Evaluation of a novel process for selecting advanced pharmacy practice experiences

INTRODUCTION

Matching an increasing number of pharmacy students with a limited number of advanced pharmacy practice experience (APPE) sites has become challenging for pharmacy schools. Selective tiered optimization (STO), a process for matching students with competitive APPE electives, was implemented by The University of Mississippi School of Pharmacy (UMSOP) in 2015 to address these concerns. This pilot study sought to evaluate student and preceptor satisfaction with the process.

METHODS

Electronic surveys were sent to students enrolled in APPEs and individuals who precepted APPE students at the UMSOP from 2016 to 2019. The surveys were designed to gauge satisfaction with STO's process, goals, utility, and fairness.

RESULTS

There were 63 responses from 149 preceptors (42% response rate) and 70 respondents from 314 students (22% response rate). Overall, both students and preceptors expressed satisfaction and found value in participating in STO. Both groups indicated that the benefit they received from participating in STO outweighed the extra effort required. Preceptors indicated that students who participated in STO were of higher quality and more focused, hardworking, and interested than those who did not participate.

CONCLUSIONS

Respondents were satisfied with the STO process and experience. The process was perceived by preceptors to be fair for all students and worthwhile for its participants. Our results also demonstrated that this process is effective for easing the competitive APPE selection process. Schools and colleges of pharmacy should consider utilizing this process to alleviate applicable challenges with APPE selection.

The Effects of Knee Orthosis with Two Degrees of Freedom Joint Design on Gait and Sit-to-Stand Task in Patients with Medial Knee Osteoarthritis

Objectives

Knee bracing as a conservative treatment option for patients with medial knee osteoarthritis (KOA) is of great interest to health practitioners and patients alike. Optimal orthotic knee joint structure is essential to achieve biomechanical and clinical effectiveness. Therefore, this study aimed to identify the effects of a knee orthosis with a new two-degrees-of-freedom (DOF) joint design on selected gait parameters and in a sit-to-stand task in patients with mild-to-moderate medial KOA.

Methods

This study was conducted both at the Physical Medicine and Rehabilitation Clinic in Shahid Modarres Academic Hospital and the Biomechanical Laboratory of Rehabilitation Faculty of Iran University of medical Sciences in Tehran, Iran from September 2015 to October 2017. The gait performance of 16 patients was assessed without an orthosis, using a common one-DOF (DOF) knee orthosis and using the same knee orthosis with a two-DOF orthotic joint design. The interactive shearing force between limb and brace in the shell area during a sit-to-stand test was also identified. Repeated measures analysis of variance was used to analyse the data.

Results

Compared with walking with no orthosis, both orthosis conditions reduced the external knee adduction moment significantly (P ≤0.05). A significant increase between the one-DOF and two-DOF conditions in terms of walking speed (P = 0.041 and P = 0.009, respectively) and stride length (P = 0.028 and P = 0.038, respectively) was observed. In a sit-to-stand test, wearing the orthosis significantly decreased knee transverse plane range of motion (P ≤0.05). There was a 41.31 ± 8.34 Newtons reduction in knee flexion constraint force.

Conclusion

The two-DOF knee orthosis was more comfortable compared to the one-DOF knee orthosis during deep knee flexion. Otherwise, the one-DOF- and two-DOF-braces performed similarly.

Implementation of general medicine topics for acute care inpatient advanced pharmacy practice experiences

INTRODUCTION

The purpose of this study was to describe the development of a general medicine student workbook to standardize acute care inpatient fourth-year pharmacy rotations among faculty with varied pharmacy practice sites.

METHODS

Four faculty designed an advanced pharmacy practice experience (APPE) student workbook on general medicine topics consisting of short answer and multiple-choice questions to ensure standardization by exposing all students to the same topics. A pre- and posttest was administered on the first and last day of the five-week rotation block to evaluate the effects of the APPE workbook on student understanding of general medicine topics. A paired t-test was used to evaluate the significance of the difference in test scores.

RESULTS

The average of the posttest exam was found to be significantly higher after the completion of the student workbook. The average grade on the pre-rotation 30-item exam was 22.8 (76.73%) and the post-rotation 30-item exam was 25.7 (86.26%), with a difference of 9.53% (P < .001, 95% CI = 7.11 to 11.96).

CONCLUSIONS

Creating a standardized student workbook for an inpatient acute care rotation was a valuable addition. All students assigned to the faculty involved were exposed to the same topics despite variability in preceptors and practice sites. Overall the verbal feedback from the students was positive about the student workbook and discussions, especially since the information was applicable to their patients on rotation. Faculty will continue to use this workbook as a tool to teach various inpatient general medicine topics during the acute care APPE.

Genetic deletion of GPR88 enhances the locomotor response to L-DOPA in experimental parkinsonism while counteracting the induction of dyskinesia

Parkinson's disease (PD) is characterized by progressive loss of midbrain dopaminergic neurons and treated with the dopamine precursor, 3,4-dihydroxy-l-phenylalanine (L-DOPA). Prolonged L-DOPA treatment is however associated with waning efficacy and the induction of L-DOPA induced dyskinesia (LID). GPR88 is an orphan G-protein Coupled Receptor (GPCR) expressed in dopaminoceptive striatal medium spiny neurons (MSNs) and their afferent corticostriatal glutamatergic neurons. Here, we studied the role of GPR88 in experimental parkinsonism and LID. Chronic L-DOPA administration to male GPR88 KO mice, subjected to unilateral 6-hydroxydopamine (6-OHDA) lesions of the medial forebrain bundle, resulted in more rotations than in their WT counterparts. Conversely, GPR88 KO mice had a lower abnormal involuntary movements (AIMs) score. These behavioral responses were accompanied by altered transcription of L-DOPA upregulated genes in lesioned GPR88 KO compared to WT striata. In accordance with a role for serotonin neurons in LID development, WT but not GPR88 KO striata exhibited 5-hydroxytryptamine displacement upon repeated L-DOPA treatment. Intact male GPR88 KO mice showed diminished tacrine-induced PD-like tremor and spontaneous hyperlocomotion. Dopamine and its metabolites were not increased in male GPR88 KO mice, but biosensor recordings revealed increased spontaneous/basal and evoked glutamate release in striata of male GPR88 KO mice. In conclusion, genetic deletion of GPR88 promotes l-DOPA-induced rotation and spontaneous locomotion yet suppresses the induction of LIDs and also reduces tremor. These data provide behavioral, neurochemical and molecular support that GPR88 antagonism may favour motor relief in PD patients without aggravating the induction of motor side effects.

Cost Savings and Clinical Interventions Made by PharmD Students During APPE Rotations at Federally Qualified Health Centers

PharmD students make significant clinical interventions during their last year of training in clinical rotations at a variety of practice sites. These interventions ranged from performing dosage adjustments to preventing adverse drug reactions and saved $92,803 dollars in the Federally Qualified Health Center practice sites that were included in this study over a 1-year period of time. The following study examines the types of interventions made and their associated cost savings.

Specific entrustable professional activities for undergraduate medical internships: a method compatible with the academic curriculum

BACKGROUND

Competency-based education has been considered the most important pedagogical trend in Medicine in the last two decades. In clinical contexts, competencies are implemented through Entrustable Professional Activities (EPAs) which are observable and measurable. The aim of this paper is to describe the methodology used in the design of educational tools to assess students´ competencies in clinical practice during their undergraduate internship (UI). In this paper, we present the construction of specific APROCs (Actividades Profesionales Confiables) in Surgery (S), Gynecology and Obstetrics (GO) and Family Medicine (FM) rotations with three levels of performance.

METHODS

The study considered a mixed method exploratory type design, a qualitative phase followed by a quantitative validation exercise. In the first stage data was obtained from three rotations (FM, GO and S) through focus groups about real and expected activities of medical interns. Triangulation with other sources was made to construct benchmarks. In the second stage, narrative descriptions with the three levels were validated by professors who teach the different subjects using the Delphi technique.

RESULTS

The results may be described both curricular and methodological wise. From the curricular point of view, APROCs were identified in three UI rotations within clinical contexts in Mexico City, benchmarks were developed by levels and validated by experts' consensus. In regard to methodological issues, this research contributed to the development of a strategy, following six steps, to build APROCs using mixed methods.

CONCLUSIONS

Developing benchmarks provides a regular and standardized language that helps to evaluate student's performance and define educational strategies efficiently and accurately. The university academic program was aligned with APROCs in clinical contexts to assure the acquisition of competencies by students.

Understanding the importance of medical student clerkships in poor health outcome regions served by Area Health Education Centers (AHECs) in impoverished locations of Southern United States

Area Health Education Centers provide health professional students the opportunity to explore the benefits of practicing in a rural and underserved location. The status of health conditions in chronic disease patients residing in impoverished regions of the US provides the chance to understand the factors that are responsible for constant inadequate outcomes in underserved and rural communities. Many limiting barriers to positive health outcomes occur in disproportionate numbers in the Southern Black Belt. Students should consider participating in rural and underserved clerkships, and ultimately a career as a health care provider in a poor health outcome region. In addition, promising programs (e.g. telemedicine, community health workers) to help implement patient-centered evidence-based interventions can tackle current chronic disease issues commonly encountered by health professionals who work with diverse patient populations.

The opinion of preceptors and students of very early IPPE rotations delivered concurrently with didactic courses

INTRODUCTION

The Marshall University School of Pharmacy had the opportunity to create an experiential education program where IPPE education was introduced in their P1 year and was concurrent with didactic coursework. The School begins the delivery of experiential education as soon as the sixth week of the first professional year.

OBJECTIVE

To ascertain the opinion of institutional preceptors, community preceptors, and students after the first academic year to discern viewpoints on the effectiveness and value of very early P1 experiential rotations.

METHODS

Institutional and community preceptors and students were assessed by anonymous survey in order to ascertain their respective opinions regarding early P1 experiential education. The results of the preceptors were further divided into institutional and community practice sites. This study was approved by the Marshall University Institutional Review Board.

RESULTS

Key findings demonstrated that early rotations were perceived as beneficial to the student by both community and institutional preceptors, as well as, the students themselves.

CONCLUSIONS

Most, but not all, preceptors felt early rotations were beneficial to their practice and the student. Institutional preceptors were less likely to perceive a benefit to their practice or to the student than were community preceptors. Students were positive about the early experience. The results of these surveys regarding early experiential rotations should help minimize concerns of both preceptors and those assigned responsibility for constructing experiential programs about implementing early experiential rotations in the curriculum.

Practical issues regarding angular and energy response in in vivo intraoperative electron radiotherapy dosimetry

AIM

To estimate angular response deviation of MOSFETs in the realm of intraoperative electron radiotherapy (IOERT), review their energy dependence, and propose unambiguous names for detector rotations.

BACKGROUND

MOSFETs have been used in IOERT. Movement of the detector, namely rotations, can spoil results.

MATERIALS AND METHODS

We propose yaw, pitch, and roll to name the three possible rotations in space, as these unequivocally name aircraft rotations. Reinforced mobile MOSFETs (model TN-502RDM-H) and an Elekta Precise linear accelerator were used. Two detectors were placed in air for the angular response study and the whole set of five detectors was calibrated as usual to evaluate energy dependence.

RESULTS

The maximum readout was obtained with a roll of 90° and 4 MeV. With regard to pitch movement, a substantial drop in readout was achieved at 90°. Significant overresponse was measured at 315° with 4 MeV and at 45° with 15 MeV. Energy response is not different for the following groups of energies: 4, 6, and 9 MeV; and 12 MeV, 15 MeV, and 18 MeV.

CONCLUSIONS

Our proposal to name MOSFET rotations solves the problem of defining sensor orientations. Angular response could explain lower than expected results when the tip of the detector is lifted due to inadvertent movements. MOSFETs energy response is independent of several energies and differs by a maximum of 3.4% when dependent. This can limit dosimetry errors and makes it possible to calibrate the detectors only once for each group of energies, which saves time and optimizes lifespan of MOSFETs.

Strategies to grow an experiential learning program-The role of administrators

With the newly released ACPE standards, challenges exist in growing experiential learning programs at many schools. The role of administrators in the experiential learning office, practice department, and the dean׳s office is critical for success. This article provides practical tips and strategies to help grow an experiential learning program by emphasizing the role of administrators. In 2012, the administrators of the University of Maryland School of Pharmacy brainstormed and came up with a list of challenges faced by its experiential learning program, provided suggested solutions to each challenge, and began a process of implementing solutions to help grow the program. As of fall 2014, we were able to document increases in the numbers of preceptors and different rotation types, growth in the clinical track program, changes in our learning management system to better accommodate our needs, and increases in satisfaction rates among our preceptors, sites, and students. This article summarizes the challenges faced by University of Maryland Experiential Learning Program, the practical solutions implemented, and the role of leadership in growing the program. Many of the suggestions and lessons learned here can benefit many programs with similar challenges.

Impact of individualized learning plans on United States senior medical students advanced clinical rotations

The individualized learning plan (ILP) is a tool that promotes self-directed learning. The aim of this pilot study was to look at the perception of the ILPs in United States senior medical school students as a way to improve their learning experience during their advanced practice clerkship. We conducted a survey of graduating medical students that contained both quantitative and open-ended questions regarding the students' experiences with the ILP during their advanced practice clerkship from July 2014 to March 2016. We systematically identified and compiled themes among the qualitative responses. Responses from 294 out of 460 subjects were included for analysis (63.9%). Ninety students (30.6%) reported that the ILP was definitely reviewed at the midpoint and 88 (29.9%) at the final evaluation. One hundred sixty one students (54.8%) felt the ILP provided a framework for learning. One hundred sixty one students (61.6%) felt it was a useful tool in helping open a discussion between the student and faculty. The qualitative data was grouped by areas most mentioned and these areas of concern centered on lack of faculty knowledge about ILP, time to complete ILP, and uncertainty of appropriate goal setting. The majority of students perceive the ILP to be helpful. Our results suggest that active intervention is needed by dedicated and trained faculty to improve ILP utilization. It is recommended that faculty gives students examples of learning goals to create their own learning framework and encourages them to discuss and review the ILP.

Chronic L-DOPA treatment attenuates behavioral and biochemical deficits induced by unilateral lactacystin administration into the rat substantia nigra

The aim of the study was to determine whether the dopamine (DA) precursor l-DOPA attenuates parkinsonian-like symptoms produced by the ubiquitin-proteasome system inhibitor lactacystin. Wistar rats were injected unilaterally with lactacystin (2.5 μg/2 μl) or 6-OHDA (8 μg/2 μl) into the substantia nigra (SN) pars compacta. Four weeks after the lesion, the animals were treated chronically with l-DOPA (25 or 50 mg/kg) for two weeks. During l-DOPA treatment, the lactacystin-treated rats were tested for catalepsy and forelimb asymmetry. Rotational behavior was evaluated after apomorphine (0.25 mg/kg) and l-DOPA in both PD models. After completion of experiments, the animals were killed and the levels of DA and its metabolites in the striatum and SN were assayed. We found that acute l-DOPA administration effectively decreased catalepsy and increased the use of the compromised forelimb in the cylinder test. However, the lactacystin group did not respond to apomorphine or acute l-DOPA administration in the rotational test. Repeated l-DOPA treatment produced contralateral rotations in both PD models, but the number of rotations was much greater in the 6-OHDA-lesioned rats. Both toxins markedly (>90%) reduced the levels of DA and its metabolites in the striatum and SN, while l-DOPA diminished these decreases, especially in the SN. By demonstrating the efficacy of l-DOPA in several behavioral tests, our study confirms the usefulness of the lactacystin lesion as a model of PD. However, marked differences in the rotational response to apomorphine and l-DOPA suggest different mechanisms of neurodegeneration evoked by lactacystin and 6-OHDA.

Influence of glenoid component design and humeral component retroversion on internal and external rotation in reverse shoulder arthroplasty: a cadaver study

BACKGROUND

A common disadvantage of reverse shoulder arthroplasty is limitation of the range of arm rotation. Several changes to the prosthesis design and implantation technique have been suggested to improve rotation range of motion (ROM).

HYPOTHESIS

Glenoid component design and degree of humeral component retroversion influence rotation ROM after reverse shoulder arthroplasty.

MATERIAL AND METHODS

The Aequalis Reversed™ shoulder prosthesis (Tornier Inc., Edina, MN, USA) was implanted into 40 cadaver shoulders. Eight glenoid component combinations were tested, five with the 36-mm sphere (centred seating, eccentric seating, inferior tilt, centred with a 5-mm thick lateralised spacer, and centred with a 7-mm thick lateralised spacer) and three with the 42-mm sphere (centred with no spacer or with a 7-mm or 10-mm spacer). Humeral component position was evaluated with 0°, 10°, 20°, 30°, and 40° of retroversion. External and internal rotation ROMs to posterior and anterior impingement on the scapular neck were measured with the arm in 20° of abduction.

RESULTS

The large glenosphere (42 mm) was associated with significantly (P<0.05) greater rotation ROMs, particularly when combined with a lateralised spacer (46° internal and 66° external rotation). Rotation ROMs were smallest with the 36-mm sphere. Greater humeral component retroversion was associated with a decrease in internal rotation and a significant increase (P<0.05) in external rotation. The best balance between rotation ROMs was obtained with the native retroversion, which was estimated at 17.5° on average in this study.

DISCUSSION

Our anatomic study in a large number of cadavers involved a detailed and reproducible experimental protocol. However, we did not evaluate the variability in scapular anatomy. Earlier studies of the influence of technical parameters did not take humeral component retroversion into account. In addition, no previous studies assessed rotation ROMs.

CONCLUSION

Rotation ROM should be improved by the use of a large-diameter glenosphere with a spacer to lateralise the centre of rotation of the gleno-humeral joint, as well as by positioning the humeral component at the patient's native retroversion value.