Objective. To develop and implement a multimodal structured approach to intentional interprofessional experiential education at a non-academic community hospital, and to evaluate students' perceptions of the program. Methods. A multimodal structured approach to intentional interprofessional experiential education was designed that consisted of medical and pharmacy students participating together in daily prerounds, daily teaching rounds, and once or twice weekly lunch-and-learn sessions at a non-academic community hospital. Pre-and post-experience surveys were administered to assess students' perceptions of physician and pharmacist collaboration in interprofessional education (IPE). The survey instrument included the Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education, Version 2 (SPICE-2) survey. Results. Thirty-nine students, including 18 fourth-year student pharmacists from Mercer University College of Pharmacy and 21 third-year medical students from three medical schools in the Caribbean, provided informed consent and were enrolled in the eight-month study. Students' perceptions of items related to the Interprofessional Education Collaborative (IPEC) competencies, including values/ethics for interprofessional practice, roles/responsibilities, and teams and teamwork, significantly improved from the pre-to the post-experience survey. Conclusion.A multimodal structured approach to intentional interprofessional experiential education had positive effects on students' perceptions of interprofessional clinical education targeting key components of the (IPEC) competencies. This approach may be a useful tool for implementing intentional IPE in the experiential setting.

Hypoglycemia is a common adverse event associated with insulin during treatment of hyperkalemia in hospitalized patients; however, limited data exist regarding hypoglycemia incidence and appropriate dosing strategies for treatment of patients in the emergency department. The study objective was to determine the incidence of hypoglycemia associated with insulin use during treatment of hyperkalemia among patients seen in the emergency department. Methods: This was an Institutional Review Board (IRB)-approved retrospective, chart-review study. All adult patients who received intravenous regular insulin as a result of an order from the emergency department hyperkalemia order set were eligible for inclusion. The main clinical outcomes were incidence of hypoglycemia (blood glucose <70 mg/dL) and severe hypoglycemia (blood glucose <40 mg/dL). Blood glucose was checked within 24 hours of insulin administration. Results: A total of 172 patients were included. The incidence of hypoglycemia was 19.8% (n = 34) and the incidence of severe hypoglycemia was 5.2% (n = 9). Hypoglycemic patients had a significantly lower median blood glucose at baseline compared to those who did not develop hypoglycemia (83.5 [72.0-112.0] mg/dL vs 123.0 [96.0-167.0] mg/dL, P < .0001); however, no difference was noted between groups in the average insulin dose administered (0.11 ± 0.04 units/kg vs 0.12 ± 0.05 units/kg, P = .6175). Conclusion: There is a concerning risk of hypoglycemia associated with insulin use during treatment of hyperkalemia in the emergency department. Standard insulin doses may not be appropriate in some cases like patients with lower baseline blood glucose. Further research is warranted to develop safer hyperkalemia treatment protocols that mitigate this high risk of hypoglycemia associated with insulin use.

Clinical pharmacy has continually evolved, with significant expansion in clinical pharmacists' qualifications and roles. However, this growth has not necessarily correlated with improved job satisfaction among clinical pharmacists. A survey of practicing clinical pharmacists performed by the American College of Clinical Pharmacy (ACCP) Clinical Practice Affairs Committee A identified low satisfaction with the time allocated for clinical activities, quality improvement, research and scholarship, and teaching and mentorship. There was also low satisfaction with the recognition provided, despite a high desire for recognition and strong agreement that recognition affects job satisfaction. Rewards for workplace successes and advancement pathways are also not commonly provided. This white paper provides an update to the previous ACCP publications from 1995 and 2010 on the current state of rewards, recognition, and advancement for clinical pharmacists. Suggestions for the pharmacy profession and administrators on how to improve job satisfaction and retention and reduce burnout were developed by the committee and are provided as best practice recommendations.

Objective. To compare first-year student pharmacists and nursing students with respect to their spirituality and perceptions of the role of spirituality in professional education and practice. Methods. This was a five-year, cross-sectional study. All first-year student pharmacists and nursing students were invited to participate in the survey during the first week of the fall semester in 2012 through 2016. Descriptive and inferential statistics were used to analyze the data. Results. A total of 1,084 students participated, including 735 student pharmacists and 349 nursing students. Significant differences in baseline demographics were noted between the groups. Students in both groups reported having frequent spiritual experiences. A significantly larger percentage of nursing students reported these experiences compared to student pharmacists. Furthermore, compared with student pharmacists, nursing students were more likely to anticipate that spirituality would play a role in their academic course work (76% vs 58%) and professional practice (90% vs 74%). Conclusion. Student pharmacists and nursing students reported having frequent spiritual experiences, and both groups anticipated that spirituality would be incorporated into their education and professional practice.

Background: Efavirenz (Sustiva®) is used for the treatment of human immunodeficiency virus (HIV) type 1 infection. Hepatoxicity is a known potential adverse drug event with efavirenz; however, to our knowledge, vanishing bile duct syndrome (VBDS), a type of liver injury, has not been reported with this therapy. Case Presentation: We report the case of a 48-year-old male with HIV and VBDS secondary to antiretroviral therapy. The patient was started on efavirenz, emtricitabine, and tenofovir disoproxil fumarate (Atripla®). Four weeks later, the patient presented with complaints of poor appetite, nausea with emesis, dark urine, and malaise. Labs obtained supported the diagnosis of acute hepatitis, and a liver biopsy confirmed a diagnosis of VBDS. The Naranjo adverse drug reaction probability scale showed that it was probable (score of 7) that the VBDS was related to drug therapy. Efavirenz was assessed to be the most likely cause of VBDS, end-stage liver disease, and the eventual need for liver transplantation. Conclusion: To our knowledge, this is the first reported case of probable efavirenz-induced VBDS in a patient living with HIV. Recognition and awareness of this adverse drug reaction by clinicians for quick diagnosis, discontinuation of therapy, and management are important in patients receiving this regimen.