The association of atrial fibrillation and resultant thromboembolic stroke is readily recognized in the published literature. However, the identification and weight of other risk factors that increase stroke risk are varied. To predict which patients are at greatest risk for thromboembolic stroke, numerous risk stratification schemas have been developed to guide thromboprophylactic treatment decisions. The well-known CHADS(2) scoring system incorporates risk factors such as congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, and previous stroke or transient ischemic attack. Recently, a novel risk stratification model, CHA2DS2 -VASc, has entered the literature and international guidelines, prompting further review of newly added risk factors-age 65-74 years, presence of vascular disease, and female sex-and the increased allotment of 2 points (vs 1 point in CHADS2) for age 75 years or older. The rationale for CHA2DS2 -VASc, as put forth by its authors, is that other risk assessment models omit important risk factors, have low predictive ability, and categorize too many patients as intermediate risk, leaving the choice of anticoagulant or antiplatelet therapy to the discretion of the clinician. Although CHA2DS2 -VASc readily identifies those patients truly at low risk, it classifies more patients as high risk who would then receive anticoagulation therapy. Therefore, implementation of this risk schema warrants further evaluation, especially when weighing the risk for bleeding and the risk for stroke. This critical review provides practitioners with an understanding of the literature that prompted the inclusion of these new risk factors and increased point allocations, compares and contrasts the risk schemas, and reviews national and international guidelines, thereby equipping the health care provider with the knowledge to aid clinical decision-making.
In 2009, the American College of Clinical Pharmacy appointed its first National Resident Advisory Committee and charged it with making recommendations on how residency programs should foster the development of their trainees as effective educators. Currently, many residency programs offer training in educational methods in the form of teaching certificate programs or additional rotations focused on teaching. However, these programs may not be formalized, and they vary in structure and quality. Moreover, many residency programs lack the resources to provide additional training in educational methods. Given the demand for pharmacists as educators, there is a need to train residents to teach. Therefore, the committee evaluated the literature and generated several strategies to aid in the development of pharmacy residents as educators. The committee recommends that programs should consider adopting principles and methods currently employed by successful teaching certificate programs, using distance-learning technology, increasing training for faculty and preceptors in educational principles and methods, standardizing programs, and developing self-learning and/or self-assessment tools to train residents. As the need for pharmacists to serve as effective educators continues to grow, it will be important for institutions, programs, and professional organizations to invest time and resources in training pharmacy residents and defining a minimal set of criteria to ensure the quality of training.
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