Work-Family Conflict and Wellbeing in US Pharmacy Faculty with Children

OBJECTIVE

Objectives of this study included characterization of the current landscape of work-family conflict (WFC), family-work conflict (FWC), wellbeing, and childcare-related factors in United States (US) pharmacy faculty members with children, as well as relationship determination between faculty characteristics and WFC, FWC, and wellbeing indices.

METHODS

A survey was developed and administered to US pharmacy faculty members with children in February 2022. Questions included demographic and childcare-related factors and the validated Netemeyer WFC and FWC scales, and World Health Organization (WHO-5) Wellbeing Index. Data were summarized using descriptive statistics, one-way analysis of variance and t tests, and multiple linear regression analysis.

RESULTS

The survey was completed by 368 faculty members with children. Respondents were primarily married females who identify as White or European American, with>90% having children less than 18 years of age. Respondents scored an average of 24.1 ± 7.2 points on the WFC scale, 19.5 ± 7.5 points on the FWC scale, and 56.8 ± 17.5 on the WHO-5 Wellbeing Index. Having dependent children resulted in statistically significantly higher WFC and FWC and lower wellbeing scores. Linear regression models for WFC, FWC, and wellbeing explained 20%, 8%, and 9% of the variability in scores, respectively.

CONCLUSION

This study identified the presence of WFC, FWC, and decreased wellbeing in pharmacy faculty members with children. Future research is needed to further qualify contributors to the indices and place findings into a larger context.

A Four-day Pharmacy Course Schedule

OBJECTIVE

To discuss the results of implementing a 4-day student didactic course schedule.

METHODS

The change from a 5-day to a 4-day course schedule was implemented in spring 2021. Students in the classes of 2023 and 2024 and faculty course coordinators were surveyed in fall 2021 regarding their experience with the new schedule format. Baseline data from fall 2020 were also collected for comparison. Quantitative data was described using frequencies, percentages, odds ratios, and 95% confidence intervals. Open-ended questions were evaluated using qualitative thematic analysis.

RESULTS

Almost all students (n = 193, 97%) who responded to the course planning survey in fall 2021 wanted to continue the 4-day course schedule. Students perceived the benefits of the 4-day schedule, to include more time for studying/preparing for classes (69%), and for self-care and wellness activities (20%). Student survey responses showed increased odds of engagement outside of the class. Qualitative analysis found that students reported increased engagement and liked the improved course structure. Students disliked the longer time spent in class. Academic performance was reported as somewhat or significantly improved by 85% of respondents. Faculty (n = 31; response rate 80%) reported that the 4-day course schedule positively impacted (48%) or had no impact (42%) on their job responsibilities. Work-life balance (87%) was noted as the most positive effect from faculty respondents.

CONCLUSION

A 4-day course schedule was well received by both students and faculty. Institutions may consider a similar approach to allow students the flexibility of this novel schedule so as to have more time to prepare for class and wellness activities.

A Scoping Review of the Hidden Curriculum in Pharmacy Education

Objective. The hidden curriculum has been defined as teaching and learning that occur outside the formal curriculum and includes the knowledge, skills, attitudes, behaviors, values, and beliefs that students consciously or subconsciously acquire and accept. It has been identified as an inherent part of learning in health professions education and may affect students' formation of professional identity. This scoping review investigated the definition and evidence of the hidden curriculum for pharmacy education.Findings. A comprehensive literature search was conducted for primary articles investigating the hidden curriculum in pharmacy education through August 2021. A total of five papers were included in the review: four papers from the United Kingdom and one from Sweden. The focus of each paper and the elements of the hidden curriculum, along with the study quality as assessed by the quality assessment tool, varied. Three papers focused on professionalism or professional socialization, and the other two focused on patient safety. All five studies used qualitative methods including focus groups and semistructured interviews of the students and faculty. Studies also identified approaches to addressing the hidden curriculum, such as integrating formal and informal learning activities, integrating work experiences, providing sustained exposure to pharmacy practice, and development of professionalism.Summary. The definition of the hidden curriculum varied across the five studies of varying quality. The evidence of the hidden curriculum was measured qualitatively in experiential and academic settings. Recognition of the impact of the hidden curriculum and strategies for addressing its negative effects are critical to the success of not only the students but also the pharmacy profession at large.

Applying Entrustable professional activities to prescription verification activities in two skills-based laboratory courses

BACKGROUND AND PURPOSE

Prescription verification is a practice-ready expectation for pharmacy graduates. Entrustable professional activities (EPAs) should be applied to practice-ready skills-based assessments. This manuscript describes the technique of two different institutions in assessing prescription verification aligned to the Practice Manager domain of the Core EPAs as defined by the Academic Affairs Standing Committee 2015-2016 report.

EDUCATIONAL ACTIVITY AND SETTING

Virginia Commonwealth University School of Pharmacy (VCU) and University of Maryland Eastern Shore (UMES) School of Pharmacy and Health Professions describe their two methods of evaluating prescription verification with the EPA Practice Manager domain. Each program performed the activities in first-year skills-based laboratory courses.

FINDINGS

Fulfillment of a medication order was framed into law, medication label, and dispensing accuracy. Both institutions' assessments were high-stakes assessments that included errors. Overall, the majority of both programs' students passed with the institution-specified level of entrustment on their first attempt, with 75.9% to 77.5% of VCU students per each assessment and 74.5% for UMES. The lowest performance, Level 1, assessment scores for the first attempt were 10% for VCU and 2% for UMES, requiring repetition of the assessment for those students. All students achieved a minimum of Level 3 during the reassessments.

SUMMARY

Different assessment techniques may arise from program design and institutional resources. However, it is important to ensure EPAs are met for all students in prescription verification. Faculty should consider their own verification activities and level of trust expected for students to meet prior to pharmacy practice experiences.

Medicinal chemistry: The key to critical thinking in pharmacotherapy

INTRODUCTION

Medicinal chemistry is a polarizing subject for pharmacy students where, if not embraced, future pharmacists may be limited in their role as drug experts. An understanding of medicinal chemistry and its structure-activity relationships creates a strong foundation upon which our knowledge of pharmacotherapy is built.

PERSPECTIVE

As the field of pharmacy has shifted to an increasingly clinical role, with an emphasis on patient care as a member of the interprofessional team, pharmacy has also seen an increase in postgraduate training, specifically residencies and fellowships. Pharmacy students noting this trend may depreciate medicinal chemistry early in the curriculum and place more focus on therapeutics and clinical rotations. However, forgoing the fundamental understanding of medicinal chemistry may hinder pharmacy students' current breadth and understanding, and the ability to rationalize future developments in their practice. Medicinal chemistry empowers pharmacists with the ability to reason through medications' impact versus simply memorizing their actions. Pharmacists play a unique role as drug experts, with advanced problem-solving and critical thinking skills that set them apart from drug references and search engines.

IMPLICATIONS

As the field moves towards pharmacists as a member of the clinical team, the faculty should integrate medicinal chemistry throughout the doctor of pharmacy curricula. Faculty without this ability for a curriculum change should consider integration in their content. The field of pharmacy must take care to not allow clinical knowledge to significantly overshadow the importance of medicinal chemistry or run the risk of saturating the field with underprepared pharmacists.

Meta-analysis of clinical outcomes of PCSK9 modulators in patients with established ASCVD

The advent of monoclonal antibodies targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) ushered in a new era of dyslipidemia pharmacotherapy. The first two antibodies targeting PCSK9 (evolocumab, alirocumab) approved by the United States Food and Drug Administration (FDA) provided significant and sustained reductions in atherogenic lipids and a reduced risk of atherosclerotic cardiovascular disease (ASCVD) events. More recently, phase 3 trials of inclisiran-a small interfering RNA-based agent targeting PCSK9-reported similar lipid-lowering effects and preliminary evidence of ASCVD risk reduction, although significant questions remain regarding the extent of benefits across cardiovascular outcomes. We conducted a systematic review and meta-analysis (random-effects model) of the available data on lipid lowering, incidence of atherosclerotic cardiovascular disease (ASCVD) events, and safety of pharmacologic agents targeting PCSK9. A significant and consistent reduction in low-density lipoprotein cholesterol (LDL-C) was observed across all agents (-51% [95% confidence interval {CI}: -61%, -41%]). Despite the impressive reduction in LDL-C, the individual effects on mortality, cardiovascular death, myocardial infarction (MI), and stroke remained nonsignificant. However, a consistent reduction was observed in the composite outcomes of MI, stroke, and cardiovascular death [relative risk {RR} (95% CI): 0.80 (0.73-0.87)] and MI, stroke, unstable angina (requiring revascularization), and cardiovascular death [RR (95% CI): 0.85 (0.74-0.97)]. In terms of safety outcomes, there was no significant difference in severe adverse events, new onset diabetes, neurocognitive disorders, or myalgia. Meanwhile, injection site reaction was more frequent in patients receiving these agents compared to placebo [RR 2.11 (95% CI): 1.26-3.54]. These findings suggest a class effect for favorable lipid changes and a low risk of serious adverse events among pharmacologic agents targeting PCSK9. Although there is compelling evidence that PCSK9-targeting agents reduce the risk of some cardiovascular outcomes, adequately powered studies with longer follow-up may be needed to fully characterize the magnitude of benefits across the cardiovascular spectrum.

A Bibliometric Analysis of Peer-Reviewed Journal Publications of Pharmacy Practice Department Chairs

Objective. To perform a bibliometric analysis of pharmacy practice department chairs at US schools and colleges of pharmacy to determine factors associated with their level of scholarly productivity.Methods. Scopus was searched for all publications by pharmacy practice chairs from all pharmacy schools through August 11, 2020. Publication metrics (total number of publications and citations and the Hirsch-index (h-index), and year of first publication), as well as characteristics of the individual chair and institution were collected. Characteristics were compared across groups. A generalized linear model was used to determine the correlation between the total number of publications and h-index to school ranking by US News & World Report (USNWR).Results. One hundred forty-one pharmacy practice chairs were identified. The majority were male and at the rank of professor, with a similar proportion from public and private institutions. The median total number of publications and citations was 19 and 247, respectively, with a median h-index of eight. Compared with female chairs, male chairs had a higher median total of publications and citations and a higher h-index. Chairs at public institutions had a higher median total of publications and citations and a higher publication rate, h-index, and m quotient. The USNWR ranking for the school was significantly correlated with total publications and the h-index.Conclusion. Pharmacy practice chairs vary significantly in their scholarship productivity, although those at institutions with a larger emphasis on research were more prolific. Observed differences in the publication metrics of male and female chairs warrants further study to determine possible explanations for this finding and its potential impact.

Stenting techniques for coronary bifurcation lesions: Evidence from a network meta-analysis of randomized clinical trials

OBJECTIVES

We conducted a systematic review and network meta-analysis of available randomized clinical trials (RCTs) to compare cardiovascular outcomes involving stenting techniques in coronary bifurcation lesions.

BACKGROUND

Although provisional stenting of the main branch and balloon angioplasty of the side branch is considered the standard approach, the use of two stents is often pursued with a wide variety of bifurcation stenting techniques available.

METHODS

We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and Clinicaltrials.gov from inception to December 2018. We performed a frequentist network meta-analysis to estimate relative risks (RR) of death, major adverse cardiovascular events (MACE), target vessel revascularization (TVR), target lesion revascularization (TLR), and stent thrombosis (ST) among different two stent bifurcation techniques.

RESULTS

We identified 14 studies, yielding data on 4,285 patients. Double Kissing (DK) Crush and Mini-crush were associated with significant reductions in MACE, TVR, and TLR when compared with the Provisional stenting (RR 0.31-0.55 [all p < .01] and RR 0.42-0.45 [all p < .02], respectively) and with the remaining bifurcation techniques (RR 0.44-0.55 [all p < .05] for DK Crush and RR 0.37-0.45 [all p < .05] for Mini-crush). In addition, Culotte and Crush were associated with an increased risk for ST compared to Provisional stenting (RR 3.25-4.27 [both p < .05]) and to DK crush (RR 3.02-3.99 [both p < .05]).

CONCLUSIONS

DK crush and mini-crush were found to be associated with fewer events and complications compared to the other techniques reviewed, including the Provisional approach. Further, Culotte and Crush were associated with an increased risk of stent thrombosis when compared to the Provisional approach.

Impact of Different Doses of Omega-3 Fatty Acids on Cardiovascular Outcomes: a Pairwise and Network Meta-analysis

PURPOSE OF REVIEW

Omega-3 fatty acid (O3FA) supplementation has shown conflicting evidence regarding its benefit in cardiovascular events. We performed a pairwise and network meta-analysis to elucidate the benefit of different doses of O3FA supplementation in cardiovascular prevention.

RECENT FINDINGS

Fourteen studies were identified providing data on 125,763 patients. A prespecified cut-off value of < 1 g per day was set for low-dose (LD) O3FA and > 1 g per day for high-dose (HD) O3FA. The efficacy outcomes of interest were total death, cardiac death, sudden cardiac death, myocardial infarction, stroke, coronary revascularization, unstable angina, and major vascular events. Safety outcomes of interest were bleeding, gastrointestinal disturbances, and atrial fibrillation events. HD treatment was associated with a lower risk of cardiac death (IRR 0.79, 95% CI [0.65-0.96], p = 0.03 versus control), myocardial infarction (0.71 [0.62-0.82], p < 0.0001 versus control and 0.79 [0.67-0.92], p = 0.003 versus LD), coronary revascularization (0.74 [0.66-0.83], p < 0.0001 versus control and 0.74 [0.66-0.84], p < 0.0001 versus LD), unstable angina (0.73 [0.62-0.86], p = 0.0001 versus control and 0.74 [0.62-0.89], p = 0.002 versus LD), and major vascular events (0.78 [0.71-0.85], p < 0.0001 versus control and 0.79 [0.72-0.88], p < 0.0001 versus LD). HD treatment was associated with increased risk for bleeding events (1.49 [1.2-1.84], p = 0.0002 versus control and 1.63 [1.16-2.3], p = 0.005 versus LD) and increased atrial fibrillation events compared to control (1.35 [1.1-1.66], p = 0.004). HD O3FA treatment was associated with lower cardiovascular events compared to LD and to control, but increased risk for bleeding and atrial fibrillation events.

A call to action: Pharmacy students as leaders in encouraging physical activity as a coping strategy to combat student stress

INTRODUCTION

Pharmacy students share a prevailing sense of stress. Many methods to increase student wellness are pharmacy program specific and faculty driven. This commentary is a call to action for student pharmacists to take shared ownership over improving the current crisis of student well-being. Schools of pharmacy should empower their students to guide the improvement of student wellness. Student-led wellness initiatives can take many forms; this commentary will focus on a student-led walking group as means to bolster wellness within a school of pharmacy.

PERSPECTIVE

Exercise activities promote school-life balance, and when initiated by peers, will naturally conform to their schedule and develop collegial support through socialization. Student pharmacists should begin with encouraging peers to engage in exercise as a positive coping mechanism. Students should lead their peers in developing activities and electronic device sharing to encourage socialization and positive coping mechanisms.

IMPLICATIONS

While many efforts are in place for faculty and schools of pharmacy to improve student well-being, little has been studied on the impact of student-led wellness programs. This article calls student pharmacists to take shared ownership over the student wellness crisis and find ways to intervene. Schools of pharmacy should empower students by providing supportive structures while allowing students to problem-solve and practice wellness themselves.

Could recruiting former college athletes be the answer to less pharmacy student burnout?

INTRODUCTION

Student pharmacists are in a notable wellness deficit. Pharmacy organizations are issuing statements and providing resources addressing efforts to increase student wellness. This commentary suggests that institutions refocus recruiting efforts on students with experience balancing the demands of school, wellness, and mental health.

PERSPECTIVE

The purpose of this commentary is to start the conversation on increasing efforts to recruit candidates who already possess the resilience needed to perform in pharmacy school, with a focus on former college athletes. This piece in no way suggests decreased attention on wellness programs or efforts to reduce burnout. Former student athletes, through their training, have increased experience in resilience and may be less at risk for burnout. These candidates will likely have an increased team mentality and acceptance of constructive criticism. Additionally, this is an untapped resource for candidates as only 2% of collegiate athletes pursuing professional athletic careers. Of the 140 accredited pharmacy schools, 82.9% have an undergraduate program that offers at least one National Collegiate Athletic Association sport.

IMPLICATIONS

Schools of pharmacy should consider additional recruitment efforts and admissions criteria weight for former student athletes who meet the same standards as other candidates. As many pharmacy faculty direct significant effort toward the prevention of student burnout, perhaps an additional approach is to recruit students who are already capable of the expected demands. The athletic community may answer both the need for additional pharmacy recruits and provide a cohort with advanced abilities in stress management, wellness, and teamwork.

Team teaching with pharmacy practice and pharmaceutics faculty in a nonsterile compounding laboratory course to increase student problem-solving skills

BACKGROUND AND PURPOSE

Combining pharmaceutics and pharmacy practice into nonsterile compounding is ideal to increase problem-solving skills. The objectives of this activity were to: (1) create a nonsterile compounding activity through a team-teaching collaboration, (2) increase students' independent problem-solving skills to compound a nonsterile natural product, and (3) assess student and faculty perceptions of the learning activity.

EDUCATIONAL ACTIVITY AND SETTING

The activity was created, implemented, and assessed using a team-teaching technique between pharmacy practice and pharmaceutics faculty. The first week students were tasked with extraction of an active ingredient from a natural product, and the second week students independently compounded a nonsterile product using the concentrated extract. Faculty and students were asked to give their perceptions of the activity.

FINDINGS

The activity has been taught to two cohorts of elective students. Students from both cohorts (n = 57) independently created a nonsterile compound, scoring an average (standard deviation) of 8.1 (1) and 8.6 (0.9) out of 10 points on their graded products for the 2018 and 2019 elective, respectively. Faculty collaboration and team-teaching adjustments to the content resulted in increased student performance (p = 0.0392). Student feedback on the activity was overwhelmingly positive. Faculty appreciated the collaborative approach and improved the course activity together.

SUMMARY

A team-teaching approach created an activity that focused on elements of both pharmaceutics and pharmacy practice. Students developed problem-solving abilities by creating their own independent nonsterile compounded natural product. The collaboration between faculty was positive and well received by students.

Using immersive simulation to engage student learners in a nonsterile compounding skills laboratory course

BACKGROUND AND PURPOSE

Although immersive simulation has been applied successfully in multiple pharmacy education settings, none have been used thus far in nonsterile compounding. The objective of this study was to increase student knowledge and confidence when compounding a natural nonsterile product during an immersive simulation.

EDUCATIONAL ACTIVITY AND SETTING

The immersive simulation activity was taught over two weeks in a third year advanced nonsterile compounding elective. The first week focused on the extraction of an active ingredient from yarrow, a natural product. The second week immersed the students into an apocalypse simulation to compound a product using the concentrated yarrow extract for a patient who developed a dental infection, using limited resources and supplies. Knowledge and confidence changes were assessed with a pre- and post-assessment. Students' compounded nonsterile products were assessed with the course rubric. Student feedback on the activity was obtained with two open-ended questions.

FINDINGS

All 30 students extracted the active ingredient from yarrow leaves and created a unique mouthwash scoring an average (SD) of 8.1 (1) out of 10 points on their graded compounded product. There was a significant increase in the overall knowledge assessment score. All student confidence assessment questions increased on the post-assessment. Student feedback was overwhelmingly positive for the immersive simulation.

SUMMARY

An immersive simulation improved students' overall knowledge and confidence in compounding a natural nonsterile product. Schools can utilize a similar approach to teach compounding skills for emergency preparedness.

Recent Developments in the Role of Coenzyme Q10 for Coronary Heart Disease: a Systematic Review

PURPOSE OF REVIEW

This review examines recent randomized clinical trials evaluating the role of coenzyme Q10 (CoQ10) in the management of coronary heart disease.

RECENT FINDINGS

CoQ10 is one of the most commonly used dietary supplements in the USA. Due to its antioxidant and anti-inflammatory effects, CoQ10 has been studied extensively for possible use in managing coronary heart disease. One of the most common applications of CoQ10 is to mitigate statin-associated muscle symptoms (SAMS) based on the theory that SAMS are caused by statin depletion of CoQ10 in the muscle. Although previous studies of CoQ10 for SAMS have produced mixed results, CoQ10 appears to be safe. Because CoQ10 is a cofactor in the generation of adenosine triphosphate, supplementation has also recently been studied in patients with heart failure, which is inherently an energy deprived state. The Q-SYMBIO trial found that CoQ10 supplementation in patients with heart failure not only improved functional capacity, but also significantly reduced cardiovascular events and mortality. Despite these positive findings, a larger prospective trial is warranted to support routine use of CoQ10. Less impressive are the effects of CoQ10 on specific cardiovascular risk factors such as blood pressure, dyslipidemia, and glycemic control. Current evidence does not support routine use of CoQ10 in patients with coronary heart disease. Additional studies are warranted to fully determine the benefit of CoQ10 in patients with heart failure before including it in guideline-directed medical therapy.

Location of the mandibular center of autorotation in maxillary impaction surgery

Controversy exists about the location of the center of autorotation of the mandible after maxillary impaction surgery. This investigation focuses on the problems associated with locating that center of autorotation and identifies factors that can increase the probability of accurately identifying its location for predicting surgical outcomes. The reliability of the Rouleaux technique for calculating the centers of rotation is established and is shown to be acceptable, as long as the landmarks used for determining the center are properly selected, and the magnitude of the rotation required is sufficient. The location of the centers of autorotation of the mandibles after maxillary impaction surgery for 46 patients was used to investigate the errors associated with landmark selection and amounts of rotation. Although there is much variation in its location, the center does not lie within the body of the condyle but instead lies away from the condyle. Guidelines for maximizing the reliability of predicting surgical outcomes on the basis of autorotation of the mandible after maxillary impaction surgery are given.