Peer evaluation of teaching programs within pharmacy education: A review of the literature.

BACKGROUND: Student evaluations of teaching are one method to evaluate faculty teaching, but alone may have bias. Peer evaluation of teaching represents an important approach in assessing and providing feedback to faculty, however, numerous strategies exist for implementation. This review was conducted to identify existing peer evaluation of teaching programs and to describe their development, implementation, and outcomes. METHODS: A literature search was conducted through January 2023 using the following search terms alone or in combination: peer evaluation, peer evaluation of teaching, peer review of teaching, pharmacy, pharmacy education, teaching evaluation, peer assessment. Articles were included that described and evaluated the development and/or specific outcomes of individual peer evaluation of teaching programs in the didactic setting within pharmacy education. RESULTS: Eight articles were identified for review; six described peer evaluation of teaching in individual programs and two described components of the same program. Classroom observation was the core component of all programs and some but not all programs included pre- and/or post-observation meetings. Outcomes of programs included perception of participants via survey in seven studies with generally positive perceptions noted. Time burden was the most common concern noted for the implementation of the peer evaluation programs. IMPLICATIONS: Limited literature exists describing peer evaluation of teaching programs and outcomes within in pharmacy education. Peer evaluation processes are individualized and vary across institutions. Opportunities exist to develop time-efficient programs to further assess the outcomes of peer evaluation of teaching and compare with student evaluations or other tools to evaluate education quality.

Integrative monitoring strategy for marine and freshwater harmful algal blooms and toxins across the freshwater-to-marine continuum.

Many coastal states throughout the USA have observed negative effects in marine and estuarine environments caused by cyanotoxins produced in inland waterbodies that were transported downstream or produced in the estuaries. Estuaries and other downstream receiving waters now face the dual risk of impacts from harmful algal blooms (HABs) that occur in the coastal ocean as well as those originating in inland watersheds. Despite this risk, most HAB monitoring efforts do not account for hydrological connections in their monitoring strategies and designs. Monitoring efforts in California have revealed the persistent detection of cyanotoxins across the freshwater-to-marine continuum. These studies underscore the importance of inland waters as conduits for the transfer of cyanotoxins to the marine environment and highlight the importance of approaches that can monitor across hydrologically connected waterbodies. A HAB monitoring strategy is presented for the freshwater-to-marine continuum to inform HAB management and mitigation efforts and address the physical and hydrologic challenges encountered when monitoring in these systems. Three main recommendations are presented based on published studies, new datasets, and existing monitoring programs. First, HAB monitoring would benefit from coordinated and cohesive efforts across hydrologically interconnected waterbodies and across organizational and political boundaries and jurisdictions. Second, a combination of sampling modalities would provide the most effective monitoring for HAB toxin dynamics and transport across hydrologically connected waterbodies, from headwater sources to downstream receiving waterbodies. Third, routine monitoring is needed for toxin mixtures at the land-sea interface including algal toxins of marine origins as well as cyanotoxins that are sourced from inland freshwater or produced in estuaries. Case studies from California are presented to illustrate the implementation of these recommendations, but these recommendations can also be applied to inland states or regions where the downstream receiving waterbody is a freshwater lake, reservoir, or river. Integr Environ Assess Manag 2023;19:586-604. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Safety and Efficacy of Indomethacin for Reducing Chest Tube Duration After Coronary Artery Bypass Grafting Surgery.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) contain a boxed warning for use in coronary artery bypass graft (CABG) surgery due to increased risk of thrombotic events, but recent research has challenged the assumption that these risks are a class effect. One anecdotal indication for NSAIDs in CABG is reducing chest tube output. Objective: The primary objective of this retrospective study was to determine whether indomethacin was associated with reduced duration of chest tube insertion after CABG surgery, defined as total chest tube duration in controls versus duration of chest tube insertion after the first dose of indomethacin in the treatment group. Secondary objectives were comparisons of daily reductions in chest tube output volume, length of stay, and safety between groups. Methods: In this retrospective, single-center case-control review, adult patients who received indomethacin after CABG were matched 1:1 to control patients based on age, sex, concomitant valve surgery, and, when possible, diabetes status. Results: Thirty-two patients were included. The mean age was 56 years and 75% were men. The primary outcome measure was 94 hours among control patients and 82.8 hours among indomethacin patients (P = 0.041). Insignificant mean reductions in daily chest tube output were observed prior to and after indomethacin initiation (38.7 vs 87.7 mL/day, P > 0.05). Conclusion: In this small, single-center study, indomethacin appeared safe and possibly effective for reducing chest tube duration after CABG surgery. Future large, prospective, randomized studies should be conducted to confirm the results.

Assessing coprescription of opioids with central nervous system depressants for nonmalignant chronic musculoskeletal pain management in the outpatient setting.

OBJECTIVES: To determine annual prescribing trends of opioids and coprescription of central nervous system (CNS) depressants in nonmalignant chronic musculoskeletal pain from the National Ambulatory Medical Care Survey (NAMCS). To determine patient and provider characteristics associated with coprescription opioids and CNS depressants. DESIGN: The cross-sectional study analyzed NAMCS data from 2014 to 2016. Pain medications and CNS depressants were determined using Multum drug classification categories. All 30 medication entries were scanned in order to capture the maximum number of entries compared to previous studies. Multivariate logistic regressions were used to determine characteristics associated with opioid and CNS depressant coprescribing. PARTICIPANTS: Adults (18 years and older) with nonmalignant chronic musculoskeletal pain diagnosis based on ICD-9 codes were identified as the reason for visit. RESULTS: A total of 47,973,413 weighted visits with nonmalignant chronic musculoskeletal pain were reported in the US ambulatory setting from 2014 to 2016. Amongst these patients, 31 percent were on opioids, of which 26 percent were also prescribed benzodiazepines, 8 percent NBSH, and 22 percent gabapentinoids. The annual prescribing rate of opioids decreased significantly in 2016 compared to 2014 (OR: 0.63, 95 percent CI: 0.43-0.94). Polypharmacy and tobacco use were associated with higher odds of having opioids and concurrent opioid with CNS depressants. CONCLUSION: Our study results are in agreement with previous studies that found a steady decline in opioid prescribing even with the inclusion of all 30 medications in our study. Likewise, as previous studies have found, certain patient characteristics continue to be significant for receiving opioid and CNS depressant prescriptions.

Evaluating the Impact of Advanced Pharmacy Practice Experiences on Student Pharmacist Metacognition.

Objective. To assess factors impacting metacognition during the advanced pharmacy practice experience (APPE) year (final year of the Doctor of Pharmacy program) for student pharmacists at five different institutions.Methods. Student pharmacists completed a pre- and post-APPE year survey that collected data on demographics, curricular and co-curricular experiences, and the 19-item modified metacognition assessment inventory (MAI). Additionally, the post-APPE survey collected data on learning activities completed during the APPE year. Matched survey responses were analyzed to identify associations between change in MAI score and individual experiences.Results. One hundred thirty-nine matched responses were analyzed. A significant improvement in overall student pharmacist metacognition was seen in matched pre- vs post-APPEs surveys. Several significant, moderate to weak correlations were associated with a change in MAI score over the APPE year.Conclusion. The APPE year resulted in a significant change in student pharmacists' metacognition at five institutions. This improvement was multifactorial as individual factors had minimal association with the change in metacognition.

Effectiveness of Journal Club Activities Versus Clinical Debate Activities in Pharmacy Experiential Education.

Objective. Within pharmacy experiential education, practicing literature evaluation skills usually occurs via journal clubs. Clinical debates have gained traction as an engaging alternative to journal club meetings while completing advanced pharmacy practice experiences (APPEs). The purpose of this study was to compare clinical knowledge and literature evaluation application between journal clubs and clinical debates during APPEs.Methods. This mixed-methods prospective study was conducted in fourth year pharmacy students completing inpatient general medicine APPEs at four institutions. Students participated in a journal club and clinical debate during their experience. Students completed a 10-item knowledge assessment after each activity. Differences in journal club and clinical debate assessment scores were analyzed. Following completion of both activities, a perception survey was administered to gauge preferences and opinions. Differences in perception survey scores for journal clubs compared to clinical debates were evaluated quantitatively, and a thematic analysis was completed for qualitative responses.Results. Fifty students participated in both activities. There were no differences between journal club and clinical debate assessment scores (57.4%±21.0% and 62.9%±20.7%, respectively). Forty students completed the post-perceptions survey and globally agreed or strongly agreed that both journal clubs and clinical debates improved confidence in literature evaluation and clinical skills. Common themes identified included applicability to pharmacists' roles and need for clear instructions and examples.Conclusion. There was no significant difference between student performance on knowledge assessments of journal clubs and clinical debates, and students found both activities to be beneficial. Clinical debates are a reasonable alternative to journal clubs to improve pharmacy students' knowledge and literature evaluation skills.

Lessons learned pivoting to a virtual OSCE: Pharmacy faculty and student perspectives.

BACKGROUND AND PURPOSE: In-person Objective Structured Clinical Examinations (OSCEs) are used as assessments in most pharmacy programs, however, reports of virtual OSCEs and skills assessments are limited. With a pivot to virtual OSCEs necessitated by the COVID-19 pandemic, it is important to consider core competencies assessed as well as logistics, technology, and other factors. EDUCATIONAL ACTIVITY AND SETTING: The virtual redesign of a Capstone OSCE for third professional year pharmacy students at the beginning of the COVID-19 pandemic. FINDINGS: Core components of pivoting an in-person Capstone OSCE to virtual included an initial assessment of what was planned, what competencies were being assessed, and how this could be accomplished in the virtual realm. Key stakeholders such as students, testing and evaluation services, and faculty were included in the planning process. In addition to changes in OSCE delivery, grading processes and remediation were also modified. SUMMARY: This Capstone OSCE merged virtual education and skills-based assessments together out of necessity and provides an example of flexibility and nimbleness in times of great change. Although further assessment is needed, processes used and lessons learned are helpful for future, intentional planning of virtual or partially virtual skills assessments.

Safety and Efficacy of Apixaban Use in Peritoneal Dialysis: A Review of the Literature.

Objective: To review the safety and efficacy of apixaban for the treatment of nonvalvular atrial fibrillation or venous thromboembolism in patients receiving peritoneal dialysis (PD). Data Sources: A PubMed and MEDLINE search was conducted through December 2020 using the following keywords and Medical Subject Headings (MeSH) terms alone or in various combinations: apixaban, peritoneal dialysis, continuous ambulatory peritoneal dialysis, end-stage renal disease, and hemodialysis. Study Selection and Data Extraction: English-language studies evaluating clinical outcomes pertaining to the use of apixaban in end stage renal disease (ESRD), which included patients receiving peritoneal dialysis were eligible for inclusion. Data Synthesis: Four studies were identified that met inclusion for this review, all retrospective in nature. These studies compared the safety and efficacy of apixaban with standard therapy in ESRD included patients on dialysis, with a very limited number of subjects receiving PD. In these studies, apixaban was shown to be potentially safer and more effective than warfarin. Outcomes did not differentiate between patients receiving PD or not. Conclusions: Use of apixaban in patients receiving PD may be safe and effective based on data from limited patients. Pharmacokinetics and pharmacodynamics of apixaban in the PD setting is an important question that clinicians should consider with use of this medication in the ESRD population. More studies focusing on the PD population are needed to better assess the use of apixaban in this understudied population.

Persistent domoic acid in marine sediments and benthic infauna along the coast of Southern California.

Blooms of the diatom genus Pseudo-nitzschia occur annually in the Southern California Bight (SCB), and domoic acid (DA) associated with these events can contaminate fisheries, presenting both human and wildlife health risks. Recent studies have suggested that marine sediments may act as a reservoir for DA, extending the risk of food web contamination long after water column blooms have ended. In this study, we conducted a regional assessment of the extent and magnitude of DA in the benthic environment, and monthly observations of sediments and benthic infauna at multiple stations over a 16-month period. DA was widespread in continental shelf sediments of the SCB. The toxin was detected in 54% of all shelf habitats sampled. Detectable concentrations ranged from 0.11 ng/g to 1.36 ng/g. DA was consistently detected in benthic infauna tissues over the monthly timeseries, while the DA concentrations in sediments during the same period were commonly below detection or at low concentrations. The presence of DA in the benthic environment did not always have an apparent water column source, raising the possibility of lateral transport, retention/preservation in sediments or undetected blooms in subsurface waters. In most cases, DA was detected in tissues but not in the co-located surface sediments. Coarse taxonomic sorting of the infauna revealed that the accumulation of DA varied among taxa. We observed that DA was widespread among lower trophic level organisms in this study, potentially acting as a persistent source of DA to higher trophic levels in the benthos.

Synthesis of ecotoxicological studies on cyanotoxins in freshwater habitats - Evaluating the basis for developing thresholds protective of aquatic life in the United States.

In recent decades, cyanobacteria harmful algal blooms (cyanoHABs) have increased in magnitude, frequency, and duration in freshwater ecosystems. CyanoHABs can impact water quality by the production of potent toxins known as cyanotoxins. Environmental exposure to cyanotoxins has been associated with severe illnesses in humans, domestic animals, and wildlife. However, the effects of sustained exposure to cyanotoxins on aquatic life are poorly understood. In this study, over 150 peer-reviewed articles were critically evaluated to better understand the ecotoxicity of 5 cyanotoxin classes (microcystins, cylindrospermopsin, anatoxin-a, saxitoxins, nodularin) on fish, amphibians, aquatic invertebrates, and birds exclusively feeding in freshwater habitats. The systemic review demonstrated that microcystins, and more specifically microcystin-LR, were the most studied cyanotoxins. Ecotoxicological investigations were typically conducted using a fish or aquatic invertebrate model, with mortality, bioaccumulation, and biochemical responses as the most frequently measured endpoints. After excluding the studies that did not meet our acceptability criteria, remaining studies were examined to identify the no-observed and lowest observed effect concentrations (NOEC and LOEC) for microcystins; the limited amount of data for other cyanotoxins did not allow for analysis. The published ecotoxicity data suggests that the U.S. EPA recreational water quality criteria for microcystin (8 µg/L) may be protective of acute toxicity in aquatic organisms but does not appear to protect against chronic toxicity. Individual U.S. states have developed more stringent recreational health-based thresholds, such as 0.8 µg/L in California. Comparisons of this threshold to the chronic NOEC and LOEC data indicate that more restrictive microcystins thresholds may be required to be protective of aquatic life. Additional research is needed to evaluate the sublethal effects of a wider array of microcystin congeners and other cyanotoxins on organisms relevant to U.S. watersheds to better support nationwide thresholds protective of aquatic life.

The tide turns: Episodic and localized cross-contamination of a California coastline with cyanotoxins.

The contamination of coastal ecosystems from a variety of toxins of marine algal origin is a common and well-documented situation along the coasts of the United States and globally. The occurrence of toxins originating from cyanobacteria along marine coastlines is much less studied, and little information exists on whether toxins from marine and freshwater sources co-occur regularly. The current study focused on the discharge of cyanotoxins from a coastal lagoon (Santa Clara River Estuary) as a consequence of an extreme tide event (King Tides; December 3-5, 2017) resulting in a breach of the berm separating the lagoon from the ocean. Monthly monitoring in the lagoon throughout 2017 documented more than a dozen co-occurring cyanobacterial genera, as well as multiple algal and cyanobacterial toxins. Biotoxin monitoring before and following the King Tide event using Solid Phase Adsorption Toxin Tracking (SPATT) in the lagoon and along the coast revealed the co-occurrence of microcystins, anatoxin, domoic acid, and other toxins on multiple dates and locations. Domoic acid was ubiquitously present in SPATT deployed in the lagoon and along the coast. Microcystins were also commonly detected in both locations, although the beach berm retained the lagoonal water for much of the year. Mussels collected along the coast contained microcystins in approximately half the samples, particularly following the King Tide event. Anatoxin was observed in SPATT only in late December, following the breach of the berm. Our findings indicate both episodic and persistent occurrence of both cyanotoxins and marine toxins may commonly contaminate coastlines in proximity to cyanobacteria-laden creeks and lagoons.

Multiple co-occurring and persistently detected cyanotoxins and associated cyanobacteria in adjacent California lakes.

The global proliferation of toxin producing cyanobacterial blooms has been attributed to a wide variety of environmental factors with nutrient pollution, increased temperatures, and drought being three of the most significant. The current study is the first formal assessment of cyanotoxins in two impaired lakes, Canyon Lake and Lake Elsinore, in southern California that have a history of cyanobacterial blooms producing high biomass as measured by chl-a. Cyanotoxins in Lake Elsinore were detected at concentrations that persistently exceeded California recreational health thresholds, whereas Canyon Lake experienced persistent concentrations that only occasionally exceeded health thresholds. The study results are the highest recorded concentrations of microcystins, anatoxin-a, and cylindrospermopsin detected in southern California lakes. Concentrations exceeded health thresholds that caused both lakes to be closed for recreational activities. Cyanobacterial identifications indicated a high risk for the presence of potentially toxic genera and agreed with the cyanotoxin results that indicated frequent detection of multiple cyanotoxins simultaneously. A statistically significant correlation was observed between chlorophyll-a (chl-a) and microcystin concentrations for Lake Elsinore but not Canyon Lake, and chl-a was not a good indicator of cylindrospermopsin, anatoxin-a, or nodularin. Therefore, chl-a was not a viable screening indicator of cyanotoxin risk in these lakes. The study results indicate potential acute and chronic risk of exposure to cyanotoxins in these lakes and supports the need for future monitoring efforts to help minimize human and domestic pet exposure and to better understand potential effects to wildlife. The frequent co-occurrence of complex cyanotoxin mixtures further complicates the risk assessment process for these lakes given uncertainty in the toxicology of mixtures.

A Review of Development Initiatives for Pharmacy Student and Resident Preceptors.

Objective. To review the published literature describing and evaluating pharmacy student and resident preceptor development. Findings. Database searches yielded 32 published articles on pharmacy preceptor development: 22 for experiential preceptors, eight for resident preceptors, and two encompassing both experiential and resident preceptors. The identified articles covered a variety of preceptor development strategies, including live, web-based, and multifaceted approaches, which were disseminated via analytical studies, needs assessment surveys, and descriptive reports. In analytical studies, the evaluation methods most commonly used were preceptor pre- and post-perception surveys. Summary. Preceptor development strategies vary among pharmacy schools and residency programs. The evaluation methods used also varied, and there is a lack of evidence-based practices related to preceptor development. Preceptor development should be tailored based on preceptor type and program needs. An opportunity exists to further evaluate which strategies are most effective for improving precepting techniques, with an ultimate goal of delineating best practices for pharmacy preceptor development.

A Systematic Review and Meta-Analysis of Metolazone Compared to Chlorothiazide for Treatment of Acute Decompensated Heart Failure.

Treatment of volume overload in the setting of acute decompensated heart failure (ADHF) is typically achieved through the use of loop diuretics. While they are highly effective, some patients may develop loop diuretic resistance. One strategy to overcome this scenario includes sequential nephron blockade with a thiazide-type diuretic; however, it is unknown which thiazide-type diuretic used in this setting is most effective. A systematic review and meta-analysis were performed to compare the efficacy and safety of chlorothiazide with metolazone as add-on therapy in the setting of loop diuretic resistance for the treatment of ADHF. Literature searches were conducted through PubMed, Google Scholar, and Science Direct from inception through February 2020 using the following search terms alone or in combination: metolazone, chlorothiazide, acute decompensated heart failure, loop diuretic, and urine output. All English-language prospective and retrospective trials and abstracts comparing metolazone to chlorothiazide for the treatment of ADHF were evaluated. Studies were included if they analyzed urine output for at least 24 hours in patients with ADHF. Meta-analysis was conducted to evaluate pooled effect size by using a random-effect model. Primary outcomes included net and total urine output. Secondary outcomes included commonly reported safety outcomes. Four studies comparing the use of metolazone to chlorothiazide as an adjunct to loop diuretics to treat ADHF were included in the evaluation. Metolazone was as effective as chlorothiazide to augment loop diuretic therapy in ADHF in most studies with no pooled difference in net or total urine output. However, there were notable differences in baseline loop diuretic dosing, ejection fraction, renal function, race, and endpoint timing across studies. Adverse effects were commonly observed and included electrolyte abnormalities, change in renal function, and hypotension but were comparable between groups. Metolazone is as effective as chlorothiazide as add-on to loop diuretics in treating ADHF without an increase in safety concerns.

Statin Effects on Incidence, Treatment Success, and Mortality of Clostridium difficile Infections.

PURPOSE: To review the effects of statin use in patients at risk for or diagnosed with Clostridium difficile infection (CDI) on CDI incidence, treatment success, and mortality. METHODS: A literature search was performed through January 2019 using the following terms: statins, HMG-CoA inhibitors, Clostridium difficile, Clostridium difficile associated diarrhea, and Clostridium difficile infection. Additional references were identified from a review of literature citations. Studies evaluating statin effects on C difficile-related outcomes were included. RESULTS: A total of 8 studies were identified for inclusion in this review. All studies were retrospective. Five studies reported the association between statin use and the development of CDI, suggesting that statins may decrease risk of CDI development in patients already on statin. In one study, there was an improved treatment response against CDI with the use of statin. Three retrospective studies evaluated statin use and mortality from CDI and only one study found significant mortality benefit in statin users. CONCLUSIONS: Statin use may have a protective effect against the development of CDI and improve CDI treatment success; however, it is unclear if use confers a mortality benefit. Current data remain sparse and larger, prospective studies are needed to confirm current results and identify the specific population that may benefit the most from this intervention.

A systematic approach to team creation and peer evaluation in a large classroom setting.

INTRODUCTION: There is limited data to support a particular method for optimal team creation in pharmacy education. We aimed to implement and evaluate a systematic approach to team creation and compare the impact on team dynamics to teams created via random selection. METHODS: Two concurrent courses were used to assess team creation methods. Student-specific variables were used for team creation in one course while another course utilized teams created via random allocation. Each course conducted similar peer evaluations to provide feedback and assess team dynamics. A matched pre- and post-course survey assessed changes in student perceptions of team creation and peer evaluation. Student-perceived team effectiveness and individual coursework performance were assessed. RESULTS: A total of 109 students were enrolled in each of the two courses, with 98% and 93% providing evaluation of team dynamics within the intervention and control methods, respectively. Students perceived better team effectiveness in intervention-created groups in relation to decreased task (p < 0.01), relationship (p < 0.01), and process conflict (p < 0.01), along with increased task attraction (p < 0.01). There was no significant difference in student performance on individual examinations team creation methods (p = 0.17). CONCLUSIONS: A systematic approach to team creation improved student-perceived team dynamics with no significant impact on coursework scores. A systematic approach to team creation via a web-based platform is feasible in a large classroom setting and may provide an avenue for assessment approaches related to teamwork and team dynamics.

Direct Oral Anticoagulants in Chronic Liver Disease.

Objective: To review the use of direct oral anticoagulants (DOACs) in patients with chronic liver disease (CLD). Data Sources: A MEDLINE literature search was performed from 1964 through February 2019 using the following search terms: cirrhosis, chronic liver disease, direct oral anticoagulant, and the individual DOACs. Study Selection and Data Extraction: All English-language human trials and reports that examined DOACs for treatment or prevention of venous thromboembolic (VTE) events in patients with CLD were included. Data Synthesis: A total of 6 clinical trials examining the use of DOACs in patients with CLD were identified. All DOACs have been utilized in patients with CLD, with the exception of betrixaban, for prevention of stroke in atrial fibrillation or treatment of VTE (except for treatment of pulmonary embolism). The studies primarily evaluated patients with mild to moderate liver disease (Child-Turcotte-Pugh class A and B). The DOACs had similar rates of bleeding compared with traditional anticoagulants. Relevance to Patient Care and Clinical Practice: This review evaluates and summarizes the available evidence on DOACs in the setting of CLD. These agents may be more appealing in this population because monitoring or administration may be difficult with traditional anticoagulants (warfarin or low-molecular-weight heparins). Conclusion: Early data suggest that DOACs may be safe in patients with mild to moderate CLD. Should a DOAC be selected as an alternative to traditional anticoagulants, more frequent monitoring should be used because hepatotoxicity may be a concern. Larger clinical trials are needed to address efficacy outcomes as well as differences among individual DOACs in this population.

Pharmacy educator evaluation of web-based learning.

BACKGROUND: Web-based learning (WBL), instruction facilitated through the Internet, has demonstrated utility in classroom and clinical education settings; however, there is a void of literature about the use of WBL by clinical educators within pharmacy. The purpose of this research is to evaluate a WBL initiative within clinical pharmacy education. METHODS: Based on the results of a pilot survey, 10 asynchronous WBL clinical modules (videos and interactive patient cases) were developed for pharmacy educators and students in clinical education affiliated with two schools of pharmacy in the midwest USA. A 21-item, cross-sectional, electronic survey was administered to pharmacy educators within acute and primary care to assess the use of WBL within clinical pharmacy education. RESULTS: Of the 115 eligible clinical educators, 69 participated in the survey (60% response rate), with the majority working within acute care; 38% of educators encouraged the use of WBL. Respondents not using WBL stated a lack of awareness (48%) or existing student time commitments (33%) as reasons. For educators encouraging WBL, 87% agreed that it enhanced student clinical knowledge, 68% stated that it decreased direct instruction time commitments and 100% stated they would encourage its use for future clinical education. CONCLUSIONS: Clinical pharmacy educators reported that the WBL initiative resulted in a perceived stronger student clinical foundation, and all pharmacy educators using WBL encouraged its continued use for future clinical education. Web-based learning provides clinical educators with a learning tool to augment clinical experiences by reinforcing student knowledge, at the same time minimising direct instruction time.

Efficacy and Safety of Appetite-Stimulating Medications in the Inpatient Setting.

BACKGROUND: Hospitalized patients are subject to acute illness and stress which may impact appetite or weight. Loss of appetite may lead to increased morbidity or mortality. Medications such as dronabinol, megestrol, and mirtazapine are used for weight gain in the outpatient setting; however, there is limited information about safety or effectiveness when initiated inpatient. OBJECTIVES: To analyze the effectiveness and safety of appetite-stimulating medications in hospitalized patients. METHODS: This was a retrospective cohort study of hospitalized patients initiated on dronabinol, megestrol, or mirtazapine for appetite. The primary outcome was change in meal intake between drug initiation and discontinuation. Secondary outcomes included documented improvement in appetite, change in weight and various laboratory parameters, and incidence of adverse effects. RESULTS: A total of 38 patients met inclusion criteria, and mirtazapine was most commonly used (42%). There was no significant difference between groups of appetite-stimulating medications with regard to mean change in meal intake, weight, albumin, or documented improvement in diet. Within groups, each agent showed numerical improvement in percentage meal intake, with a mean change from initiation to discontinuation of 17.12%. Almost half (48%) of the patients experienced improvement in diet after the start of medications. No serious adverse effects were observed. Conclusion and Relevance: In inpatients, there was no difference in change in meal intake or weight between dronabinol, megestrol, or mirtazapine, but they may show numerical improvements in meal intake. To our knowledge, this is the first study to evaluate the use of dronabinol, megestrol, and mirtazapine initiated in the inpatient setting.