A Comparison of the Knowledge of Alzheimer's Disease among Community Pharmacists Based on Regional Practice Setting Using the Alzheimer's Disease Knowledge Scale (ADKS).

Alzheimer's Disease (AD) is the most prevalent type of dementia and has a high prevalence in the aging population. Due to the requirements for care, it is valuable for members of the healthcare system to be knowledgeable about AD and its treatment. Community pharmacists are particularly valuable in assisting in AD care because of their accessibility to the general public and they are a source for dispensing AD medications. The purpose of this study is to assess the level of knowledge of AD among Ohio community pharmacists based on regional practice settings using the Alzheimer's Disease Knowledge Scale (ADKS). A standardized, 30-question assessment tool known as the Alzheimer's Disease Knowledge Scale exists to measure the level of knowledge of AD among a given population. Studies on AD knowledge have been conducted using this tool, and the use of this scale identifies major misconceptions about AD that could be addressed in education initiatives for both the general public and for health care professionals. This study implemented this tool to compare the knowledge of community pharmacists that serve rural areas to those that serve urban areas. The Ohio Board of Pharmacy provided a list of emails of community pharmacists to send an anonymous survey including both demographic questions and the ADKS. Statistical analyses including independent t-tests and descriptive statistics were conducted using SPSS to determine the significance of the data. This study found no statistically significant difference between urban versus rural community pharmacists. However, in the future we hope to identify specific questions that correlate to areas of AD where continuing education may be helpful in improving patient outcomes by enabling caregivers and healthcare providers with a more accurate understanding of AD.

The utilization of peer feedback during collaborative learning in undergraduate medical education: a systematic review.

BACKGROUND: Peer evaluation can provide valuable feedback to medical students, and increase student confidence and quality of work. The objective of this systematic review was to examine the utilization, effectiveness, and quality of peer feedback during collaborative learning in medical education. METHODS: The PRISMA statement for reporting in systematic reviews and meta-analysis was used to guide the process of conducting the systematic review. Evaluation of level of evidence (Colthart) and types of outcomes (Kirkpatrick) were used. Two main authors reviewed articles with a third deciding on conflicting results. RESULTS: The final review included 31 studies. Problem-based learning and team-based learning were the most common collaborative learning settings. Eleven studies reported that students received instruction on how to provide appropriate peer feedback. No studies provided descriptions on whether or not the quality of feedback was evaluated by faculty. Seventeen studies evaluated the effect of peer feedback on professionalism; 12 of those studies evaluated its effectiveness for assessing professionalism and eight evaluated the use of peer feedback for professional behavior development. Ten studies examined the effect of peer feedback on student learning. Six studies examined the role of peer feedback on team dynamics. CONCLUSIONS: This systematic review indicates that peer feedback in a collaborative learning environment may be a reliable assessment for professionalism and may aid in the development of professional behavior. The review suggests implications for further research on the impact of peer feedback, including the effectiveness of providing instruction on how to provide appropriate peer feedback.

A Survey of Health Sciences Faculty Practices and Attitudes Regarding the Peer Feedback Component of Team-Based Learning.

BACKGROUND: Peer feedback, an essential component of team-based learning (TBL), fosters accountability among team members. Effective utilization can be advantageous for both students and faculty, although there may be many implementation challenges. Our study objectives were to (1) identify current practices of peer feedback in TBL, (2) identify curricular assessment related to peer feedback, and (3) identify challenges with peer feedback in TBL. METHODS: A survey link was sent via medical and TBL web boards. The survey asked for both quantitative and qualitative information regarding the peer feedback process. Quantitative results were analyzed using SPSS®. NVivo® was used to identify and code themes in open-ended responses. Both investigators reviewed and agreed upon themes. RESULTS: Sixty-one TBL users in health professions completed the survey. Multiple health professions were represented with medicine and pharmacy being the most common. Information on current practices showed a wide variety of implementation. Curricular alignment was common. Time and training were the most common challenges and difficulties. CONCLUSIONS: Meaningful feedback should be considered an important curricular outcome. Specific learning objectives and appropriate assessment strategies should be developed to meet the mission of the program. Students must receive guidance from faculty members on how to improve their skills in providing effective feedback. Overall, faculty saw peer evaluation as valuable. However, the time commitment, lack of student training, and student attitudes make implementation difficult. Future research should focus on best practices to streamline the TBL feedback process and on student training regarding how to provide effective feedback.

The development and psychometric properties of the bipolar disorders knowledge scale.

PURPOSE: Bipolar Disorder (BD) presents in 1-4% of the world's population, carrying significant financial and functional consequences. Beyond the direct disease burden, patients with BD experience a high degree of both internal and external stigma. Additionally, medication adherence tends to be poor in patients with BD. Knowledge appears to play a role in mitigating both stigma and non-adherence, but these relationships have not been fully elucidated. The Bipolar Disorder Knowledge Scale (BDKS) was designed to explore the role of knowledge and better define such relationships. This research provides the evidence for the reliability and validity of the scale. METHODS: Forty-seven items were developed to assess knowledge of BD. The 47-item survey was sent out to two groups: first a group of 43 pharmacists with BCPP credentials from the College of Psychiatric and Neurologic Pharmacists (CPNP) who were recruited from the CPNP directory, and second a group of 250 members of the general public who were recruited using Qualtrics Online Sample service. Participants were surveyed on their education status, health literacy, BD diagnostic status, and exposure to patients with BD. Participants then completed the 47-item scale. After 48 h 100 members from the original general public group were sent the same survey to assess test-retest reliability. For each item a difficulty index to evaluate how well participants performed on the item and a discrimination index to determine how well each item performed in high-scorers versus low scorers were calculated. Additionally, Cronbach's alpha was calculated to determine internal consistency validity and a Pearson correlation was run to determine test-retest reliability. Items were removed based on the results from the difficulty index, discrimination index, and Cronbach's alpha. Finally the pharmacist final scores were compared to the general public using an unpaired t-test to assess whether content experts were more likely to perform better on the scale. Following item removal, the scale was finalized at 25-items. RESULTS: The mean score for the scale was 34.48 (71.83%; SD: 5.50) and the Cronbach's alpha was 0.773 before item analysis. Following item analysis, 22 items were dropped leaving 25 items on the final version of the scale. The remaining items retained a difficulty index below 90% and a discrimination index above 20%. The mean of the 25-item scale was 18.40 (73.6%; SD: 4.13) for the general public and 23.20 (92.8%; SD: 1.36) for the pharmacists group (p < 0.001). The Cronbach's alpha for the finalized scale was 0.760, indicating a high-degree of internal consistency. While this is lower than the original alpha, this may be explained by the reduced number of scale items. A 25-item scale is much more practical and the items on the scale retain stronger item analysis statistics. Finally, the Pearson Correlation for the group who underwent the test-retest procedure was 0.841 (p < 0.001) indicating strong test-retest reliability. CONCLUSION: The BDKS is a 25-item true-false scale that takes approximately 5-10 min to complete. The scale assesses knowledge of BD with items targeting diagnosis, etiology, disease course, symptoms, treatment, and life impact. The scale has shown strong internal consistency and test-retest reliability in a general population and will be useful for evaluating knowledge of BD as it relates to stigma, non-adherence, and other variables.

Tone and style in pharmacy course syllabi.

OBJECTIVE: Syllabi are a part of the teaching and learning experience in pharmacy curricula. Yet, little has been done to understand the effects of these documents. Studies in Psychology and Social Work report important effects of style and tone of syllabi on student perceptions and performance. We sought to describe a cross-sectional pattern in the tone and style of pharmacy course syllabi. METHODS: We retrieved syllabi via US pharmacy institutions and association website searches. The tone was characterized as "warm" or "cold" based on the publications in Psychology and Social Work higher education. QSR NVivo® software was used to code syllabi. Subsequently, categories of style and tone were quantified in a descriptive manner. RESULTS: We retrieved 416 pharmacy course syllabi from 30 public universities (69.8%) and 13 private universities (30.2%) across curricular disciplines. After observing saturation where no new patterns arose, 141 syllabi were analyzed. CONCLUSIONS: Pharmacy course syllabi were rarely warm in tone and did not fully employ the components of the syllabus as a potential learning tool. This may have important implications on student-teacher interactions, professional development, and student perceptions and academic performance. More work should be done to determine whether and in what manner style and tone may affect pharmacy student learning and engagement.

Practical Team-Based Learning from Planning to Implementation.

Team-based learning (TBL) helps instructors develop an active teaching approach for the classroom through group work. The TBL infrastructure engages students in the learning process through the Readiness Assessment Process, problem-solving through team discussions, and peer feedback to ensure accountability. This manuscript describes the benefits and barriers of TBL, and the tools necessary for developing, implementing, and critically evaluating the technique within coursework in a user-friendly method. Specifically, the manuscript describes the processes underpinning effective TBL development, preparation, implementation, assessment, and evaluation, as well as practical techniques and advice from authors' classroom experiences. The paper also highlights published articles in the area of TBL in education, with a focus on pharmacy education.

Management of hallucinations and psychosis in Parkinson's disease.

BACKGROUND: Hallucinations and psychosis are common in patients with Parkinson's disease (PD), with reported prevalences of up to 48% and 80%, respectively. However, few randomized, double-blind, placebo-controlled trials evaluating the treatment options have appeared in the literature. The studies that have been published were complicated by lack of agreement on the diagnosis of psychosis in PD, poor completion rates, mixed populations that included dementia, and other issues. Several reviews, guidelines, and consensus statements have sought to establish standards for treating these symptoms of PD. In 2006, the American Academy of Neurology (AAN) published a practice guideline (based on articles published up to 2004) for management of depression, psychosis, and dementia in patients with PD. Since then, a number of relevant studies have been published. OBJECTIVE: The purpose of this article was to review data that have appeared in the literature since publication of the AAN guideline regarding the management of hallucinations and psychosis in PD. METHODS: A literature search of the PubMed, CINAHL, and PsychInfo databases was conducted for human studies published in English from January 2004 to June 2010. All clinical studies were included except case reports and case series. Studies with <20 participants were also excluded. Search terms included psychosis, hallucinosis, hallucination, delusion, Parkinson, atypical antipsychotic, neuroleptic, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone. RESULTS: Thirteen studies were included in the review: 3 studies of clozapine, 7 studies of quetiapine, 2 head-to-head trials comparing quetiapine and clozapine, and 1 noncomparative trial of clozapine or quetiapine interventions. Most of the studies included participants with a mean age in the early to mid 70s and a mean duration of PD typically >10 years. CONCLUSIONS: Results of the identified studies suggested that patients with PD might benefit from long-term clozapine therapy. Results of the quetiapine studies were conflicting. However, no statistically significant difference in effectiveness was found between quetiapine and clozapine in comparative trials. The significance of the differences in treatment responses between patients with dementia and those without dementia remains unclear, and it was not possible to draw conclusions for or against other atypical antipsychotics because of insufficient evidence. Further studies are needed to address the methodologic issues in the current trials and to assess safety issues in larger cohorts.

Open-label trial regarding the use of acupuncture and yin tui na in Parkinson's disease outpatients: a pilot study on efficacy, tolerability, and quality of life.

OBJECTIVES: This study evaluates the effects of sequential tui na massage, acupuncture, and instrument-delivered qigong for patients with Parkinson disease (PD) over a 6-month period. DESIGN: Patients received weekly treatments, which included tui na massage prior to acupuncture followed by instrument-delivered qigong. Each patient was assessed at baseline and at 6 months. SETTING: The setting was an outpatient research/academic clinic for patients with PD and nonacademic acupuncture clinic. SUBJECTS: Twenty-five (25) patients with idiopathic PD were the subjects. OUTCOME MEASURES: Before and after treatment patients were evaluated with the Unified Parkinson Disease Rating Scale (UPDRS), Hoehn and Yahr Staging (H&Y), Schwab and England Activities of Daily Living (S & E), Beck Depression Inventory (BDI), Parkinson's Disease Questionnaire (PDQ-39) quality of life assessment, and patient global assessments. RESULTS: There were no significant improvements in treatment measures; however, there was a 2.4-point worsening in UPDRS motor scores (24.0 versus 26.4, p = 0.018). There was a 16% improvement in the PDQ- 39 total score (23.2 versus 19.6, p = 0.044) and a 29% improvement in the BDI (9.6 versus 6.8, p = 0.006). Sixteen (16) patients reported moderate to marked improvement. There were no adverse effects. CONCLUSIONS: Acupuncture is safe and well tolerated in patients with PD. Most patients reported subjective improvement. The BDI and PDQ-39 total score, measuring depression and quality of life, demonstrated some improvement, but UPDRS motor scores worsened.

The cost effect of newer medication adoption in an older Medicaid cohort.

OBJECTIVES: State Medicaid programs struggle with rapidly increasing expenditures for pharmaceuticals, and Medicare will likely face the same challenge. This article demonstrates how the adoption of newer drugs across diverse therapeutic classes contributed to one state's Medicaid expenditures over a 3-year period. DESIGN: Retrospective analysis of administrative claims data. SETTING: Older Kansas Medicaid community dwellers and institutionalized beneficiaries. PARTICIPANTS: A 15% random sample (N = 6,256) of recipients aged 60 and older. MEASUREMENTS: Prescription medication use was tracked for three sequential 1-year periods for eight therapeutic classes accounting for the greatest Medicaid drug expenditures, categorizing individual medications as newer or older agents based on generic availability and other clinical distinctions. Outcome measures were utilization per person-year, price per prescription, market share as percentage of prescriptions, and market share as percentage of expenditures for prescriptions within each class. RESULTS: Use increased for all classes, driven by the adoption of newer agents. Mean prescription prices rose in nearly all classes primarily because of the higher prices of the newer agents. Newer drugs accounted for more than 50% of prescriptions in four of eight classes and constituted a disproportionately greater share of expenditures than their prescription share among several classes: antidepressants (>95%), antipsychotics (>92%), antiulcer agents (>63%), antiinflammatory drugs (>60%), and opiates (>45%). CONCLUSION: Newer drug products for a variety of treatment indications consume a majority of pharmaceutical expenditures through widespread adoption and higher prices. Although these agents may offer some therapeutic advantages, further research is needed to determine in what circumstances, and for which patients, the advantages of new pharmaceuticals outweigh their higher costs.

Patterns of potentially inappropriate medication use across three cohorts of older Medicaid recipients.

BACKGROUND: Potentially inappropriate medication use is a serious quality concern, especially when it occurs in more vulnerable older adults or for extended durations. OBJECTIVE: To characterize patterns of inappropriate medication use and duration among 3 cohorts with differing health status. METHODS: We identified unconditionally inappropriate drug use, using Beers 1997 criteria, among 3185 older Kansas Medicaid beneficiaries. Claims from May 2000 to April 2001 provided data for 3 cohorts: nursing facility (NF) residents, recipients of home- and community-based services through the Frail Elderly (FE) program, and persons with neither NF/FE care (Ambulatory). Duration, categorized as short-term (< or = 1 month's supply), extended (> 1-9 mo), or chronic (> 9-12 mo), was determined for each drug and cohort. Drug-disease associations were explored. RESULTS: Any inappropriate medication use occurred in 21%, 48%, and 38% of Ambulatory, FE, and NF cohorts, respectively. Inappropriate analgesics, antihistamines, antidepressants, muscle relaxants, and oxybutynin were most common, but prevalence and duration varied by cohort. Short-term analgesic and antihistamine use was common. FE cohort members had the highest use rates for all drugs. The NF cohort had less antidepressant and muscle relaxant use. Drug-disease associations were noted for amitriptyline use in diabetes mellitus, propoxyphene use in musculoskeletal and upper gastrointestinal conditions, and muscle relaxant use in musculoskeletal conditions. CONCLUSIONS: Cross-sectional, one-year prevalence figures are comprised of both short- and long-term use that varies by drug and cohort. NF residence is associated with reduced use of drugs scrutinized during mandated medication review. Relevant diseases are associated with specific inappropriate prescribing. Future efforts should target extended and chronic duration of use and persons at highest risk for adverse effects, including recipients of home- and community-based care.

Comparison of the association between disease burden and inappropriate medication use across three cohorts of older adults.

BACKGROUND: Use of potentially inappropriate medications is common in nursing facilities (NFs), in which frail older adults are particularly vulnerable to adverse drug effects. The community-dwelling elderly are generally healthier and have lower overall rates of medication use, but their prescribed medications are not subjected to the same degree of regulatory scrutiny as those of residents in NFs. Frail elderly (FE) adults who are nursing home eligible but are receiving home- and community-based services (HCBS) constitute a distinct group sharing a high disease burden and high levels of medication use with the NF population. OBJECTIVE: The goal of this study was to examine the relationship between disease burden and inappropriate medication use in these 3 cohorts, with adjustment for demographic and clinical differences. METHODS: We performed retrospective analyses of Medicaid claims data from May 2000 through April 2001 to identify 3 cohorts of Kansas Medicaid beneficiaries: community-dwelling older adults (the ambulatory cohort); persons receiving HCBS through the Kansas Frail Elderly Program (the FE cohort); and elderly NF residents (the NF cohort). Demographic, clinical, and medication data were extracted from the Medicaid claims data. Unconditionally inappropriate medications were identified using the 1997 Beers criteria. The Cumulative Illness Rating Scale for Geriatrics was used to calculate the disease burden sum, classified as 0 or 1, 2 or 3, 4 or 5, or > or =6 disease categories. Odds ratios for inappropriate medication use at each level of disease burden in each cohort were derived using multivariable models adjusted for demographic and clinical factors, including overall level of medication use. RESULTS: The final sample included 3185 persons in the 3 cohorts (1163 ambulatory, 858 FE, 1164 NF). Inappropriate medication use was determined to have occurred in 21%, 48%, and 38% of the respective cohorts and was highest in FE cohort members with the greatest disease burden (61%). For the ambulatory and FE cohorts, inappropriate medication use rose as the disease burden increased. The same was not observed in the NF cohort, in whom rates of inappropriate medication use showed little variation regardless of disease burden. CONCLUSIONS: The relationship between disease burden and inappropriate medication use varied by setting. Those members of the FE cohort with the highest disease burden had the greatest risk for inappropriate medication use.

Pharmacologic management by clinical pharmacists of behavioral and psychological symptoms of dementia in nursing home residents: results from a pilot study.

A pharmacist-based consulting service was developed for the pharmacologic management of behavioral and psychological symptoms of dementia (BPSD) in a nursing home setting. Patients were evaluated using the Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) rating scale, and pharmacotherapy was selected using a structured approach. Eleven patients were evaluated and treated with various psychotropic drugs. The most commonly administered drug was trazodone at a mean dosage of 70 mg/day (range 50-100 mg/day). Nine of the patients demonstrated satisfactory treatment responses as shown by a decreased BEHAVE-AD score of 30% or more (average BEHAVE-AD scores at baseline and 1 month after treatment were 13 +/- 4 and 4 +/- 3, respectively), and no clinical side effects were observed. The service was well received by the facility staff and primary care providers. These preliminary results suggest that pharmacists can play an important role in the pharmacotherapy of BPSD with positive clinical outcomes.