorous studies (large, double-blind, placebo-controlled trials) on the safety and efficacy of these agents are needed in order to recommend their use in patients with GAD.

Antipsicóticos/uso terapéutico , Trastornos de Ansiedad/tratamiento farmacológico , Antipsicóticos/efectos adversos , Aripiprazol , Benzodiazepinas/efectos adversos , Benzodiazepinas/uso terapéutico , Ensayos Clínicos como Asunto , Dibenzotiazepinas/efectos adversos , Dibenzotiazepinas/uso terapéutico , Resistencia a Medicamentos , Humanos , Olanzapina , Piperazinas/efectos adversos , Piperazinas/uso terapéutico , Fumarato de Quetiapina , Quinolonas/efectos adversos , Quinolonas/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Risperidona/efectos adversos , Risperidona/uso terapéutico , Inhibidores de la Captación de Serotonina/efectos adversos , Inhibidores de la Captación de Serotonina/uso terapéutico , Tiazoles/efectos adversos , Tiazoles/uso terapéutico
Community Ment Health J ; 45(4): 251-4, 2009 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-19472052


Quetiapine is frequently prescribed for insomnia that is comorbid with psychiatric disorders, but there has been no documentation of metabolic adverse effects associated with this practice. The objective of this study was to document changes in weight, body mass index, and waist circumference that occurred when low-dose quetiapine was used at bedtime for insomnia. The study was a retrospective chart review conducted at a community mental health center. Patients were non-elderly (19-65 years old) psychiatric patients who received quetiapine at < or =200 mg at bedtime for the explicit indication of insomnia. Forty-three patients were included in the study. Weight and BMI increased by an average of 4.9 lb. (P = 0.037) and 0.8 points (P = 0.048), respectively. Males experienced statistically significant increases in weight and BMI, and Caucasians experienced a statistically significant increase in BMI. There were no significant differences between baseline and endpoint metabolic parameters when examined by baseline BMI, age category, psychiatric diagnosis, or concomitant psychotropic medication. Despite the low doses typically used when quetiapine is prescribed for insomnia, metabolic adverse effects can occur and should be considered in the overall benefit to risk analysis.

Antipsicóticos/administración & dosificación , Antipsicóticos/metabolismo , Dibenzotiazepinas/administración & dosificación , Dibenzotiazepinas/metabolismo , Trastornos Mentales , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Adulto , Alabama , Índice de Masa Corporal , Comorbilidad , Femenino , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Fumarato de Quetiapina , Estudios Retrospectivos , Aumento de Peso/efectos de los fármacos , Adulto Joven
Am J Health Syst Pharm ; 64(11): 1174-86, 2007 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-17519460


PURPOSE: Data collected from the Food and Drug Administration (FDA) under the Freedom of Information Act are presented to help clinicians understand the data prompting the black-box warning for droperidol and to make educated decisions regarding the use of droperidol and alternative agents. SUMMARY: A written request was submitted to FDA to provide a report of any and all reports of cardiovascular adverse events related to droperidol that were part of the decision to add a black-box warning to the label of droperidol. The report listed 277 cases of adverse effects associated with droperidol since its introduction to the market in 1970. Many of the reports were duplicates, leaving a total of 65 individual cases. Of these cases, only 2 described adverse effects possibly caused by droperidol in dosages commonly used in the United States. In addition to these reports, the results of two European studies prompted FDA to make the decision for the black-box warning. Both studies used droperidol doses 50-100 times higher than those used in the United States. CONCLUSION: Studies show that there is a dose-dependent increase in the rate of adverse cardiovascular events when droperidol is used either alone or in combination with other medications that cause Q-T interval prolongation. At this time, there does not appear to be significant evidence to suggest that serotonin type 3-receptor (5-HT(3)) antagonists are safer than droperidol with regard to Q-T interval prolongation. More studies are needed to determine the safety and efficacy of droperidol when used in doses of 0.625-1.25 mg compared with the 5-HT(3) antagonists.

Antipsicóticos/administración & dosificación , Antipsicóticos/efectos adversos , Arritmias Cardíacas/inducido químicamente , Droperidol/administración & dosificación , Droperidol/efectos adversos , Etiquetado de Medicamentos , Adulto , Sistemas de Registro de Reacción Adversa a Medicamentos , Anciano , Recolección de Datos , Medicina Basada en la Evidencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo/métodos , Estados Unidos , United States Food and Drug Administration/estadística & datos numéricos