Alison M. Walton

Canagliflozin, a new sodium–glucose cotransporter 2 inhibitor, in the treatment of diabetes

PURPOSE The published evidence on the pharmacology, pharmacodynamics, pharmacokinetics, safety, and efficacy of a promising investigational agent for managing type 2 diabetes is evaluated. SUMMARY Canagliflozin belongs to a class of agents-the sodium-glucose co-transporter 2 (SGLT2) inhibitors-whose novel mechanism of action offers potential advantages over other antihyperglycemic agents, including a relatively low hypoglycemia risk and weight loss-promoting effects. Canagliflozin has dose-dependent pharmacokinetics, and research in laboratory animals demonstrated high oral bioavailability (85%) and rapid effects in lowering glycosylated hemoglobin (HbA(1c)) values. In four early-stage clinical trials involving a total of over 500 patients, the use of canagliflozin for varying periods was associated with significant mean reductions in HbA(1c) (absolute reductions of 0.45-0.92%) and fasting plasma glucose (decreases ranged from 16.2% to 42.4%) and weight loss ranging from 0.7 to 3.5 kg. More than a dozen Phase II or III clinical trials of canagliflozin in adults are ongoing or were recently completed, but the final results of most of those studies have not been published. Adverse effects reported in clinical trials of canagliflozin include urinary tract and genital infections, occurring in about 10% of patients. Additional and larger Phase III clinical trials to delineate the potential role of canagliflozin and other SGLT2 inhibitors in the management of diabetes (including studies involving the elderly, children, and patients with renal or hepatic dysfunction) are planned or currently underway. CONCLUSION Canagliflozin and other investigational SGLT2 inhibitors have a novel mechanism of action that may offer a future alternative treatment pathway for managing type 2 diabetes.

Survey of pharmacist-managed primary care clinics using healthcare failure mode and effect analysis

Objective The primary objective was to expand upon results of a previously piloted patient perception survey with Healthcare Failure Mode and Effect Analysis (HFMEA), to identify areas within pharmacist-managed clinics needing improvement. Methods The survey was adapted for use in pharmacist-managed clinics. Patients completed the survey following regularly scheduled pharmacist appointments. Data were analyzed with a method adapted from HFMEA. Product scores could range from five to 25. A product of five indicates that pharmacists are doing a good job on the items that patients place the most value on, while a product score of 25 indicates that pharmacists are doing a poor job. A score greater than or equal to ten was used to identify areas for improvement. Results Seventy-one patients completed surveys. Thirteen components were assessed and no item achieved a mean product greater than or equal to ten. The survey item with the highest mean product pertained to discussion of potential medication side effects (mean: 7.06; interquartile range: 5-10). Analysis of each survey item found that all survey items had multiple individual responses that provided a product score of greater than or equal to ten. The survey items most frequently listed in the overall population as being most valued were “Told you the name of each of your medicines and what they are used for”, “Answered your questions fully,” and “Explained what your medicines do”. Conclusions Educational components provided during pharmacist-managed clinic appointments are aligned with patients’ needs and are successfully incorporating the components that patients value highly in a patient-healthcare provider interaction. The HFMEA model can be an important teaching tool to identify specific processes in need of improvement and to help enhance pharmacists’ self-efficacy, which may further improve patient care.

Pharmacy residents as primary educators within a professional pharmacy elective

BACKGROUND AND PURPOSE The purpose of this study was to evaluate the impact of a course change from a faculty-led professional pharmacy elective to a primarily pharmacy resident-led course on student satisfaction and learning. EDUCATIONAL ACTIVITY AND SETTING In 2014, pharmacy residents were transitioned into primary teaching roles in a drug-induced diseases elective to increase student exposure to residents and different teaching styles. Student learning roles did not change. Course evaluations and grades were compared between the resident-led year and prior year. FINDINGS There was no significant difference between overall course grades during the resident-led year (94.2 ± 36.6 in 2014 vs. 94.1 ± 2.7 in 2013; p=0.975). Course evaluations were similar to the previous year and students provided favorable feedback. DISCUSSION AND SUMMARY This pharmacy resident-led elective allowed for resident integration in to an interactive professional elective. Student satisfaction with the course remained similar to the previous year and overall course grades did not differ.

Interactive Web-based Learning Modules Prior to General Medicine Advanced Pharmacy Practice Experiences

Objective. To implement and evaluate interactive web-based learning modules prior to advanced pharmacy practice experiences (APPEs) on inpatient general medicine. Design. Three clinical web-based learning modules were developed for use prior to APPEs in 4 health care systems. The aim of the interactive modules was to strengthen baseline clinical knowledge before the APPE to enable the application of learned material through the delivery of patient care. Assessment. For the primary endpoint, postassessment scores increased overall and for each individual module compared to preassessment scores. Postassessment scores were similar among the health care systems. The survey demonstrated positive student perceptions of this learning experience. Conclusion. Prior to inpatient general medicine APPEs, web-based learning enabled the standardization and assessment of baseline student knowledge across 4 health care systems.

Student-generated e-learning for clinical education.

Within clinical education, e‐learning facilitates a standardised learning experience to augment the clinical experience while enabling learner and teacher flexibility. With the shift of students from consumers to creators, student‐generated content is expanding within higher education; however, there is sparse literature evaluating the impact of student‐developed e‐learning within clinical education. The aim of this study was to implement and evaluate a student‐developed e‐learning clinical module series within ambulatory care clinical pharmacy experiences.

Assessment of Learner Metacognition in a Professional Pharmacy Elective Course

Objective. To investigate the effect of strategic feedback and metacognitive processes on learners’ ability to predict performance and improve self-awareness. Methods. Strategic faculty and peer feedback, as well as self-assessments, were implemented in a professional pharmacy elective course throughout the semester, focused on three case-based oral presentations. After each presentation, students utilized an objective rubric to determine self-predicted and peer-predicted scores. Actual scores from faculty were compared to students’ predicted scores. Results. Students’ ability to predict presentation scores did not improve over time; however, students were able to accurately estimate performance in certain rubric sections on individual presentations (depth of problem, presentation). Students were generally overconfident in predicting their performance. When broken down into tertiles, top performing students were more accurate in their self-assessments compared to bottom performing students. Bottom performing students were highly overconfident in their assessment. Conclusion. Self-awareness is essential for professionals, though difficult to cultivate and improve in one semester. Incorporating longitudinal, continuous feedback and metacognitive skills may help learners become more aware of their own performance and devise a plan for enhancement.

Inter-rater Reliability of a Care Plan Grading Rubric in a Team-taught Pharmacy Therapeutics Case Course

• Changes in U.S. population demographics characteristics require the preparation of culturally diverse competent healthcare providers who are capable of practicing in an increasingly diverse society.1 • Training in cultural diversity competence has been recognized as a pre-requisite to fostering the transformation of healthcare1 • As response, the accreditation agencies of health-related academic programs have included new requirements of implementing cultural diversity competence along the curriculum.2,3 • Although demonstration of students’ cultural diversity competence and multicultural communication skills are required in most of the accreditation standards for healthrelated programs, more evidence is needed to determine the best teaching and learning practices for achieving these competencies.A Program to Foster Global Citizenship in Pharmacy Education. Ana Maria Castejon, Nova Southeastern University, Dawn Dacosta, Nova Southeastern University, Jaroslav Toth, Comenius University in Bratislava, Jan Kyselovic. Objectives: Understanding the practice of pharmacy from a global perspective is not a traditional curricular outcome in most US pharmacy programs. The objective of this CoCurricular activity was to provide students with an understanding, and appreciation for pharmaceutical and medical practices outside the UnitedStates. A total of 35 student pharmacists participated in aTravel Study Program (TSP) to Slovakia during the summer of 2013 at Comenius University in Bratislava, Slovakia. Topics covered included pharmacognosy, molecular drug design, European pharmaceutical regulatory agencies and the practice of the profession in Slovakia and the European Union (EU). Live lectures, laboratory practices at the host institution together with multiple site visits to different professional practice settings were included in the TSP. Through reflective exercises we assessed the students’ ability to: 1. Compare the practice of pharmacy in the US versus Slovakia and the EU 2. Identify the professional benefits of attending a structured pharmacy TSP Method: The 35 students completed reflective academic assignments and cultural competency activities before and after the three-week visit to Bratislava. The students’ reflective exercises were analyzed using narrative and content analysis, allowing us to capture the multiple meanings and dimensions of the experiences. Results: The students’ narrations reflected a major impact on their professional growth, intercultural sensitivity and competencies. Participants identified major differences in legal and regulatory aspects of the profession. They highlighted the establishment of connections and international learning networks. Implications:We believe that these programs promote global citizenship, while fostering learning and cultural exchange within the pharmacy profession.

Evaluating student-pharmacists’ perspectives in medication adherence before and after a pillbox simulation. [abstract]

Objective: The utilization of interprofessional education and collaborative practice delivers optimal health services and improves patient outcomes. Training future healthcare providers in an integrated environment promotes a “collaborative practice-ready” workforce. The aim of this study was to identify ongoing specific interprofessional collaborative projects and promote their awareness among faculty at the St. John Fisher College Wegmans School of Pharmacy. Methods: Faculty members were surveyed to identify the ongoing interprofessional collaborative initiatives among pharmacy faculty. Results: A total of four collaborative practices were identified among faculty: ambulatory care, assistedliving, didactic, and assessment. The ambulatory care setting at an osteoporosis clinic provides patientcentered care with a clinical component. Each patient with a new diagnosis or change in medication therapy receives education/counseling from a pharmacist, a registered nurse for medication administration and a physician for a physical exam. In the assisted-living setting, pharmacy and nursing students are paired to conduct a high-level health assessment in their respective disciplines. Didactic interprofessional efforts are being conducted to create a flexible and comprehensive pain education curriculum. Physicians, dentists, nurses, pharmacists, psychologists, chiropractors, and oriental medicine practitioners will develop the curriculum. The pain module will be adaptable for interprofessional education activities. Finally, recognizing the similarities in accreditation standards for communication and professionalism, the School of Pharmacy and the NY Chiropractic School are sharing strategies and rubrics for assessing these outcomes. Implications: The survey revealed a broader range of interprofessional collaborations than was originally suspected. The school will continue to foster and support interprofessional education and collaborative practice. Disciplines Pharmacy and Pharmaceutical Sciences Comments Poster presented at: • Annual meeting of the American Association of Colleges of Pharmacy in Orlando, Florida, July, 2012. • Faculty Scholarship Celebration at St. John Fisher College in Rochester, New York, October 25, 2012. Abstract is published in American Journal of Pharmaceutical Education 2012; 76 (5) Article 99. https://doi.org/10.5688/ajpe76599is published in American Journal of Pharmaceutical Education 2012; 76 (5) Article 99. https://doi.org/10.5688/ajpe76599 Authors David Hutchinson, Jane M. Souza, Jennifer Mathews, Anthony Corigliano, Katherine Juba, Jill Lavigne, Andrea Traina, Karen A. Bobak, Constance Baldwin, and O.J. Sahler This poster presentation is available at Fisher Digital Publications: https://fisherpub.sjfc.edu/pharmacy_facpub/20 THE CROSSROADS OF INTERPROFESSIONALISM: Four Avenues of Collaboration at the Wegmans School of Pharmacy at St. John Fisher College David Hutchinson, Pharm.D.; Jane Souza, Ph.D.; Jennifer Mathews, Ph.D.; Anthony Corigliano, R.Ph.; Katherine Juba, Pharm.D.; Jill Lavigne, Ph.D.; Andrea Traina, Pharm.D.; Karen A. Bobak D.C. Constance Baldwin, Ph.D.; O.J. Sahler, M.D.

Teaching Residents to Teach: Preparing Faculty and Clinical Educators

A Novel Continuing Pharmacy Education Program: Overcoming Barriers toHealthcare inTransgenderPatients.Kevin Eich, St. John Fisher College, Bernard P. Ricca, St. John Fisher College, Keith DelMonte, St. John Fisher College, Jennifer L. Mathews, St. John Fisher College.Objectives: The Wegmans School of Pharmacy strives to educate and expose students to many topics related to cultural competence, including transgender health. A continuing pharmacy education program (CPE) was utilized to promote a similar opportunity for pharmacists and preceptors. The CPE aimed to educate those currently in practice so they may model the behavior which is reflective of the school’s mission of providing appropriate care and services to all patients.Method: The CPE was offered to any practicing pharmacist, preceptor, faculty or student interested. The first hour included current pharmacotherapy guidelines and counseling tips. The second hour consisted of a panel discussion with local transgender patients. An anonymous, voluntary survey was administered at the conclusion of the presentation and included both demographic and presentationspecific questions. Correlation data from the Likert-Scale survey responses were analyzed using median and Kruskal-Wallis tests. Results: Several significant differences between groups of attendees were found. Preceptors and pharmacists were more concerned than pharmacy faculty about the reaction of their heterosexual patients to creating a transgender friendly environment. Those with previous training about and/or experience with transgender patients felt more capable of promoting a transgender friendly environment and indicated greater understanding of and comfort with transgender-related concepts. Implications: Transgender patients rely heavily on the expertise and accessibility of their pharmacist, but little formalized education related to their healthcare needs has been provided in the past. Within our curriculum students are now provided with these training opportunities. Of equal importance was to also include area pharmacists and preceptors with similar educational tools.

Health literacy and dietary education by pharmacy students within elderly communities. [abstract]

Objective: The utilization of interprofessional education and collaborative practice delivers optimal health services and improves patient outcomes. Training future healthcare providers in an integrated environment promotes a “collaborative practice-ready” workforce. The aim of this study was to identify ongoing specific interprofessional collaborative projects and promote their awareness among faculty at the St. John Fisher College Wegmans School of Pharmacy. Methods: Faculty members were surveyed to identify the ongoing interprofessional collaborative initiatives among pharmacy faculty. Results: A total of four collaborative practices were identified among faculty: ambulatory care, assistedliving, didactic, and assessment. The ambulatory care setting at an osteoporosis clinic provides patientcentered care with a clinical component. Each patient with a new diagnosis or change in medication therapy receives education/counseling from a pharmacist, a registered nurse for medication administration and a physician for a physical exam. In the assisted-living setting, pharmacy and nursing students are paired to conduct a high-level health assessment in their respective disciplines. Didactic interprofessional efforts are being conducted to create a flexible and comprehensive pain education curriculum. Physicians, dentists, nurses, pharmacists, psychologists, chiropractors, and oriental medicine practitioners will develop the curriculum. The pain module will be adaptable for interprofessional education activities. Finally, recognizing the similarities in accreditation standards for communication and professionalism, the School of Pharmacy and the NY Chiropractic School are sharing strategies and rubrics for assessing these outcomes. Implications: The survey revealed a broader range of interprofessional collaborations than was originally suspected. The school will continue to foster and support interprofessional education and collaborative practice. Disciplines Pharmacy and Pharmaceutical Sciences Comments Poster presented at: • Annual meeting of the American Association of Colleges of Pharmacy in Orlando, Florida, July, 2012. • Faculty Scholarship Celebration at St. John Fisher College in Rochester, New York, October 25, 2012. Abstract is published in American Journal of Pharmaceutical Education 2012; 76 (5) Article 99. https://doi.org/10.5688/ajpe76599is published in American Journal of Pharmaceutical Education 2012; 76 (5) Article 99. https://doi.org/10.5688/ajpe76599 Authors David Hutchinson, Jane M. Souza, Jennifer Mathews, Anthony Corigliano, Katherine Juba, Jill Lavigne, Andrea Traina, Karen A. Bobak, Constance Baldwin, and O.J. Sahler This poster presentation is available at Fisher Digital Publications: https://fisherpub.sjfc.edu/pharmacy_facpub/20 THE CROSSROADS OF INTERPROFESSIONALISM: Four Avenues of Collaboration at the Wegmans School of Pharmacy at St. John Fisher College David Hutchinson, Pharm.D.; Jane Souza, Ph.D.; Jennifer Mathews, Ph.D.; Anthony Corigliano, R.Ph.; Katherine Juba, Pharm.D.; Jill Lavigne, Ph.D.; Andrea Traina, Pharm.D.; Karen A. Bobak D.C. Constance Baldwin, Ph.D.; O.J. Sahler, M.D.