Background: Reports on using virtual patients to assess counselling skills is scarce. Aim: This paper describes the feasibility and acceptability of assessing patient counselling skills of pharmacy students using a virtual patient simulator.
Description: In this innovative method, a high quality simulator ‘Virtual Patient Learning’ (VPL) was developed at Gulf Medical University (GMU) and was used to assess the counselling skills of 15 pharmacy graduate students. Counselling skills were measured using a four-domain scoring rubric of 1 to 5 marks followed by instant feedback for improvements. Student and faculty satisfaction scores were collected based on the feasibility and acceptability of the assessment method.
Evaluation: The average counselling skills score for all students was 68.4 (85.5%) out of 80 (range 54-76), with a standard deviation of 5.8. The overall student agreement on the feasibility and acceptability of the assessment method was 92.8%; it was 100% agreement for faculty.
Conclusion: The use of a high quality VPL simulator in assessing counselling skills was deemed feasible and acceptable for students and faculty. The assessment was repeated among 30 Doctor of Pharmacy (Pharm.D.) graduates with similar outcomes. The virtual counselling method will be used in the programme exit exams, as well as in students entering their experiential year. Further studies are required to assess its validity and reliability with more students.
Non-steroidal anti-inflammatory drugs (NSAIDs) were differentiated from steroidal anti-inflammatory medicines to help clinicians who needed to use anti-inflammatory agents that were safer than steroids. With market entry of rofecoxib in 1999, NSAIDs were then further classified into traditional NSAIDs and cyclooxygenase (COX)-2 inhibitors (coxibs), the latter posing potentially fewer gastrointestinal risks. In 2005, rofecoxib was withdrawn from the market because of concerns about the risk of heart attack and stroke with long-term use, and clinical practice began focusing more on the cardiovascular versus gastrointestinal safety of coxibs. Since then, many coxibs have remained unapproved by the US FDA or have been removed from the market. This article explains how coxibs refocused attention on the cardiovascular safety of NSAIDs and the general implications of that. COX-2 activity/specificity is one factor associated with increased cardiovascular risks; however, these risks cannot be attributed to coxibs alone. The traditional NSAIDs (i.e., meloxicam, etodolac, and nabumetone) have significant COX-2 specificity, but naproxen and ibuprofen have less specificity. All NSAIDs, whether traditional or a coxib, pose some cardiovascular risks. It is possible that clinicians continue to focus more on decreasing the immediate gastric risks than preventing the later cardiovascular risks. The cardiovascular risks posed by NSAIDs should not be disregarded for the sake of achieving gastrointestinal benefits. Current recommendations suggest NSAIDs should be considered a single class of non-aspirin NSAIDs. Preferred NSAIDs are ibuprofen and naproxen. Coxibs are preferred in patients with low cardiovascular risk and high gastrointestinal risk who are intolerant to anti-dyspepsia therapy.
Background:Intensive care unit is a potential area for drug-related problems. As many of the patients treated are complex patients, clinical pharmacy intervention could find drug therapy problems.Materials and Methods:Drug information liaisons daily attended ward rounds with intensivists and screened the patient for drug therapy assessment using the American Society for Health-System Pharmacists clinical skills competition DTA format. This was a prospective study done for 6 months from August 2012 to January 2013. Simple statistics were used to tabulate the drug-related problems assessed.Results:A total of 72 patients were screened for drug therapy problems, for which 947 drug doses were prescribed in the study period. The total number of prescriptions was 148. The average number of drugs per prescription was 6.39 and the average number of drugs per patient was 13.15. A total of 243 problems were identified; on an average, 1.67 problems were present per prescription. The total number of drug interactions identified was N = 192 (78.2%); majority of them (61.4%) were of type C (not serious). So, 55.73% of them were monitored and not stopped or substituted. The second type of problem was a correlation between drug therapy and medical problem (7.4%). Appropriate drug selection and drug regimen was the third problem, and the adverse drug reactions and therapeutic duplications accounted for approximately 2% of the drug-related problems identified.Conclusion:Drug interactions constituted the major problem of ICUs, but not many were serious or significant. Consensus in assessment of drug-related problems and convincing intensivists with good quality evidences are required for better acceptance of interventions.
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