Using Technology in Pharmacy Education: Pharmacy Student Performance and Perspectives When Visual Aids Are Integrated Into Learning

Objectives: The role of the pharmacist has evolved and continues to evolve. The traditional role of the dispenser has been replaced with a patient-centered profession. This requires integration and application of pharmaceutical knowledge and skills to solve patient therapeutic problems and advance patient care. Therefore, having evidence-based teaching strategies for learning within pharmaceutical sciences is essential. New and maturing technologies enable traditional principles of pharmaceutical science to be visualized. We aimed to explore pharmacy students' performance before and after visual aids for learning are integrated within pharmaceutical science teaching. Student's opinions and views of the visual aids were determined.Methods: Students were taught about selected pharmaceutical science concepts at two time points; during the second teaching point, visual aids were introduced. Students' performance was compared before and after the implementation of visual aids using pre and post-quizzes. Alongside the post-quiz an evaluation was also completed by the students; a descriptive analysis was conducted for the Likert-type responses and an in-depth thematic analysis of the student's free-text questions was completed using an iterative process.Results: Significant differences were seen between pre and post-quiz sessions for total score and questions that mapped to the revised-Bloom's taxonomy lower and higher categories. Student evaluation of the visual aids were positive. Interesting themes and subthemes emerged regarding the perspectives of pharmacy students to these visual aids. Students indicated visual aids made it easier to understand, compared to written or verbal explanations, and helped with the application of pharmaceutical science concepts. However, a minority of students reported that the visual aids were irrelevant, or they did not understand them.Conclusion: Students had better performance after the introduction of, and favorable responses to, the visual aids. Visual aids were a beneficial tool in regards to understanding and application of complex concepts. Improvements can be made; tailoring accompanying descriptions and using more repetition

Economic evaluation of prescribing conventional and newer oral anticoagulants in older adults.

INTRODUCTION: Anticoagulants refer to a variety of agents that inhibit one or more steps in the coagulation cascade. Generally, clinical conditions that require the prescribing of an oral anticoagulant increase in frequency with age. However, a major challenge of anticoagulation use among older patients is that this group of patients also experience the highest bleeding risk. To date, economic evaluation of prescribing of anticoagulants that includes the novel or newer oral anticoagulants (NOACs) in older adults has not been conducted and is warranted. Areas covered: A review of articles that evaluated the cost of prescribing conventional (e.g. vitamin K antagonists) and NOACs (e.g. direct thrombin inhibitors and direct factor Xa inhibitors) in older adults. Expert commentary: While the use of NOACs significantly increases the cost of the initial treatment for thromboembolic disorders, they are still considered cost-effective relative to warfarin since they offer reduced risk of intracranial haemorrhagic events. The optimum anticoagulation with warfarin can be achieved by providing specialised care; clinics managed by pharmacists have been shown to be cost-effective relative to usual care. There are suggestions that genotyping the CYP2C9 and VKORC1 genes is useful for determining a more appropriate initial dose and thereby increasing the effectiveness and safety of warfarin

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Methamphetamine use and cognitive function: A systematic review of neuroimaging research

Background: Long-term use of MA has been associated with cognitive dysfunction in several domains. Neuroimaging studies have also reported structural, metabolic, and functional changes in MA users. However, no systematic review has been conducted on those studies in MA users that combined neuroimaging and cognitive tasks. Methods: This article systematically reviews correlation between brain imaging measures and cognitive performance in subjects with current and previous history of MA use. Findings are categorized based on cognitive domain. Results: MA users performed more poorly than controls in all cognitive domains (psychomotor, working memory, attention, cognitive control, and decision- making) and a positive correlation has been repeatedly observed between performance and brain measures (regional volume/density, blood flow, glucose metabolism, FA value, NAA level, and activation) in MA users. Performance in cognitive control was consistently reported to show relationship with brain measures in the PFC and ACC, while decision- making consistently showed correlation with brain measures in the PFC, ACC, and striatum. Conclusions: There is solid evidence for brain- behavior relationship in cognitive functioning in MA users, particularly in cognitive control and decision-making. More research with correlation analysis between brain-behavior and MA use parameters is strongly encouraged

Pharmacy student perspectives of interprofessional learning in a simulated ward environment course

Objective. To assess pharmacy students’ opinions of an interprofessional learning (IPL) course in their final year of the Bachelor of Pharmacy program at The University of Auckland. Methods. Pharmacy students participated in the second day of a two-day simulation-based course, WardSim, alongside medical and nursing students in an acute care, hospital ward setting. After finishing the course, all students were asked to complete a questionnaire. The responses of pharmacy, nursing, and medical students on the scaled questions were compared. An in-depth thematic analysis of the pharmacy students’ responses to the open-ended questions was completed using an iterative process. Results. Significant differences were found among the students’ responses regarding the prioritization of care, systematic assessment of patients, and communication strategies. Pharmacy students had less favourable responses regarding the IPL experience than medical and nursing students. However, overall responses were positive. Some of the themes that emerged among the pharmacy students’ responses included: learning communication tools, being assertive in communicating with other health care professionals, and understanding their own and others’ roles in the health care team. Furthermore, some pharmacy students reported feeling underprepared for and underutilized during patient care scenarios. Conclusion. An IPL experience in an acute patient care setting demonstrated clear and beneficial learning outcomes for pharmacy students, especially in regards to communicating and understanding their roles and those of others on their team. Tailoring the pre-work or scenarios for the IPL experience to be more pharmacy orientated and having pharmacy students participate on both days may improve the preparedness for IPL

Investigation of the effects of ‘piperazine-containing party pills’ and dexamphetamine on interhemispheric communication using electroencephalography

Background: ‘Piperazine-containing party pills’ were marketed and sold as legal alternatives to methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA) until 2008 in New Zealand. The major constituents of these ‘pills’ were benzylphenylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP). Despite their popularity, there is a paucity of knowledge about their central effects in humans. This study investigated their effects on human neural processing using electroencephalographic techniques. Methods: A randomised, double-blind, placebo-controlled study investigated the effects of an acute dose of these compounds on the interhemispheric transfer of information (IHTT) using the Poffenberger task. Reaction time data were also collected. Healthy, right-handed males were given an oral dose of either BZP (n = 13) (200 mg), TFMPP (n = 15) (60 mg), a combination of BZP + TFMPP (n = 15) (100 mg/30 mg), dexamphetamine (n = 16) (20 mg), or placebo (n = 23) and tested both before and 120 min after drug administration. Results: A mixed factorial repeated measures analysis of variance of absolute N160 latency and contrast analysis revealed that only TFMPP (F(1,77) = 17.30, p ≤ 0.001) significantly reduced the absolute N160 latency. Analysis of the IHTT revealed that only TFMPP (F(1,77) = 5.266, p ≤ 0.02) significantly reduced the IHTT, while BZP, BZP + TFMPP and dexamphetamine had no effect. Contrast analysis revealed that both TFMPP (F(1,77) = 17.30, p ≤ 0.001) and placebo (F(1,77) = 15.08, p ≤ 0.001) preserved the laterality of information transfer from one hemisphere to the other. Reaction time (p > 0.05) was not significantly affected by any of the drug treatments. Conclusions: The usual directional asymmetry (i.e. faster R-to-L transfer relative to L-to-R) observed in healthy control group was absent following the administration of either BZP, BZP + TFMPP or dexamphetamine. Surprisingly, lateralised hemispheric function was not affected by TFMPP. Our findings highlight how the administration of BZP, TFMPP and BZP + TFMPP leads to changes in the pattern of information transfer

Mycotoxin binder increases growth performance, nutrient digestibility and digestive health of finisher pigs offered wheat based diets grown under different agronomical conditions

The objective of this study was to investigate the effect of a wheat-based diet, exhibiting different levels of mycotoxin contamination and the presence of a mycotoxin binder on growth performance, nutrient digestibility and digestive health in finisher pigs. Sixty-four pigs (38.7 kg (SD 3.48 kg)) were assigned to one of four dietary treatments: (T1) low quality wheat diet, (T2) low quality wheat diet containing 2 g/kg of a mycotoxin binder, (T3) high quality wheat diet, (T4) high quality wheat diet containing 2 g/kg of a mycotoxin binder. The inclusion of wheat was 500 g/kg. The mycotoxin binder used was a Hydrated Sodium-Calcium-Aluminum-Silicate, which also included calcium propionate and calcium formate. The low quality wheat grain had a higher level of zearalenone (233.02 vs. 33.36 μg/kg), aflatoxin (4.08 vs. 2.94 μg/kg) and ochratoxin (28.20 vs. 4.23 μg/kg). Pigs offered the low quality wheat diet had a lower average daily gain (ADG) (P < 0.05), average daily feed intake (ADFI) (P < 0.001) and had a reduced coefficient of apparent total tract digestibility (CATTD) (P < 0.05) of nitrogen (N) and gross energy (GE) compared with pigs offered the high quality wheat diets. The inclusion of a mycotoxin binder improved ADG and ADFI (P < 0.05) and also increased the CATTD of N and GE compared to diets without a mycotoxin binder. Pigs offered the low quality wheat diets had increased (P < 0.05) expression of tumour necrosis factor (TNF) in the duodenum and colon and of claudin 2 (CLDN2) (P < 0.001) in the duodenum, compared to pigs offered the high quality wheat diets. Pigs offered diets containing a mycotoxin binder had increased expression of ghrelin (GHRL) (P < 0.05) in the duodenum compared to pigs offered diets without a mycotoxin binder. There was a wheat × mycotoxin binder interaction on the expression of peptide transporter 1 gene (SLC15A1/PEPT1) and sodium-glucose linked transporter 1 gene (SLC5A1/SGLT1) (P < 0.05) in the duodenum. Pigs offered the low quality wheat with a mycotoxin binder had lower expression of SLC15A1/PEPT1 and SLC5A1/SGLT1 expression compared to the low quality wheat diet only. However, there was no response to mycotoxin binder supplementation with the high quality wheat diet. In conclusion, the low quality wheat reduced ADG, ADFI, nutrient digestibility and modified the gene expression of genes involved in intestinal nutrient transport and inflammation. The supplementation of a mycotoxin binder improved ADG, ADFI, nutrient digestibility and also improved digestive health through increases in nutrient transporter and tight junction gene expression.Department of Agriculture, Food and the MarineDepartment of Agriculture Food and the Marine Research Stimulus Fund; 11/S/122: Feed Evaluation for Accurate Nutritio