Objective. To determine whether a flipped classroom design would improve student performance and perceptions of the learning experience compared to traditional lecture course design in a required pharmacotherapy course for second-year pharmacy students. Design. Students viewed short online videos about the foundational concepts and answered selfassessment questions prior to face-to-face sessions involving patient case discussions. Assessment. Pretest/posttest and precourse/postcourse surveys evaluated students' short-term knowledge retention and perceptions before and after the redesigned course. The final grades improved after the redesign. Mean scores on the posttest improved from the pretest. Postcourse survey showed 88% of students were satisfied with the redesign. Students reported that they appreciated the flexibility of video viewing and knowledge application during case discussions but some also struggled with time requirements of the course. Conclusion. The redesigned course improved student test performance and perceptions of the learning experience during the first year of implementation.
Patients are at risk of having their medication histories inaccurately documented while being admitted to an emergency department (ED). Allowing a pharmacist to access patient medication history is an effective way of reducing the number of errors. We sought to determine if having a pharmacist (as opposed to the admitting clinical team) verify patients' medication histories would result in fewer discrepancies in inpatient medication regimens. We performed a prospective cohort comparison study of adult ED patients admitted to general medicine floors for continuing care. In the intervention group, pharmacists in the ED performed a brief inquiry into the patients' medication history, a process called medication reconciliation. In the control group, the admitting clinical team conducted the medication reconciliation. Both groups received a second reconciliation by a trained pharmacy team and all discrepancies were recorded. Our cohort had 172 intervention and 172 control subjects. In the control group, 561 medication discrepancies were recorded while no medication discrepancies were observed in the intervention group. Having pharmacists consult with patients in the ED about their medication histories led to fewer discrepancies than when admitting clinical teams performed the same inquiry.
Abstract:Clopidogrel is an antiplatelet agent indicated in the management of atherothrombotic conditions. Bleeding is a predictable adverse event associated with antiplatelet agents. While non-ulcerogenic; a major site of bleeding with clopidogrel is the gastrointestinal (GI) tract. The risk of GI bleeding with clopidogrel monotherapy is generally low; however, it increases with the presence of other risk factors such as aspirin use, advanced age, prior GI bleed, non-steroidal anti-inflammatory drugs, steroids and anticoagulants. In patients with a prior GI bleed, the risk of recurrence is high and strategies to prophylactically mitigate the risk should be implemented. In this review, evidence supporting the use of proton pump inhibitors to reduce the risk of recurrent GI bleed is discussed. Recommendations on an appropriate regimen to diminish the risk are provided.
Objective To evaluate the change of geriatric anticholinergic cognitive burden (ACB) over acute admission for fall, fracture, or altered mental status (AMS) with a secondary endpoint of associated 30-day all-cause readmission. Design Retrospective, single-center chart review. Setting An academic, 636-bed level-I trauma and tertiary care hospital in Texas. Patients, Participants Participants at least 65 years of age admitted for acute fall, fracture, or AMS between January 1, 2014, and August 31, 2018. A total of 265 participants were included; average age was 83 years, with 56% female. Main Outcome Measures Change in ACB of home medications from hospital admission to discharge. Results At admission, ACB averaged 2.6 with 43.4% of participants having clinically significant scores, defined as ACB greater than or equal to 3. Overall, ACB decreased by 0.1 by discharge with 63.8% and 13.9% of participants having no change and increases in their ACB over admission, respectively. Clinically significant anticholinergic burden at discharge was significantly associated with 30-day all-cause readmission (P<0.001). Conclusions Anticholinergic burden in older people admitted for fall, fracture, or AMS is not consistently intervened upon in this acute care setting. Strategies to optimize deprescribing in this setting are needed.
Objective: To evaluate third-year pharmacy students self-identified preconceptions about the term "clinical pharmacy" as defined by the American College of Clinical Pharmacy (ACCP) Methods: Third-year pharmacy students were led in a multi-part activity focused on evaluating their preconceptions about the term "clinical pharmacy" after exposure to the unabridged definition published by ACCP. Students were asked to identify two preconceptions before the activity which were dispelled after reading the article. Thematic coding was used to identify semantic themes and generate summaries of student perceptions. Results: Three hundred and twenty-two third-year pharmacy students' assignment data was coded to reveal six major themes about their preconceptions related to the term "clinical pharmacy": 1) setting 2) required training, 3) job responsibilities, 4) scope within the healthcare system, 5) job environment (physical, emotional, financial), and 6) limited knowledge about clinical pharmacy. Consistencies in thought were found within two of these themessetting and required training. Significant variance was seen in the types of activities performed, job environment, the scope of practice, and impact in the healthcare system with the remaining four themes. Conclusion: Identified preconceptions of "clinical pharmacy" by third-year pharmacy students highlight consistent themes related to the exclusivity of where it can be practiced and the need for additional training as a requirement. However, high variability was seen in the majority of the remaining themes, illustrating an inconsistent view of what clinical pharmacy is and the need for intentional focus on professional identity formation within the pharmacy curriculum.
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