Processes and Metrics to Evaluate Faculty Practice Activities at US Schools of Pharmacy.

Objective. To determine what processes and metrics are employed to measure and evaluate pharmacy practice faculty members at colleges and schools of pharmacy in the United States. Methods. A 23-item web-based questionnaire was distributed to pharmacy practice department chairs at schools of pharmacy fully accredited by the Accreditation Council for Pharmacy Education (ACPE) (n=114). Results. Ninety-three pharmacy practice chairs or designees from 92 institutions responded. Seventy-six percent reported that more than 60% of the department's faculty members were engaged in practice-related activities at least eight hours per week. Fewer than half (47%) had written policies and procedures for conducting practice evaluations. Institutions commonly collected data regarding committee service at practice sites, community service events, educational programs, and number of hours engaged in practice-related activities; however, only 24% used a tool to longitudinally collect practice-related data. Publicly funded institutions were more likely than private schools to have written procedures. Conclusion. Data collection tools and best practice recommendations for conducting faculty practice evaluations are needed.

A collaboration among health sciences schools to enhance faculty development in teaching.

Those involved in providing faculty development may be among only a few individuals for whom faculty development is an interest and priority within their work setting. Furthermore, funding to support faculty development is limited. In 2010, an interprofessional, self-formed, faculty learning community on faculty development in teaching was established to promote collaboration on faculty development initiatives that have transference to faculty members across disciplines and to share expertise and resources for wider impact. The organic structure and processes of the faculty learning community created an environment that has not only resulted in an increased offering of faculty development opportunities and resources across the health science campus, but has created a rich environment that combines the knowledge, innovation, and experience to promote collaborative efforts that benefit all. The background, structure, processes, successes, and lessons learned of the interprofessional faculty learning community on faculty development in teaching are described.

Best practices for implementing team-based learning in pharmacy education.

Colleges and schools of pharmacy are incorporating more team-based learning (TBL) into their curriculum. Published resources are available to assist instructors with implementing TBL and describing it in the health professions literature. The 7 core elements include: team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the 4 "S" structure for developing team application exercises (significant problem, same problem, specific answer choice, simultaneous reporting), incentive structure, and peer evaluation. This paper summarizes best practices related to implementation of TBL in pharmacy education, including courses taught using teaching teams.

New therapeutic options for the management of diabetes.

OBJECTIVE: To review new hypoglycemic and antihyperglycemic agents recently approved for the treatment of type 1 and type 2 diabetes mellitus. DATA SOURCES: A MEDLINE search of articles published from 1966 to March 2006 was conducted to identify English-language literature available on the newer therapies approved for the treatment of diabetes. Search terms used were: Byetta, exenatide, insulin detemir, NN304, Exubera inhaled insulin, Levemir, pramlintide, Symlin, AC137, AC0137, and Tripro-Amylin. These articles, abstracts, and data provided by the pharmaceutical manufacturers were reviewed to identify pertinent data. Additional references were obtained from the bibliographies of these publications. STUDY SELECTION: Randomized, English-language studies investigating safety or efficacy data on these newer agents with a focus on human studies. DATA EXTRACTION: These hypoglycemic and antihyperglycemic agents were reviewed with regard to background information, pharmacokinetic and pharmacodynamic data, relevant clinical studies, U.S. Food and Drug Administration-approved indications, dosing and administration, contraindications, drug interactions, adverse effects, storage, cost, availability, and role in therapy. DATA SYNTHESIS: Over the last decade, management options for the treatment of diabetes have exploded. Among these are the incretin mimetics, amylin analogs, insulin analogs, and inhaled insulin. Short-term studies demonstrate that each of these therapies may offer specific advantages such as improved glycemia, convenience, and/or weight loss. Continued study of the incretin mimetics, amylin analogs, and inhaled insulin will be needed to verify long-term safety and efficacy of these agents. CONCLUSIONS: These agents with novel mechanisms of action and a new insulin-delivery device offer patients and clinicians additional options that improve glycemic and nonglycemic factors while addressing some of the concerns of older agents. Longer term studies will help providers weigh the benefits, adverse effects, cost, and unknown long-term risks of these medications.

Development of a competency-based assessment process for advanced pharmacy practice experiences.

OBJECTIVES: To develop and implement a competency-based assessment process for the experiential component of a pharmacy education curriculum. DESIGN: A consultative process was used in the development of new assessment forms and policies, and a survey regarding student and faculty satisfaction was conducted. Information received from the survey and from consultations with faculty preceptors resulted in revision of the forms in subsequent years. ASSESSMENT: Faculty and student perceptions of the assessment process were generally positive. We were moderately successful in reducing grade inflation. The new process also provides the school with data that can be used to evaluate the effectiveness of our curriculum in preparing students for practice. CONCLUSIONS: Development and implementation of a competency-based assessment process require a considerable amount of work from dedicated faculty members. With health professions schools under pressure to provide evidence of their graduates' clinical competence, this is a worthwhile investment.

Nonhormonal alternatives for the treatment of hot flashes.

OBJECTIVE: To review the literature on clonidine, venlafaxine, selective serotonin reuptake inhibitors, and gabapentin for the treatment of hot flashes. DATA SOURCES: A MEDLINE search (January 1966-July 2003) was conducted to identify English-language literature available on the treatment of hot flashes that focused on clonidine, venlafaxine, selective serotonin reuptake inhibitors, and gabapentin. These articles, relevant abstracts, and additional references listed in articles were used to collect pertinent data. STUDY SELECTION: All controlled and uncontrolled trials were reviewed. DATA SYNTHESIS: In women unable or unwilling to take hormonal therapies, several nonhormonal alternatives have been evaluated in small controlled and uncontrolled trials. Oral and transdermal formulations of clonidine are moderately effective in reducing hot flashes. Results of studies evaluating venlafaxine, paroxetine, and gabapentin suggest greater reductions in hot-flash frequency and severity compared with those of clonidine. Fluoxetine appears to display a modest benefit compared with paroxetine, although no comparative trials have been conducted. Most women studied in these trials had a history of breast cancer, and many were taking concurrent tamoxifen. All of these agents were fairly well tolerated. CONCLUSIONS: Clonidine, venlafaxine, paroxetine, fluoxetine, and gabapentin are nonhormonal agents that have demonstrated efficacy in small controlled and uncontrolled trials in reducing hot flashes and should be considered in patients unwilling or unable to take hormonal therapies.

Should postmenopausal hormone therapy be used to prevent osteoporosis?

OBJECTIVE: To discuss the risks and benefits of hormone therapy for the prevention of postmenopausal osteoporosis. DATA SOURCES: A MEDLINE search was conducted to identify articles that are pertinent to the risks and benefits of hormone therapy for the prevention of postmenopausal osteoporosis. Additional references were obtained from the bibliographies of these articles. STUDY SELECTION: Human studies that present efficacy and safety data for the effects of postmenopausal hormone therapy. DATA EXTRACTION: Analysis of studies to determine the benefits of hormone therapy on bone (in terms of bone mineral density or fracture risk) and risks of hormone therapy in postmenopausal women. DATA SYNTHESIS: Studies were analyzed to determine the risk-benefit profile of hormone therapy for the prevention of postmenopausal osteoporosis. This information was synthesized to help practitioners make decisions regarding the role of postmenopausal hormone therapy in the prevention of osteoporosis. CONCLUSION: Given the risks of hormone therapy, some of which are associated with increased duration of use, hormone therapy cannot be routinely recommended for the sole purpose of preventing osteoporosis. Many alternative therapies exist that may offer patients a better benefit versus risk ratio.

Ortho Evra, a new contraceptive patch.

Ortho Evra is the first transdermal patch approved for the prevention of pregnancy. Comparative trials have shown that Ortho Evra has efficacy similar to the oral contraceptives Mercilon (not available in the United States) and Triphasil for the prevention of pregnancy when used as directed. Adverse effects with Ortho Evra are similar to those reported with combined oral contraceptives, with the exceptions of mild-to-moderate application-site reactions and an increased frequency of breast symptoms. The most commonly reported adverse reactions were breast symptoms, headache, application-site reactions, nausea and vomiting, dysmenorrhea, and abdominal pain. Approximately 5% of study subjects had at least one patch that did not stay attached to their skin, and about 2% of women withdrew from clinical trials due to irritation from the patch. In clinical studies, the patch appeared to be less effective in women weighing more than 90 kg than in women with lower body weights. More research is needed on the relationship between body weight and contraceptive patch efficacy. In two clinical trials, compliance was greater with the patch than with oral contraceptives. Whether this will result in reduced pregnancy rates in general use is unknown. Additional studies are warranted to determine if the patch offers any significant efficacy or safety advantages over current methods of hormonal contraception.

Newer insulin therapies for management of type 1 and type 2 diabetes mellitus.

OBJECTIVE: To provide an overview of type 1 and type 2 diabetes mellitus and review newer insulin therapies used to manage patients with diabetes. DATA SOURCES: A MEDLINE search covering articles published from 1985 to March 2003 was conducted to identify English-language literature available on the management of diabetes, specifically focusing on the newer insulin products insulin glargine and insulin aspart, and any other novel insulin therapies (Medical Subject Headings [MeSH] search terms used were: diabetes, insulin, insulin aspart, insulin glargine, inhaled insulin, intranasal insulin, oral insulin). These articles, abstracts, and data provided by the pharmaceutical manufacturers were reviewed to collect pertinent data. Additional references were obtained from the bibliographies of those publications. STUDY SELECTION: Human studies presenting safety or efficacy information on newer insulin formulations. DATA EXTRACTION: Specific insulin formulations were reviewed with regard to background information, pharmacokinetic data, relevant clinical studies, U.S. Food and Drug Administration-approved indications, dosing and administration, adverse effects, storage, cost, and role in therapy. DATA SYNTHESIS: Insulin therapy is essential in the management of patients with type 1 diabetes, as well as in many patients with type 2 diabetes. No single insulin product currently on the U.S. market mimics natural endogenous insulin secretion. Problems encountered with traditional insulin products include variable absorption, peaks leading to hypoglycemic events, troughs leading to inadequate duration of response, and difficulty accurately timing injections in relation to meals. Insulin analogs such as insulin glargine and insulin aspart have been synthesized in an effort to overcome those difficulties. Novel insulin formulations (oral, intranasal, and inhaled) are also in various stages of investigation. CONCLUSION: Insulin glargine and insulin aspart are two of the newest insulin products approved for managing diabetes mellitus. Clinical trials have shown that these agents may offer certain clinical benefits and conveniences for patients. These advantages, however, must be weighed against the increased cost of insulin glargine and insulin aspart relative to traditional insulins.