Andrew P. Traynor

Pharmacotherapy of fibromyalgia

PURPOSE Published evidence on the pathophysiology, diagnosis, and treatment of fibromyalgia is reviewed, with an emphasis on recent clinical trials of various pharmacologic agents. SUMMARY Fibromyalgia affects an estimated 2% of the general U.S. population, and its incidence is sevenfold higher among women. The diagnostic characteristics of fibromyalgia are chronic widespread pain, thought to arise from abnormalities of ascending pain and descending inhibitory sensory pathways, and allodynia on palpation of specific tender points. Three medications available in the United States are labeled for treatment of fibromyalgia-related symptoms: the serotonin- and norepinephrine-reuptake inhibitors duloxetine and milnacipran and the α(2)-δ ligand pregabalin. Evidence from clinical trials indicates that all three drugs can have a significant impact on fibromyalgia-related pain; duloxetine and pregabalin have been demonstrated to reduce sleep disturbances and improve quality of life (the former also has been shown to improve mood), while milnacipran can offer significant benefits in reducing fatigue. A growing body of evidence suggests that the best treatment approach may involve the use of one or more agents whose mechanisms of action are aligned with patient-specific clusters of symptoms. Several other agents have been used for fibromyalgia, with mixed results, including tricyclic antidepressants, selective serotonin-reuptake inhibitors, opioids, and gabapentin. Given the limitations of the evidence from clinical trials to date, controlled trials directly comparing different agents are needed to better delineate adverse-event risks, cost considerations, and optimal management approaches. CONCLUSION A broad range of drugs has been used to treat fibromyalgia. Symptoms, comorbidities, adverse effects, and patient preference are important considerations in drug selection.

Guiding Principles for Student Leadership Development in the Doctor of Pharmacy Program to Assist Administrators and Faculty Members in Implementing or Refining Curricula

Objective. To assist administrators and faculty members in colleges and schools of pharmacy by gathering expert opinion to frame, direct, and support investments in student leadership development. Methods. Twenty-six leadership instructors participated in a 3-round, online, modified Delphi process to define doctor of pharmacy (PharmD) student leadership instruction. Round 1 asked open-ended questions about leadership knowledge, skills, and attitudes to begin the generation of student leadership development guiding principles and competencies. Statements were identified as guiding principles when they were perceived as foundational to the instructional approach. Round 2 grouped responses for agreement rating and comment. Group consensus with a statement as a guiding principle was set prospectively at 80%. Round 3 allowed rating and comment on guidelines, modified from feedback in round 2, that did not meet consensus. The principles were verified by identifying common contemporary leadership development approaches in the literature. Results. Twelve guiding principles, related to concepts of leadership and educational philosophy, were defined and could be linked to contemporary leadership development thought. These guiding principles describe the motivation for teaching leadership, the fundamental precepts of student leadership development, and the core tenets for leadership instruction. Conclusions. Expert opinion gathered using a Delphi process resulted in guiding principles that help to address many of the fundamental questions that arise when implementing or refining leadership curricula. The principles identified are supported by common contemporary leadership development thought.

Investigating Student Pharmacist Perceptions of Professional Engagement Using a Modified Delphi Process

Objective. To develop a definition of professional engagement, a list of professionally engaging and disengaging activities, and characteristics of those activities. Methods. A 2-round modified Delphi process was conducted using student pharmacists. The first round captured input while the second assessed agreement using a 5-point Likert scale. Results. A definition was created using the 3 items that reached consensus. All engaging characteristics reached consensus, and 25% (3/12) of the disengaging characteristics reached consensus. Lower rates of consensus were observed for activities, with 78% (7/9) of the professionally engaging and none of the disengaging activities reaching consensus. Conclusion. The findings of this study have implications for creating professionally engaging learning experiences for student pharmacists and suggest that ensuring activities contain certain professionally engaging characteristics may be more important than the activities themselves.

Competencies for Student Leadership Development in Doctor of Pharmacy Curricula to Assist Curriculum Committees and Leadership Instructors

Objective. To assist curriculum committees and leadership instructors by gathering expert opinion to define student leadership development competencies for pharmacy curricula. Methods. Twenty-six leadership instructors participated in a 3-round, online, modified Delphi process to define competencies for student leadership development in pharmacy curricula. Round 1 asked open-ended questions about leadership knowledge, skills, and attitudes. Round 2 grouped responses for agreement rating and comment. Round 3 allowed rating and comment on competencies not yet meeting consensus, which was prospectively set at 80%. Results. Eleven competencies attained 80% consensus or higher and were grouped into 3 areas: leadership knowledge, personal leadership commitment, and leadership skill development. Connections to contemporary leadership development literature were outlined for each competency as a means of verifying the panel’s work. Conclusions. The leadership competencies will aid students in addressing: What is leadership? Who am I as a leader? What skills and abilities do I need to be effective? The competencies will help curriculum committees and leadership instructors to focus leadership development opportunities, identify learning assessments, and define program evaluation.

Student pharmacist perspectives of rural pharmacy practice

OBJECTIVE To evaluate the level of interest of upper-level doctor of pharmacy students in rural pharmacy practice, rural pharmacy ownership, and a proposed rural pharmacy practice model. DESIGN Cross-sectional study. SETTING Minnesota, North Dakota, and South Dakota in October through December 2003. PARTICIPANTS Third- and fourth-year professional student pharmacists at the University of Minnesota, North Dakota State University, and South Dakota State University. INTERVENTION Self-administered questionnaire completed by study participants. MAIN OUTCOME MEASURES Student interest in rural pharmacy practice and potential future directions for maintaining access to medications and the knowledge of pharmacists in rural communities. RESULTS Of 177 respondents, 62.7% has given serious consideration to practice in rural communities with populations of 5,000 or fewer residents. Of these 111 students, 81% would be interested in the proposed practice model explained in the survey. Of the 108 total students expressing interest in the proposed rural pharmacy practice model, 63% had not previously given serious consideration to pursuing ownership (full or partnership) of a community pharmacy. CONCLUSION Students from the schools that have traditionally supplied the majority of Minnesota rural pharmacists indicated an interest in practicing in rural areas as long as opportunities align with their personal and professional interests.

Refinement of strengths instruction in a pharmacy curriculum over eight years.

Objective. To develop, refine, and integrate introductory-level strengths instruction within a doctor of pharmacy (PharmD) curriculum. Design. Over 8 years, student pharmacists completed the StrengthsFinder assessment tool and identified their top 5 Signature Themes (talents). They then participated in either Web-based learning modules or live workshops designed to facilitate professional development. Assessment. Students preferred the live instruction over Web-based learning modules. Post-instruction evaluations demonstrated that students discussed their Signature Themes with peers, preceptors, and family members. Pharmacists working with students in strengths-related activities reported that the students applied the information in the practice setting. Both pharmacists and students recommended that this material be required for all students. Conclusions. Identifying a role in pharmacy that aligns with ones personal talents is critical for the success of pharmacy graduates. Strengths instruction is an important component of professional and career development, and can aid in identifying roles.

Report of the 2010-2011 Professional Affairs Committee: Effective partnerships to implement pharmacists' services in team-based, patient-centered healthcare.

According to the Bylaws of the AACP, the Professional Affairs Committee is to study: issues associated with the professional practice as they relate to pharmaceutical education, and to establish and improve working relationships with all other organizations in the field of health affairs. The Committee is also encouraged to address related agenda items relevant to its Bylaws charge and to identify issues for consideration by subsequent committees, task forces, commission, or other groups. COMMITTEE CHARGE President Rodney A. Carter charged the 2010-2011 American Association of Colleges of Pharmacy (AACP) Professional Affairs Committee with: Examining how AACP and its members can most effectively partner with a variety of key stakeholders to accelerate the implementation of pharmacist services (e.g., MTM, primary care) as the standard for team-based, patient-centered care. Members of the 2010-2011 Professional Affairs Committee include faculty from various colleges and schools of pharmacy as well as pharmacy practice association representatives from the American Pharmacists Association (APhA), the American Society of Health-System Pharmacists (ASHP), the National Association of Chain Drug Stores (NACDS), and the National Community Pharmacists Association (NCPA). In order to fulfill the Committee charge, the Committee members met for a day and a half in Arlington, Virginia in October 2010 to discuss the committee charge and develop a plan of action to address the charge. Following this meeting, the Committee communicated via a series of conference calls as well as personal exchanges via telephone and email. The result is the following report which is positioned to discuss various models of care, challenges and opportunities pertaining to the charge, successful practices of AACP members and multiple pharmacy practice organizations, and recommendations to AACP in response to the Committee charge. BACKGROUND The pharmacy profession has been intransition from a product-based to a patient-centered care model since the introduction of the pharmaceutical care philosophy in the 1990s. (1) This transition has been accomplished to varying degrees in different pharmacy practice settings and has been influenced by a variety of factors including the transition to the clinically-focused Doctor of Pharmacy (Pharm.D.) degree as the entry level degree and the increasing recognition that medication-related problems pose a significant threat to public health. (2) The Centers for Medicare and Medicaid Services (CMS) recognized the importance of medication therapy management (MTM) services by requiring all Medicare Part D plans to provide MTM as part of their programs. Recent healthcare reform (HCR) legislation includes provisions for MTM and pharmacist-provided services as part of integrated team-based care models designed to improve the quality of healthcare delivered in the United States. (4) Pharmacists are well-positioned to serve as the medication therapy expert on the healthcare team. (5) Currently, MTM services are not offered to all patients in all settings. This creates a situation of inequality and fragmentation of pharmacy services. It is imperative that the profession and the Academy accelerate the implementation of patient-centered, team-based care as the standard of pharmacy practice with the availability of MTM services to all patients. This vision has been clearly articulated in the Joint Commission of Pharmacy Practitioners (JCPP) vision for pharmacy practice. (6) Identification of the factors that are impeding the realization of this vision and the development of strategies to accelerate its adoption as the standard of pharmacy practice in 2015 are the focus of this report. With the current HCR legislation, increasing the momentum for implementation of medication management services and chronic disease management services provided by pharmacists is a critical issue for pharmacy practice and education. …

Editors’ Perspectives on Enhancing Manuscript Quality and Editorial Decisions Through Peer Review and Reviewer Development

Objectives. To identify peer reviewer and peer review characteristics that enhance manuscript quality and editorial decisions, and to identify valuable elements of peer reviewer training programs. Methods. A three-school, 15-year review of pharmacy practice and pharmacy administration faculty’s publications was conducted to identify high-publication volume journals for inclusion. Editors-in-chief identified all editors managing manuscripts for participation. A three-round modified Delphi process was used. Rounds advanced from open-ended questions regarding actions and attributes of good reviewers to consensus-seeking and clarifying questions related to quality, importance, value, and priority. Results. Nineteen editors representing eight pharmacy journals participated. Three characteristics of reviews were rated required or helpful in enhancing manuscript quality by all respondents: includes a critical analysis of the manuscript (88% required, 12% helpful), includes feedback that contains both strengths and areas of improvement (53% required, 47% helpful), and speaks to the manuscript’s utility in the literature (41% required, 59% helpful). Hands-on experience with review activities (88%) and exposure to good and bad reviews (88%) were identified as very valuable to peer reviewer development. Conclusion. Reviewers, individuals involved in faculty development, and journals should work to assist new reviewers in defining focused areas of expertise, building knowledge in these areas, and developing critical analysis skills.

Identifying student learning competencies for urban underserved practice using a Delphi process

INTRODUCTION The pharmacy profession has a growing opportunity to provide high-quality patient care to urban underserved patients. The Accreditation Council for Pharmacy Education (ACPE) has also recognized the necessity of training pharmacy students to care for underserved patients within Standard 3.5 in Standards 2016. Despite this recognized need to train students to care for urban underserved patients, there is limited literature to guide schools and colleges of pharmacy in developing learning activities and curricula to meet this need. METHODS This study utilized a three-round modified Delphi process to develop learning competencies. Participation was solicited from pharmacy practice faculty members of the American Association of Colleges of Pharmacy (AACP) Health Disparities and Cultural Competency Special Interest Group (SIG). This study used a proportion of experts rating agree or strongly agree at 80% to determine consensus. RESULTS The expert pool had a combined 235 years of pharmacy practice experience in urban underserved settings. Ten learning competencies were developed and finalized: Identified learning competencies related to the development of pharmaceutical and social knowledge base; development of pharmaceutical care and social skills; and building awareness of benefits and disadvantages of working with urban underserved patient populations. DISCUSSION The learning competencies described in this study provide schools and colleges of pharmacy a tool to help guide learning activity and curricular development to educate students to provide high-quality and compassionate care to urban underserved patients. CONCLUSIONS This study is the first description of practice-based student learning competencies for urban underserved pharmacy practice in the literature.