Human papillomavirus vaccine and cervical cancer prevention: practice and policy implications for pharmacists.

OBJECTIVES: To review the epidemiology and natural history of human papillomavirus (HPV), summarize relevant clinical trials of the prophylactic HPV vaccines, and describe the practice and policy implications that HPV vaccine represents for pharmacists. DATA SOURCES: Search of Medline through June 2007 using keywords human papillomavirus vaccine, Gardasil, and Cervarix; meeting abstracts; bibliographies from selected articles; and National Institutes of Health clinical trials registry. STUDY SELECTION: English language review articles, clinical trials, and published abstracts were considered for inclusion. DATA SYNTHESIS: HPV is a sexually transmitted infection that is necessary for the development of cervical cancer, and types 16 and 18 are associated with 70% of cases of invasive cervical cancer worldwide. A quadrivalent prophylactic vaccine against HPV-6, -11, -16, and -18 is currently available, and a bivalent vaccine targeting HPV-16 and -18 is under review by the Food and Drug Administration. Both are highly effective at preventing persistent HPV infection and precancerous lesions caused by vaccine-specific HPV. HPV vaccine is currently indicated for girls aged 9 to 26 years, but ongoing trials are evaluating the efficacy in other populations. Implementation of a vaccine administration program is an area of opportunity for new policies to include pharmacists in the administration of prophylactic HPV vaccines. Pharmacists are allowed to administer vaccinations in 46 states and can potentially play a role in HPV vaccine administration. For this to happen, however, multiple legal and regulatory changes must occur. CONCLUSION: Prophylactic HPV vaccines safely and effectively prevent HPV infection and precancerous lesions in the cervix. The availability of these vaccines also create new clinical opportunities for community pharmacists, provided needed legal, regulatory, and policy changes are made.

Prophylaxis for opioid-induced constipation in elderly long-term care residents: a cross-sectional study of Medicare beneficiaries.

BACKGROUND: Opioid analgesics are effective therapeutic agents for malignant and nonmalignant pain, but their use is often compromised by unwanted adverse effects on the central nervous system and gastrointestinal (GI) tract. These adverse effects include sedation, respiratory depression, nausea and vomiting, reduction in biliary and pancreatic secretions, decreased GI motility, increased GI transit time, and subsequent constipation. OBJECTIVE: The goal of this study was to determine national estimates of laxative use, with and without concurrent opioids, in the long-term care (LTC) population and to determine factors associated with laxative underuse among elderly LTC residents receiving opioids. METHODS: This cross-sectional study was conducted in LTC facilities in the United States. Medicare beneficiaries participating in the Medicare Current Beneficiary Survey (MCBS) aged >or=65 years residing at least 1 month in a nursing home or assisted living facility in 2001 were considered eligible. Monthly and annual measures of laxative and opioid use were developed to estimate prevalence of drug use in the LTC population. Multivariable logistic regression was used to determine factors associated with the use of laxatives. RESULTS: Among our sample of 867 MCBS beneficiaries (mean [SD]age, 85.0 [7.7] years), 281 (32%) received at least 1 opioid at some time during 2001. Of these 281 patients, 186 (66%) were administered at least 1 laxative at any time of the year. We found that the mean monthly prevalence of concurrent opioid and laxative use was 55% (476/867). There was a low prevalence of as-needed laxative and opioid use; 96% of resident-months were identified as scheduled bowel regimen administrations, and 89% of resident-months with opioid use had >or=3 opioid administrations. The results of the multivariable analysis showed that white, female, and currently married patients spend 227% (P < 0.007), 52% (p < 0.008), and 39% (P < 0.02), respectively, more months with at least 1 administration of a laxative and an opioid than their counterpart nonwhite, male, unmarried patients, Comorbidities were not associated with laxative prophylaxis. CONCLUSION: Although laxatives are widely recommended in patients taking opioids, only 66% of elderly LTC residents in this study received this standard of care.

A primer for objective structured teaching exercises.

The objective structured teaching exercise (OSTE) is a high-fidelity training method for advancing the teaching and interpersonal communication skills of faculty members and preceptors. This paper is a primer for implementation of OSTEs as part of a comprehensive faculty development program. This primer addresses teaching and precepting skills that can be most effectively enhanced and assessed by the OSTE method. Development of case scenarios, recruitment and training of standardized students, OSTE session implementation processes, and OSTE evaluation methods are discussed. The experience of the authors as well as recommendations from a review of the literature and discussions with educators with OSTE experience are included.

Prevalence of and factors that influence board certification among pharmacy practice faculty at United States colleges and schools of pharmacy.

Board certification is a means of demonstrating expertise above the minimum licensing standards. For many health care professionals, this credential is a necessity. As pharmacists become involved in more advanced patient care services, board certification becomes an essential component to ensuring quality care. The prevalence of United States pharmacy practice faculty members who are board certified, however, is unknown. In addition, to our knowledge, factors that serve to motivate or discourage faculty from obtaining board certification have not been previously described; thus, 900 pharmacy practice faculty members listed in the American Association of Colleges of Pharmacy (AACP) online directory were invited to complete an online survey regarding motivators and barriers for board certification. In addition, a list of board-certified pharmacists, obtained from the Board of Pharmacy Specialties, was used to check the board certification status of all pharmacy practice faculty members listed in the AACP directory. In 2011, the prevalence of board certification among the 2867 pharmacy practice faculty members was 37% (1063 pharmacists), with the highest prevalence found among assistant professors (39.4%). A total of 322 faculty members (36% response rate) completed the survey; of these, 308 self-identified as pharmacy practice faculty, and their responses were included in the analysis. Current board certification in pharmacy specialties was reported by 163 respondents (52.9%); 14 (4.5%) were previously certified. Among the 308 respondents, the most common perceived reason why pharmacy practice faculty become board certified was the desire to be recognized as an expert in the field (71.5%). Those who were currently board certified indicated personal growth as the most important reason (60.1%). Those previously certified indicated no perceived benefit as the most common reason for not recertifying (71.4%). Among those never certified, no perceived need (52.0%) or benefit (44.8%) were the most common reasons for not becoming certified; however, a majority of those never certified (68%) stated that they would become board certified if there was no associated cost and they were confident they would pass. To increase the prevalence of board certification in pharmacy practice faculty at U.S. schools and colleges of pharmacy, the benefits of this credential must be addressed at each institution. Steps should be taken to assist and encourage board certification.

Readiness for self-directed learning and academic performance in an abilities laboratory course.

OBJECTIVE: To assess the relationship between readiness for self-directed learning, academic performance on self-directed learning activities, and resources used to prepare for an abilities laboratory course. METHODS: The Self-directed Learning Readiness Scale (SDLRS) was administered to first-year (P1) doctor of pharmacy (PharmD) candidates at the University of Maryland. Additional data collected included final course grades, quiz scores, resources used to prepare for laboratory activities, and demographics. RESULTS: The mean SDLRS score was 148.6 ± 13.8. Sixty-eight students (44%) scored > 150, indicating a high readiness for self-directed learning. These students were more likely to complete assignments before the laboratory, meet in study groups, and report postgraduation plans to enter noncommunity pharmacy. No significant association was found between academic performance and the SDLRS. CONCLUSIONS: Readiness for self-directed learning is associated with self-directed learning habits, but may not be necessary for learning foundational knowledge, provided students are given specific instructions on what to study. Whether high readiness for self-directed learning is necessary for more complex learning or for self-identification of learning needs is unknown.

Objective structured clinical examinations in doctor of pharmacy programs in the United States.

OBJECTIVES: To describe current objective structured clinical examination (OSCE) practices in doctor of pharmacy (PharmD) programs in the United States. METHODS: Structured interviews were conducted with PharmD faculty members between September 2008 and May 2010 to collect information about awareness of and interest in OSCE, current OSCE practices, and barriers to OSCEs. RESULTS: Of 108 US colleges and schools of pharmacy identified, interviews were completed for a representative sample of 88 programs (81.5% participation rate). Thirty-two pharmacy programs reported using OSCEs; however, practices within these programs varied. Eleven of the programs consistently administered examinations of 3 or more stations, required all students to complete the same scenario(s), and had processes in place to ensure consistency of standardized patients' role portrayal. Of the 55 programs not using OSCEs, approximately half were interested in using the technique. Common barriers to OSCE implementation or expansion were cost and faculty members' workloads. CONCLUSIONS: There is wide interest in using OSCEs within pharmacy education. However, few colleges and schools of pharmacy conduct OSCEs in an optimal manner, and most do not adhere to best practices in OSCE construction and administration.

Scoring objective structured clinical examinations using video monitors or video recordings.

OBJECTIVE: To compare scoring methods for objective structured clinical examinations (OSCEs) using real-time observations via video monitors and observation of videotapes. METHODS: Second- (P2) and third-year (P3) doctor of pharmacy (PharmD) students completed 3-station OSCEs. Sixty encounters, 30 from each PharmD class, were selected at random, and scored by faculty investigators observing video monitors in real-time. One month later, the encounters were scored by investigators using videotapes. RESULTS: Intra-rater reliability between real-time and videotaped observation was excellent (ICC 3,1 of 0.951 for P2 students and 0.868 for P3 students). However, 13.3% of students' performance in both P2 and P3 cohorts changed in pass/fail determination from passing based on real-time observation to failing based on video observation, and 3.3% of students changed from failing real-time to passing on video. CONCLUSIONS: Despite excellent overall reliability, important differences in OSCE pass/fail determinations were found between real-time and video observations. These observation methods for scoring OSCEs are not interchangeable.

The impact of advanced pharmacy practice experiences on students' readiness for self-directed learning.

OBJECTIVE: To evaluate the impact of advanced pharmacy practice experiences (APPEs) on doctor of pharmacy (PharmD) students' readiness for self-directed learning. METHODS: The Self-Directed Learning Readiness Scale (SDLRS) was administered to students prior to and after completing their APPEs. SDLRS is a validated instrument that determines the relative degree to which students have the attitudes and motivation to engage in self-directed learning. RESULTS: Seventy-seven (64%) students completed the SDLRS prior to starting their APPEs and 80 (67%) students completed the instrument after completing their APPEs. Forty-six (38%) students completed both. Prior to starting their APPEs, 74% of students scored greater than 150 on the SDLRS, indicating a high level of readiness for self-directed learning. No significant difference was found between the mean scores of students who took the SDLRS both prior to (159 +/- 20) and after completing their APPEs (159 +/- 24; p > 0.05). CONCLUSION: Students at our institution appear to be ready for self-directed learning but APPEs had a minimal impact on their readiness for self-directed learning.