James S. Wheeler

Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease

Background Chronic obstructive pulmonary disease (COPD) is a chronic and progressive disease that affects an estimated 10% of the world’s population over the age of 40 years. Worldwide, COPD ranks in the top ten for causes of disability and death. Given the significant impact of this disease, it is important to note that acute exacerbations of COPD (AECOPD) are by far the most costly and devastating aspect of disease management. Systemic steroids have long been a standard for the treatment of AECOPD; however, the optimal strategy for dosing and administration of these medications continues to be debated. Objective To review the use of corticosteroids in the treatment of acute exacerbations of COPD. Materials and methods Literature was identified through PubMed Medline (1950–February 2014) and Embase (1950–February 2014) utilizing the search terms corticosteroids, COPD, chronic bronchitis, emphysema, and exacerbation. All reference citations from identified publications were reviewed for possible inclusion. All identified randomized, placebo-controlled trials, meta-analyses, and systematic reviews evaluating the efficacy of systemic corticosteroids in the treatment of AECOPD were reviewed and summarized. Results The administration of corticosteroids in the treatment of AECOPD was assessed. In comparison to placebo, systemic corticosteroids improve airflow, decrease the rate of treatment failure and risk of relapse, and may improve symptoms and decrease the length of hospital stay. Therefore, corticosteroids are recommended by all major guidelines in the treatment of AECOPD. Existing literature suggests that low-dose oral corticosteroids are as efficacious as high-dose, intravenous corticosteroid regimens, while minimizing adverse effects. Recent data suggest that shorter durations of corticosteroid therapy are as efficacious as the traditional treatment durations currently recommended by guidelines. Conclusion Systemic corticosteroids are efficacious in the treatment of AECOPD and considered a standard of care for patients experiencing an AECOPD. Therefore, systemic corticosteroids should be administered to all patients experiencing AECOPD severe enough to seek emergent medical care. The lowest effective dose and shortest duration of therapy should be considered.

Impact of Combination Antibiogram and Related Education on Inpatient Fluoroquinolone Prescribing Patterns for Patients With Health Care–Associated Pneumonia

Background: Previous studies have shown that development of a unit-specific combination antibiogram improves optimal selection of empiric therapy for Gram-negative infections, yet no published data exist regarding the role of the combination antibiogram as an antimicrobial stewardship program tool for disease-specific prescribing. Objective: To evaluate the utility of a combination antibiogram to guide antibiotic prescribing for patients with health care–associated pneumonia (HCAP). Methods: This was a retrospective preprovider and postprovider education intervention study aimed to evaluate fluoroquinolone (FQ) use in patients with HCAP. Data were collected retrospectively to evaluate antibiotic prescribing patterns and patient outcomes. Results: A total of 87 patients were eligible for study inclusion. The primary end point, FQ days of therapy (DOT) was decreased by 2.3 days (P < 0.001). The secondary end point included FQ DOT per 1000 patient-days in patients with discharge diagnosis-related group of pneumonia and was decreased by 83.5 days (P = 0.08); double coverage reduced by 13% postintervention (P = 0.22); mean days of double coverage decreased by 2.1 days (P < 0.001), and length of stay was shortened by 2.1 days (P = 0.22). Clinical success was achieved more often in the postintervention group (90% vs 98%, P = 0.18) when compared with the preintervention group. No difference was found in microbiological outcomes in the subset of microbiologically evaluable patients (P = 0.57). Conclusion: Facility-specific combination antibiograms may be used to inform antibiotic prescribing in HCAP patients.

Opportunities for inhaler device selection in elderly patients with asthma or COPD

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Patient Intelligence 2015:7 53–65 Patient Intelligence Dovepress

Development and implementation of an interdisciplinary pulmonary care clinic within an existing clinic program.

Asthma and chronic obstructive pulmonary disease (COPD) continue to impose noteworthy public health burdens. In the United States, COPD is the third leading cause of death, claiming approximately 138,000 lives annually, while asthma exacerbations contribute to over 1.8 million emergency room visits

Medical marijuana in the United States: Historical perspectives, legal considerations, and professional obligations of the pharmacist

Twenty‐nine states have passed legislation regarding the use of medicinal cannabis, commonly referred to as medical marijuana. Despite the ever‐increasing number of statutes approved by state legislatures, marijuana, whether used for medicinal or recreational purposes, remains illegal under federal law via the Controlled Substances Act. As the majority of states now permit medical marijuana use, pharmacists must be prepared to provide pharmaceutical care for patients who use these therapies, while practicing within the limits of the law. Medical marijuanas historical events, legislative timeline, legal considerations, professional dilemmas, and future implications are reviewed.

The Benefit of Continuing Professional Development for Continuing Pharmacy Education

As the health care environment undergoes rapid transformation, increasing costs paired with technological advancements have highlighted the need for value-based health care services and innovative models of delivery. Simultaneously, the role of the pharmacist is undergoing transformation. Pharmacy graduates are now expected to be able to engage in direct patient care roles via collaborative practice, perform comprehensive medication management, and provide preventive care services. Further, the tenets of pharmacy education, while including preparing and dispensing of product, now extend to all-encompassing pharmaceutical care responsibilities. With these transformations, expectations for ensuring competence have grown.1 To meet these and future challenges, pharmacists must be prepared for continuous learning and growth after earning their doctor of pharmacy degree. Unfortunately, the current continuing education (CE) system does not encourage intentional, individualized plans and may need to be reconstructed to meet the needs of today’s practitioners.2,3 Integrating continuing professional development into the current continuing education structure could transform continuing education into a vehicle that advances both the professional’s practice and the greater health care system. Continuing pharmacy education (CPE) has served as the standard for maintaining professional competence for over 40 years in the United States. Defined by the Accreditation Council for Pharmacy Education (ACPE), CPE is a “structured educational activity designed or intended to support the continuing development of pharmacists and/or pharmacy technicians to maintain and enhance their competence.”4 All 50 state boards of pharmacy, the District of Columbia, Guam, and Puerto Rico require CPE hours as a prerequisite for re-licensure.5 Although specific CPE requirements vary from state to state, the majority of state boards of pharmacy (43 states) require either 15 contact hours [1.5 continuing education units (CEUs)] annually or 30 contact hours (3 CEUs) biennially.5 Twenty-three states specifically require “live” CPE hours, and 17 state boards require specific CPE topics such as law, patient safety, immunizations, HIV, or pain management.5 From a regulatory standpoint, completing the hours-based CPE requirements by definition equals competency. Researchers have debated the impact of continuing education in the health professions in the literature for decades.6 The debate centers around the question, “Does participation in continuing education enable the learner to enhance their practice and ultimately improve health care outcomes?”7 The prevailing evidence suggests the answer to this question is both “yes” and “it’s complicated.” Between 1977 and 2014, 39 systematic reviews were published on the impact of continuing medical education (CME).8 These reviews have consistently demonstrated that CME more reliably impacts provider knowledge and performance versus patient outcomes.8 Further, traditional CE activities (conferences, symposia, lectures) improve participant knowledge but generally have a very limited effect on improving clinician practice and patient outcomes.8 Examples of published practice improvements include screening practices, prescribing, and adhering to guideline measurements. Patient outcome measurements include a broad array of clinical endpoints such as smoking cessation, diet, or blood pressure in patients with hypertension, to name a few.8,9 Specific to the pharmacy profession, studies analyzing individual CPE activities have generally, although not exclusively, shown positive effects on behaviors or patient outcomes,10-16 and one systematic review cited the effectiveness of the majority of CPE programs based on their reported outcomes measures, most often knowledge or skill modification.17 Given the frequency of evidence supporting continuing education outcomes, the ultimate CE research question is not “Is CE effective?” but rather “What kinds of CE are effective?”18 Learning activities that are interactive, use multiple delivery methods (case-based learning, demonstrations, feedback, simulations or patient roleplay), involve multiple exposures, and focus on outcomes considered important by the learner lead to more positive outcomes.18 Other factors that affect performance include audience/room size, shorter versus longer sessions, and complexity of intended behavior.8 ACPE classifies accredited CPE activities as one of three types: knowledge-based, application-based, and practice-based.4 In 2015, almost 90% of the 29,661 CPE activities offered by providers were knowledge-based activities or programs designed for participants to acquire factual knowledge as defined by ACPE CPE standards.4,19 Herein lies perhaps one of the major challenges facing continuing education: the overwhelming majority of activities are knowledge-based programs designed to improve a learner’s knowledge of facts when growing expectations from employers, regulators, and payers call for documented improvements in outcomes. Thus, how can one advance one’s practice in a system dominated by activities designed to improve knowledge? One model that has been proposed to aid learners in achieving goals through education is the Continuing Professional Development (CPD) approach. The CPD Approach ACPE defines CPD as an ongoing, self-directed, structured, outcomes-focused learning cycle focused on maintaining and improving performance of professional practice.20 CPD does not replace CE, but rather enhances CE in a broader approach ensuring pharmacist competence and performance and patient health outcomes.1 CPD exists as a cyclical learning process (Figure 1) where the learner reflects, plans, learns, evaluates, and applies. The determination of learning experience is based on assessment of needs and goals. Central to each step in the cycle is a personal learning portfolio where learners record self-evaluations.20 Open in a separate window Figure 1. The CPD Cycle

Exploring employer job requirements: An analysis of pharmacy job announcements

OBJECTIVES Postgraduate training, dual degrees, and board certifications are credentials viewed by academic pharmacy communities and professional organizations as positive assets for those seeking pharmacist jobs; however, a key question merits further investigation: do these views match employer expectations? The primary objective of this study was to identify the most common qualifications employers require as stated in job advertisements. METHODS Pharmacist job postings from the aggregate jobs website Indeed.com were evaluated for the 20 largest metropolitan areas in the United States. Search criteria included: pharmacist, full-time, and within a 50-mile radius of the metropolitan area. Positions were excluded if they were not pharmacist specific, did not require a pharmacy degree, were part-time, or were temporary. Required and preferred qualifications were collected in the following categories: practice type, experience needed, training, certification, and desired skills. RESULTS Six hundred and eleven of 1356 postings met inclusion criteria. Positions were classified as community (113), health-system (264), industry (149), academia (9), or other (76). Four hundred and six (66.4%) required a minimum of a Bachelors of Pharmacy degree, while 174 (28.4%) required a Doctor of Pharmacy degree. Experience was required for 467 positions (range of 6 months to 14 years). Postgraduate training was required for 73 positions (66 residency/7 fellowship). One job required a Masters degree, type unspecified. BPS certifications were required for 7 positions (1.1%) and preferred for 22 positions (3.6%). Certifications and skills most required by employers were verbal and written skills (248), Microsoft Office proficiency (93), immunization certifications (51), and Basic Life Support/Cardiopulmonary Resuscitation certifications (37). CONCLUSION Postgraduate training, dual degrees, and board certification were not significant factors in the qualification criteria for the positions identified. The qualifications most often required by employers were experience and skills. Our findings indicated that employers wanted many soft skills that cannot be quantified.

Assessing self-assessment practices: A survey of U.S. colleges and schools of pharmacy

OBJECTIVE This study quantifies and describes student self-assessment approaches in colleges of pharmacy across the United States. METHODS Faculty members identified as assessment directors from college websites at U.S. colleges of pharmacy were electronically surveyed. Prior to distribution, feedback and question validation was sought from select assessment directors. Surveys were distributed and recorded, via Qualtrics® survey software and analyzed in Microsoft Excel®. RESULTS Responses were received from 49 colleges of pharmacy (n = 49/134, 37% response rate). The most commonly used strategies were reflective essays (n = 44/49, 90%), portfolios (n = 40/49, 82%), student self-evaluations (n = 35/49, 71%) and questionnaires/surveys/checklists (n = 29/49, 59%). Out of 49 submitted surveys, 35 programs noted students received feedback on self-assessment. Feedback came most commonly from faculty (n = 31/35, 88%). Thirty-four programs responded regarding self-assessment integration including fifteen colleges (n = 15/34, 44%) that integrated self-assessment both into the curriculum and co-curricular activities, while 14 (n = 14/34, 41%) integrated self-assessment exclusively into the curriculum, and five (n = 5/34, 15%) used self-assessment exclusively in co-curricular activities. DISCUSSION AND CONCLUSIONS Student self-assessment is a critical first step of the Continuing Professional Development (CPD) process. Colleges and schools of pharmacy use a wide variety of methods to develop this skill in preparing future practitioners.

Medication Errors and Trainees: Advice for Learners and Organizations:

Limited information exists regarding medication errors and trainees (students or residents). Yet during the experiential education component of their training, learners are expected to assume significant responsibilities in the medication use process. This commentary addresses both trainees and organization leaders on medication safety practices and the incorporation of learners into the organization’s medication safety culture.

Videoconferencing for residency interviews during the Phase II Match

Recent changes in the National Resident Matching Program resulted in an expansion from a one-phase to a two-phase process, thus prolonging the typical pharmacy residency interview cycle. In 2017, 5,752 applicants participated in the Match, with 3,831 candidates matching in Phase I.[1][1] A total of