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The Ironman 70.3 is done and the baby is still 2.5 months away so I was able to carve out a few hours this week to complete the next module.

This module contains 4 article with the main focus on meta-analysis. The first article is a meta-analysis of perioperative beta-blocker use. The second article is a study of a new combo drug for heart failure, and the final two articles are general information on how to assess and interpret meta-analyses.

The module provides 5 hours of CE, but I completed the whole thing in under 4 hours. The papers were not long and took a little over 2 hours to dig through (not counting the time I fell asleep reading about meta-analyses!) The test this time was 20 questions and took about an hour.

I feel like the test this module was a little tougher than module 1A. I missed no questions in 1A, but did end up missing a few here in 1B. You can miss 5 and still pass, so I was OK there. I do wish they would at least let you know what questions you miss as I think this would be the greatest learning opportunity. I know they probably cannot tell us the correct answers, but at least let us know what we missed so we can review the articles to see if we misinterpreted something. Otherwise, I think this was a good module that will improve my knowledge base. 
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I am delighted to update you on exciting efforts to transform AJHP and to outline the roadmap to achieving that transformation that will unfold over the next several months. As we build on the extraordinary legacy of exceptional efforts of AJHP’s past editors in chief C. Richard Talley, William A. Zellmer, George P. Provost, and Donald E. Francke, we are moving quickly to ramp up delivery of new cutting-edge content, expand reader engagement and introduce innovations to enhance the print and digital experience.

In January 2015, Dr. Daniel Cobaugh became the fifth editor-in-chief of AJHP in its 72-year history. He brings his experiences as a researcher, author, and pharmacy leader to the editor role. In the March 15, 2015 issue of the Journal, Dan described his vision for ensuring that AJHP is recognized for its relevance and impact in the complex 21st century healthcare system.

I hope you’ve noticed the enhancements to the AJHP editorial page that reflect Dan’s vision; they are really extraordinary! When the next table of contents arrives in your email box or the print version of the Journal arrives at home, turn to the editorial page to read thoughtful scientific, clinical, patient care-oriented, and public health discussions on some of the most complex topics that confront us as we work to provide the best care for our patients.
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Hello everyone!  May has been a whirlwind month for me with final grades being due, commencement ceremonies, then 2 weeks in Ireland/UK with students learning about pharmacy and healthcare in those countries. And to top it off, I'm heading out of town to a family high school graduation this weekend! Needless to say, I found it a challenge to find time to do recertification credits. Fortunately, I found a few hours to try out a new recertification product from ASHP: Intensive Study A (Pharmacogenomics).  As a reminder, as an ASHP Recertification Ambassador, the recertification products were provided to me for free, but the opinions below are entirely my own.

If you've never done an Intensive Study (like me before this one), here are the details: the presentations were recorded live at an ASHP meeting (Midyear, in this case), and you have access to a pdf of the handouts and the video.  There were 2 videos associated with Intensive Study A, both on Pharmacogenomics, with the first one being under 1 hour and the second being just over 90 minutes.  You don't see the speakers in the videos, just the slides, and there's no way to "speed up" the videos (I work in academia- I know the students do it!).  However, I'm not sure I would have wanted to speed up these videos since they cover some detailed material that is not completely familiar to me.  After you watch the videos, then you take the assessment test.
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I am (now!) a fourth year student pharmacist at the University of New Mexico College of Pharmacy.  I am honored to say that I am one of the students accepted for the 2014-2015 ASHP Student Leadership Award. 

As a requirement for the acceptance of our award we are asked to post our application essay about our ideas for increasing awareness and understanding of the Pharmacy Practice Model Iniative among our fellow students.  I am excited to post my essay for you and look forward to your ideas on the subject.

Please feel free to make any comments or suggestions!  Thank you.

ASHP Student Leadership Award Application Essay

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Mind Tools Club in How to Manage Rivalry in the Workplace has the following advice for leaders.

  • In the workplace rivalry is when individuals compete with another person rather than focusing on attaining the results needed
  • The more similar people are the more likely they are to become rivals especially if they have similar jobs
  • Healthy rivalry can bring out the best in people as long as it doesn’t get out of hand.
  • Strategies for managing rivalry
    • Look for signs of unhealthy rivalry such as frequent arguments, gossip, rumors or do they focus on the others shortcomings
    • Meet with your people because ignoring it won’t stop it. Meet with rivals individually to get each perspective keeping them focused on the facts not their frustrations. Describe how their negative behavior is affecting the group and the consequences of it continuing. Suggest ways to resolve the conflict.
    • Establish clear boundaries because sometimes if roles are poorly defined people step on each other.  Be sure you have clear job descriptions that are understood by everyone.
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My apologies in advance if I am positng in the wrong place.  It is my first time blogging.  I am a pharmacist for a rural hospital.  I currently visit with patients and perform medication reconciliation and medication education for our patients in the hospital.  In the February 2015 issue of Pharmacy Practice News, an article discussed billing for MTM services in the hospital.  Does anyone know how your billing department/financial goes about doing this?
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ASHP BCPS Recertification Module 1B Review

The clinical literature can be overwhelming at times.  A few clinical studies might tout the benefits of a medication, only to have several other trials contradict the initial trials’ results.  A meta-analysis is a useful way to look at sufficient detail of the trees (trials) to determine what clinical conclusion the forest plot (meta-analysis) provides.  Meta-analyses are becoming increasingly popular. It is important for pharmacists to understand how to interpret meta-analyses and not immediately accept the author’s conclusions.

This BCPS recertification module focused on cardiology and meta-analyses.  It was composed of two meta-analysis review articles, one meta-analysis, and one cardiology randomized controlled trial.  The meta-analysis was interesting, as it was conducted to challenge a national guideline recommendation and SCIP measure that is followed by hospitals across the country.  It was a well written meta-analysis that gave the added benefit of helping me stay current with the literature.  A definite bonus!

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General : Ambassador, BCPS, Cardiology, MetaAnalysis, Recertification

Have you thought about volunteering with the medically indigent population? If you haven’t had a chance to do so, I would strongly encourage you to find a free health clinic in your area and give it a try. This semester, I had the opportunity to volunteer at the University of Kentucky Salvation Army Clinic (UKSAC): a free clinic run by medical and pharmacy students. UKSAC opened in 1986 to offer care to the uninsured adult population in Lexington. This leadership effort allows underserved patients to have access to free group smoking cessation classes, individualized care, and medications.

My experience at the Salvation Army Clinic was very enriching. It made me realize how important our help is to the underserved population and how interprofessional work can optimize patient outcomes. Having the opportunity to collaborate with other healthcare students/professionals and help assist in the clinical decision making process was very rewarding. Not only was I able to utilize my knowledge but I also had the chance to apply my clinical skills to suggest ways to optimize some of the patients’ treatments.

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(Written by Allie Sturm Vecchiet*) Have you ever experienced change? Have you ever had to stand before teams that are indifferent, or even hostile, and convince them that change is necessary? In light of the changes to healthcare and pharmacy practice recently, it is very likely that we have all experienced some type of change in our workplaces. Were you successful or prepared to handle or deal with that change?

 Stacking the Deck, written by David Pottruck, is for all leaders facing major change in their organizations. Pottruck presents a 9-step course of action to follow from assembling the right team and communicating the situation. Pottruck based the 9-steps on his experiences leading change as CEO of Charles Schwab. He emphasizes that while success is never guaranteed, the right leadership, process, and team can make all the difference.

 Listed below are Pottruck’s 9 steps and key actions to apply each of the steps to your practice.

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I'm a guy, she's a girl.  I'm a pharmacist, she's an artist.  I'm into sports, she writes songs about not being into sports. We have a lot of similarities.  Ok maybe not but we have at least one thing in common...we both get excited to teach.

It was about a year ago when I decided I was just like Taylor.  My wife and I were watching the Voice and she was a guest mentor.  She seemed very excited to be there helping the young artists who were trying to find their way.  She gave pertinent, valuable advice that you could tell helped the singers when they went on stage.  I found myself watching Taylor and smiling because I get that same feeling of excitement when I get to help out my students who are preparing for their stage - pharmacy pracactice. 

Precepting students is one of the main reasons I became board certified.  I feel they need up to date, accurate, evidence-based information when they are on rotation and BCPS helps me (forces me) to be that for them.  The ASHP Literature Study module has been a really good way to stay up to date.  I feel drug literature is a cornerstone of clinical pharmacy practice and this module really shores up any deficiencies you may have
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For those of you accustomed to my verbose ramblings, this one should be a relief.

I would like to encourage our profession to develop more precision in our speech. In the 40 years I have been in practice (good heavens!) and the 28 years I have been in industry, I have found myself constantly amazed at the lack of precision in our speech, and the resulting confusion we create within those who lack the context to figure out what we mean.

For example, consider the word "drug":
  • Sometimes we use it to mean a chemical therapeutic entity
  • Sometimes we use it to mean a commercial pharmaceutical product
  • Sometimes we use it to mean an abstraction of all commercial products that deliver the same medication in the same amount in the same doseage form

Typically, if most of us listen to the conversation long enough, we can figure out how the speaker intends us to interpret the word in this particular conversation. But that is highly dependent on our outlook and our experience.

It gets even more confusing when we treat different concentrations of the same chemical entity as if they were different drugs. For example, we often treat treat 0.9% Sodium Chloride as if it were a completely different substance than 3% sodium chloride.

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Pharmacy Informatics Reporting Structure:  Pharmacy or the Health Care Information Services Department?

Trinh Le

Change.  It’s inevitable in an academic medical center.   I have reported to five different managers and have seen a lot of organizational changes and restructuring.  Two years ago, we selected a new electronic medical record vendor for our health system.  This decision brought a shift from a local support model to a health care system support model.  During the contractual negotiation, resource requirements were discussed and the transition began from supporting the pharmacy department at one hospital to an integrated support model to convert the existing EMR.

I “volunteered” as one of the many resources that were requested.  After our implementation, it became official that the pharmacy support team would transition to the health care system information services department (ISD).  The official transition from pharmacy to ISD was about 9 months ago.  So taking a pulse check, I can say it has been a good transition.  Here are the unexpected good and the not so good parts of my transition.

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The Mind Tools’ Club Beware The Mid-Career Slump Bouncing Back From a Career Plateau has the following advice for us.

  • Realize that job satisfaction is U-shaped over time as you start and end your career on a high while slumping or plateauing in the middle.
  • Stop and think about how you felt at the beginning of your career as chances are your were excited about the possibilities that lay ahead and keen to develop your skills and expertise. You were also probably full of ideas and ambitious goals.
  • Towards the end of your working life there is a good chance that you will feel satisfied and rewarded by how far you have come and looking forward to your next stage in retirement.
  • So where does this leave people in the middle having established their careers but are a long way from retirement?  They can experience a drop in their level of motivation and enthusiasm and they might struggle to find their work as exciting as when they began.
  • Recognize that you have a mid-career slump if you experience some of these signs
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Having nearly completed my PGY2 in Emergency Medicine, I realize while my knowledge of topics pertinent to EM have made quantum leaps throughout the year - I had not realized how my knowledge in other areas had dwindled so rapidly.  I consider my 'system' of keeping up with the literature to be sufficient (previous blog post link) and, in general, Emergency Medicine covers a breadth of clinical topics compared to other specialties.  I have begun to realize what my preceptors had warned me about just a few years prior... New drugs keep coming onto the market.  My epiphany occurred when discussing a patient admitted for hypoglycemia who was prescribed a plethora of oral anti-hyperglycemic medications.  The EM intern asked about the drugs on the list and how they worked.  A fairly simple task that I felt adequately prepared to handle; that is until I happened upon "#@^&$gliflozin".  Took a quick peak in my mobile drug reference and glanced at the medication class "SGLT2 Inhibitor".  Perplexed look ensued.
What I love about my Emergency Medicine residency is how often this year I have said "I don't know".  This was another instance of countless episodes of the show affectionately referred to by members of the ED staff as, "Cole Doesn't Know Now, But He Will Know Soon" (followed by 
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So I actually set down tonight and started the Literature Study Module for BCPS re-certification. I was pleasantly surprised once I completed the statement of attestation and the activities were opened up to me. Instead of reading and reading to learn, the literature study modules let you analyze articles that are pertinent and new in the area. The modules provides you the article to read and assess using guided questions. While I have not made if far in the articles, I find it refreshing to have a way to re certify that is active and requires more than just sitting and reading. I have to critically analyze the articles provided and I refresh my statistics skills while learning the most update information in cardiology. I view that as a win-win situation!
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General : ASHPCerts

I haven’t gotten as much done this month as I had planned… but I had an amazingly awesome time at the ASHP Pain and Palliative Care Traineeship!!  I will refocus on the BCPS Ambassador program next month.

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Well, April is in full swing in the mid and deep south. There has been a strange, solid yellow wind over the lovely bluff city of Memphis the past few weeks. With this inspiration, and being an allergy/asthma sufferer myself, I decided to try out the COPD and Asthma review module this month. I have definitely seen an increase of cases of COPD exacerbations in our Emergency Department as of late. Time for a refresher. 

The module consisted of 4 fairly recently published articles from NEJM, Respiratory Research (a new journal to me), and, my all time favorite, the Lancet. The articles themselves were of a manageable length to review when you have an hour or so to take a look at them for a little light, in-depth, reading. The topics themselves, 2 of which pertained to IV/nebulized magnesium sulfate for acute asthma exacerbations, are quite relevant to some budding topics in clincal treatment today. I have recently overheard our residents and clinical specialists discussing these topics, so the module is spot on with choosing the most current literature for review. Practicing in an emergency department, we definitely use a combination of inpatient, ambulatory, and community knowledge to assist our teams in their every need. You must become a "jack of all trades" as it were. Having been out of the community setting for almost 2 years, and only one ambulatory care rotation as a student that focused on diabetes and anticoagulation, I greatly appreciate this mix of topics. 
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The May 1 issue AJHP features Susan Winckler’s 2014 Zellmer lecture, titled “The Intersection of Public Policy and Professional Responsibility.” I highly recommend that all pharmacists read this paper and ponder its implications as we enter a new era of health care.

Winckler describes pharmacy’s historical approach to law and regulation and compares our profession’s approach with that of medicine’s. She notes that pharmacy has chosen a detailed road map seeking detailed and specific permissions, “In defining the pharmacist’s scope of practice, our profession has chosen a very detailed, step-by-step structure that can be quite restrictive… But if a certain activity isn’t explicitly authorized, I may not engage in it on my own, even if it’s in the best interest of my patient.” Whereas other professions, notably medicine, provide wide discretion, “Other professions have taken a different approach: state medical practice acts, for example, tend to be far shorter than ours and provide physicians wide discretion in how to best care for their patients. In a nutshell, they define the practice of medicine as ‘everything you do to care for a patient.” She closes her lecture noting that “In the evolving healthcare system, the road is opening up a bit for us—requiring more individual engagement to stay within the guardrails and increase our speed, but with the opportunity to better contribute to patient care.”

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I want to thank each and every one of you for giving me the opportunity to be KCHP president this last year… because if nothing else, it gave me a captive audience for my Twilight Zone geeky obsession! Thank you to everyone who read those articles. I’m sure Jeff will have his own theme he’s ready to roll out, so get ready…

A year ago, I stood before you and gave what was probably the longest inaugural speech on record… Don’t worry, I won’t repeat that today…

But I want to remind you of one of the statements in that speech. I quoted Don Francke, who said it in 1964 when he released the findings of the study “The Mirror to Hospital Pharmacy.” The statement is:

The survival of pharmacy as a profession rests to a major degree on Health-System Pharmacists.

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What a month! Maybe it’s the warmer weather and sunshine skewing my perception of time, but I swear the days have been flying off the calendar this month.  Is it really almost May??

I was lucky enough to travel to Japan week before last and spend some time in Tokyo, at Mt. Fuji, and in Kyoto. (Do yourself and favor and make the trip one day!!—such a beautiful country, great food, and the friendliest people). But between the trip, recovering from jet lag (not that I’m complaining), work, and the anticipation of my very-soon-to-be-born nephew (‘very soon’ as in tomorrow), I have struggled to get through a single learning module! But that’s life, right? There is always something more pressing, more exciting, more important fighting for your time. I know I am preaching to the choir. A lot of you have far more responsibility than I could imagine, and you work hard to balance and stay on top of it all.

That’s one of the great things about ASHP’s recertification program. You can go at your own pace, working through the modules and completing them as you have time. And with this module, as I’m sure it will be with all of them, you are given the information you need to prepare and complete it successfully.

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