Jennifer D. Robinson

Using Human Patient Simulation to Prepare Student Pharmacists to Manage Medical Emergencies in an Ambulatory Setting

Objective. To implement a simulation-based educational experience focused on medical emergencies in an ambulatory pharmacy setting. Design. Second-year student pharmacists were assigned randomly to groups and played the role of pharmacists in a community pharmacy setting in which a simulated patient experienced 1 of 5 emergency scenarios: medication-related allergic reaction, acute asthma attack, hypoglycemia, myocardial infarction, and stroke. The students were expected to use patient assessment techniques to determine which emergency the simulated patient was experiencing and the appropriate intervention. Following each simulation, a debriefing session was conducted. Assessment. Eighty-two student pharmacists completed the simulation activity. Ninety-three percent of student groups correctly identified the emergency. A post-activity survey instrument was administered, and 83% of responders indicated this activity was effective or very effective. Conclusion. Simulation of emergencies seen in an ambulatory pharmacy setting allowed students to assert knowledge, practice communication skills, apply assessment techniques, and work as a team in a low-risk environment.

Diabetes Mellitus, Inflammation, Obesity: Proposed Treatment Pathways for Current and Future Therapies:

Objective To review the pathophysiology, pharmacology, and current or future therapies under study for use in treating diabetes mellitus, inflammation associated with diabetes mellitus, and/or obesity related to diabetes mellitus, through 1 of 4 investigational pathways: adiponectin, ghrelin, resveratrol, or leptin. Data sources A literature search using MEDLINE (1966–December 12, 2009), PubMed (1950–December 12, 2009), Science Direct (1994–December 12, 2009), and International Pharmaceutical Abstracts (1970–December 12, 2009) was performed using the terms adiponectin, ghrelin, resveratrol, leptin, inflammation, obesity, and diabetes mellitus. English-language, original research, and review articles were examined, and citations from these articles were assessed as well. Study selection and data extraction Clinical studies and in vitro studies were included in addition to any Phase 1, 2, or 3 clinical trials. Data synthesis Mechanistic pathways regarding adiponectin, ghrelin, resveratrol, and leptin are of interest as future treatment options for diabetes mellitus. Each of these pathways has produced significant in vitro and in vivo clinical data warranting further research as a possible treatment pathway for diabetes-related inflammation and/or obesity reduction. While research is still underway to determine the exact effects these pathways have on metabolic function, current data suggest that each of these compounds may be of interest for future therapies. Conclusions While several pathways under investigation may offer additional benefits in the treatment of diabetes mellitus and associated impairments, further investigation is necessary for both investigational and approved therapies to ensure that the impact in new pathways does not increase risks to patient safety and outcomes.

Can a new ultra-long-acting insulin analogue improve patient care? Investigating the potential role of insulin degludec.

The basal-bolus concept of delivering insulin to diabetic patients makes physiological sense, as it mimics normal insulin release in people without diabetes. In line with this concept, a major effort put forth by insulin manufacturers has been to develop the ideal exogenous basal insulin product. The perfect basal insulin product would be injected into subcutaneous tissue without causing irritation, release insulin continuously at a constant rate for at least 24 hours, be stable, not contribute to weight gain, have a low risk of allergic reactions and, very importantly, minimize the risk of hypoglycaemia. While the perfect insulin has not yet been discovered, advancements are still being made.Insulin degludec is an ultra-long-acting basal insulin analogue that possesses a flat, stable glucose-lowering effect in patients with type 1 or type 2 diabetes mellitus. Insulin degludec achieves these pharmacokinetic properties by forming soluble multihexamers upon subcutaneous injection, resulting in the formation of a depot in the subcutaneous tissue that is slowly released and absorbed into circulation. Insulin degludec has been associated with slightly less weight gain and fewer nocturnal hypoglycaemic episodes when compared with insulin glargine in some, but not all, clinical studies. This article briefly reviews current evidence for the use of insulin degludec in patients with type 1 or type 2 diabetes mellitus and discusses the potential impact of this new basal insulin on clinical practice.

Telephone Coaching to Improve Diabetes Self-Management for Rural Residents

L ow-cost methods are desperately needed for improving diabetes management for people with diabetes in rural communities. With this understanding, the research team designed a project that used student pharmacists as coaches. High rates of diabetes and its complications in many rural communities point to these sites as diabetes hot spots.1 In Washington States diabetes hot-spot communities, 17% of people > 45 years of age have diabetes on average, compared to 8.6% of people ≥ 45 years of age statewide. In one remote rural community, 40% of the population has diabetes. People in diabetes hot-spot communities also have higher rates of hospitalizations for severe diabetes complications. Controlling diabetes to reduce the incidence of its complications rests largely on individual patients and requires vigorous self-management of the disease.2 Unfortunately, without sustained support, few people achieve their goals or master the tasks that will allow them to live healthfully and reduce their risk of costly complications.3 Telephone follow-up for education and support has been shown to be a cost-effective method for improving healthy lifestyle behaviors in a variety of conditions, including diabetes.4-7 This project tested the use of brief telephone coaching sessions to improve the health of rural residents with diabetes by helping them achieve diabetes self-management goals for regular medical care and adherence to medication, diet, and physical activity regimens. Specifically, the research intent was to determine whether: 1. Participants would be better able to implement self-management tasks and reduce their risk of diabetes complications compared to a historical control group not receiving coaching, 2. Faculty and staff at the Washington State University (WSU) Extension and College of Pharmacy would be able to develop a telephone-coaching program to support additional lifestyle modifications after diabetes education to augment health care in rural areas, and 3. Telephone coaches would be …

Role of colesevelam in managing heterozygous familial hypercholesterolemia in adolescents and children

Background Colesevelam hydrochloride is a synthetic, nonsystemically absorbed polymer that functions as a bile acid sequestrant for the treatment of hypercholesterolemia. Recently, colesevelam was investigated for the treatment of heterozygous familial hypercholesterolemia (HeFH) in the pediatric/adolescent population aged 10–17 years. Objective The purpose of this article is to review the disease state of HeFH in children and adolescents, review the pharmacologic mechanism of action, kinetics, and safety profile of colesevelam, analyze the results of a recent clinical trial of colesevelam in the pediatric/adolescent HeFH population, and discuss the role of colesevelam as a viable treatment option for HeFH. Methods A literature search using Medline (1966–03 May 2010), PubMed (1950–03 May 2010), Science Direct (1994–03 May 2010), and International Pharmaceutical Abstracts (2004–2010) was performed using the search term colesevelam. English language, original research, and review articles were examined, and citations from these articles were also assessed. The manufacturer’s prescribing information and the Food and Drug Administration review of the new drug application for the powder formulation were also examined. Results A 32-week trial was performed investigating the efficacy of colesevelam as monotherapy or combination therapy with a stable statin regimen. Upon completion of the trial, significant benefits were found in regard to the treatment of HeFH and the lowering of low-density lipoprotein cholesterol, total cholesterol, and other secondary measures. Safety and tolerability were also examined throughout the duration of the clinical trial, with adverse drug reactions considered mild in severity. Conclusion Colesevelam has been shown to reduce low-density lipoprotein cholesterol levels significantly in pediatric/adolescent patients with HeFH, while maintaining a mild side effect profile. Although further research would be beneficial for long-term effects in this population, colesevelam should be considered when developing a treatment regimen for HeFH in the pediatric/adolescent population.

Moving from Novice to Expertise and Its Implications for Instruction

Objective: To address the stages of expertise development, what differentiates a novice from an expert, and how the development and differences impact how we teach our classes or design the curriculum. This paper will also address the downside of expertise and discuss the importance of teaching expertise relative to domain expertise. Summary: Experts develop through years of experience and by progressing from novice, advance beginner, proficient, competent, and finally expert. These stages are contingent on progressive problem solving, which means individuals must engage in increasingly complex problems, strategically aligned with the learners stage of development. Thus, several characteristics differentiate experts from novices. Experts know more, their knowledge is better organized and integrated, they have better strategies for accessing knowledge and using it, and they are self-regulated and have different motivations.

Developing Student Pharmacist Leadership Skills Through Core Curricular Modules Addressing the Triple Aim Goals

Objective. To develop, deliver, and evaluate an innovative curriculum designed to increase student pharmacists’ skills and confidence in addressing unmet patient care needs and the Institute for Healthcare Improvement’s (IHI) Triple Aim goals in the community pharmacy setting. Methods. Course modules developed collaboratively between the University of Washington and Washington State University focused on student pharmacist exposure to and direct application of leadership theory in addressing real world challenges. Both programs delivered the curriculum to all second-year student pharmacists during the fall 2015 and fall 2016 semesters. Student teams were asked to identify a new or enhanced service for a community pharmacy based on a needs assessment and the IHI’s Triple Aim goals. Students completed precourse, postcourse, and retrospective assessments of their confidence, comfort level in leadership theory application, and project implementation. Effectiveness of the project pitch and team dynamics were assessed. Precourse, postcourse, and retrospective assessments of individual student progress in leadership, innovation, self-awareness, and professionalism also were completed. Results. For all confidence questions, a significant relationship was found between mean precourse and postcourse scores. A comparison of students’ postcourse scores and their retrospective reflection scores indicated an increase in confidence to lead. At the conclusion of the course, the students reported improved confidence in their ability to communicate decisions (73%), create a vision (64%), and form a guiding coalition (55%). Conclusion. A five-module curriculum with corresponding project proposal successfully increased the confidence and comfort level of student pharmacists’ in their leadership skillset.