Each May, on behalf of the Office of Provost and the Faculty Mentoring Institute (FMI), faculty are invited to present and attend the Annual MCPHS University Faculty Scholarship Showcase & Reception. This institute was established in 2010 to support faculty development, celebrate scholarly achievements, and share ideas. Two submissions in each of the Boyer Scholarship categories are recognized for their excellence based on the following:
• Project/study goals are clearly stated.
• Methods are clearly described and appropriate for the design and goals.
• Results of the project/study are clearly stated.
• The author's conclusions are appropriate for the design of the project/study.
• Conclusions provide insights to the field.
The Showcase also highlights the achievements of faculty who were awarded MCPHS Intramural Grant funds the past year.
Each spring, the Showcase seeks submissions from any faculty or staff member who was accepted to present a podium presentation or poster at an international, national, or regional professional conference in the past year and for articles accepted for publication in peer reviewed journals, published books, or book chapters.
Carroll-Ann W. Goldsmith, School of Pharmacy-Worcester/Manchester
Cheryl A. Abel, School of Pharmacy-Worcester/Manchester
ABSTRACT: Project/Study Goals. The objectives of this pilot study were to assess refugees’ understanding of the U.S. pharmacy system and to develop and determine whether an educational workshop designed to introduce basic pharmacy concepts to refugees improved their understanding of the U.S. pharmacy system. Methods. A workshop and survey on the U.S. pharmacy system were developed for and delivered to refugees resettled in NH. Participants were enrolled in an English for speakers of other languages (ESOL) program at a U.S. Committee for Refugees and Immigrants-affiliated institute. The same pharmacy student delivered the 60-minute workshop to 3 different groups of participants (n=59) and included a slide presentation, interactive activities, and a demonstration. Comparison of pre- and post-workshop survey responses was conducted for: knowledge-based questions about the U.S. pharmacy system; ability to interpret a medication label pictogram; and comfort level and willingness to speak to a pharmacist. Results. Post-workshop significant increases were seen in: awareness that identification is needed when filling a prescription, that prescription medication labels have refill information, and that a translator can be requested in U.S. pharmacies. Participants who had not used a U.S. pharmacy before the workshop showed significant improvement post-workshop in mean percent correct responses to knowledge-based questions. Participants who were in the U.S. for less than 3 months showed significant improvement in mean correct responses to knowledge-based questions post-workshop. Comfort level and willingness to speak to a pharmacist were not significantly increased post-workshop. Conclusions. Participants who were in the U.S. for the least time and those who had never used a U.S. pharmacy showed significant increases in understanding specific aspects of the U.S. pharmacy system after an educational workshop. Participants’ comfort level and willingness to speak with a pharmacist did not change post-workshop regardless of length of time in the U.S. Significance. While the U.S. provides sanctuary for tens of thousands of refugees each year, limited description of work to assist refugees as they negotiate the U.S. healthcare system has been reported. Of the reported work, most was conducted with refugees who were settled in the U.S. for some time, rather than newly resettled persons, and was not pharmacy-specific. As it is likely that many pharmacists will encounter refugees in practice and that many of these refugees will be recently resettled, information about the abilities of these refugees to navigate the U.S. pharmacy system is useful to practicing pharmacists.
Kathleen O’Leary, School of Optometry
Anne Reuter, School of Optometry
ABSTRACT: Project/Study Goals. Our goal of this study was to determine if additional vision screening tests that are not required by the State of Massachusetts are helping to identify children with binocular vision dysfunctions, significant refractive errors or abnormal ocular health findings. Specifically, MCPHS conducts additional vision screening tests that are not required by the State of Massachusetts. We want to see how many students passed the required state vision tests, but then failed one or more of the additional tests performed at these screenings. This will help us to determine what specific tests are the most sensitive in identifying children with vision problems. Methods. Over the 2015-2016 academic year, school vision screenings were conducted. At each vision screening, 4-5 optometry students and 1 faculty member participates in the screenings. The students who are selected to participate in the vision screenings is determined by the school nurse. The tests performed that were required by the state of Massachusetts. Each test has certain pass/fail criteria that was collected on every child screened. The results of each test, along with the age of the student, grade and gender were recorded and stored for comparative data analysis. Results. Data was analyzed on 400 students that were screened. Of these 400 students, 275 (69%) passed both what was required by Massachusetts and the additional tests that MCPHS performed. 85 (21%) students failed one or more of the Massachusetts required tests. 40 (10%) students passed the Massachusetts vision screening requirements, but failed one or more of the additional tests that MCPHS conducts. The majority of these 40 students failed retinoscopy (45%), followed by cover test (17.5%) and color vision (17.5%). All students who failed color vision were males. One student failed both retinoscopy and cover test. Additional reasons students failed included appearance of a large c/d ratio, anisocoria, subjective complaints of floaters, and poor/jerky extraocular muscle movements. Conclusions. In addition to the Massachusetts Vision Screening protocol, MCPHS will going continue to do retinoscopy and cover test on all students. We will consider conducting color vision only on males. The rationale behind this conclusion is that retinoscopy can pick up uncorrected refractive errors that could be causing vision problems; cover test can pick up intermittent strabismus, higher exophoria and esophoria that would otherwise go undetected if stereopsis was the only form of binocular test being conducted, resulting in a higher yield of visually impaired students during screenings, while cutting down on absolute time needed to screen each child (as compared to MCPHS's extended protocol above). Significance. We can share this information with other eye care professionals that conduct school vision screenings so that they know which tests pick up significant vision problems. These eye care professionals will be able to conduct school vision screenings more efficiently. Also this information can be shared with school nurses who also conduct school vision screenings. This information will also helps states that do not have clearly defined laws on school vision screenings.
Brian E. Rittenhouse, School of Pharmacy-Boston
Tewodros Eguale, School of Pharmacy-Boston
Alissa Segal, School of Pharmacy-Boston
Joanne Doucette, Library & Learning Resources
ABSTRACT: Project/Study Goals. Clarify ambiguous and conflicting conclusions of a published Diabetes Prevention Program (DPP) and DPP Outcomes Study (DPPOS) cost-effectiveness study of placebo, metformin, individual and group lifestyle (ILS and GLS) interventions and indicate the degree of uncertainty around them by performing a probabilistic sensitivity analysis (PSA). Methods. We took various costs (inside and outside DPP) and effectiveness (QALYs - quality adjusted life years) numbers from the original publication and reproduced the original deterministic ICER (incremental cost-effectiveness ratio) results. We then explored how the significant ambiguity of the original paper’s conclusions could be clarified by using standard concepts of a net benefit (NB) formulation and the cost-effectiveness plane. We also explored uncertainty through a PSA (probabilistic sensitivity analysis), assigning probability distributions for costs and outcomes and doing a simulation, producing net benefit results for each set of drawn values and constructing cost-effectiveness acceptability curves and frontiers (CEAC/Fs). Results. Analysis clearly indicated GLS dominates or is cost-effective relative to the other three interventions for conventional maximum WTP (willingness to pay) thresholds (<$50,000/QALY). If GLS is eliminated as an option, ILS is optimal, ICER= $19,433. Metformin is only cost-effective if the WTP is unrealistically low (<$1585/QALY). The PSA and CEAF show that GLS probability of being cost-effective varies, but it is the clear optimal choice throughout (and beyond) a wide range of “reasonable” WTP values ($10,000 – $50,000/QALY). Its probabilities of being cost-effective, indicating uncertainty, but not optimality, are .68, .55 and .50 for WTP values of 10, 50 and 100K/QALY. Conclusions. The original paper's ambiguous/conflicting conclusions (e.g. “policies should support the funding of intensive lifestyle and metformin interventions”) obscure the simplicity of the results. The value of various depictions of deterministic and probabilistic results is shown by clarifying the original results – if these data reflect the performance of the interventions accurately, GLS is the cost-effective alternative in diabetes prevention. From these data, contrary to the original article, there is no place for metformin in diabetes prevention. Significance. The relatively young field of economic evaluation of health care technologies has made significant strides in the past 15 years in both methods and particular ways of presenting results. Informal standards have evolved, in some cases becoming formalized (e.g. in national health care systems like in the UK). These methods are critical in formulating and presenting proper policy-relevant results. Our research shows how proper methods and presentation of results may clarify what has previously been presented in ways that are confusing and likely to lead to different (and incorrect) policies and prescriptions in diabetes prevention.
Hongwei Zhang, PhD, School of Pharmacy-Boston
ABSTRACT: Project/Study Goals. Piperlongumine (PL) is an alkaloid isolated from the Piper species, which has a selective cytotoxicity to cancer cells as well as an inhibitory effect on growth of tumor. The poor aqueous solubility of piperlongumine has limited its further investigation and potential therapeutic application. Nanotechnology is an amazing approach to overcome the poor water solubility of lipophilic drugs. The objective of this study was to enhance the aqueous solubility of PL and to investigate the cytotoxicity effect of nanosized PL on prostate cancer cells. Methods. Cationic liposomes were prepared using a thin film hydration method followed by water-bath sonication. PL liposomal formulations were characterized in terms of the particle size, size distribution, surface charge, encapsulation efficiency and drug loading efficiency. The physical stability of the formulations at 4 °C were studied for up to three months. The solubility of PL in aqueous medium and in liposomal formulations were determined using HPLC. The in vitro cytotoxicity liposomal PL formulations to human prostate cancer PC-3 cells were determined using a commercial cell proliferation assay kit. Results. Nine different PL-containing liposomes were prepared. They have average diameters ranging from 102nm to 160nm with the PDI ranging from 0.24 to 0.3. Their surface charges range from 18 mV to 26 mV. All of these formulations have a high encapsulation efficiency around 98% and a low drug loading efficiency around 3%. The liposomal formulations have significantly increased the apparent aqueous solubility of PL by 10 times. The PL-containing liposomes remained stable during storage for three months. The IC50 of liposomal PL was around 23 uM, which was significantly lower than that of free PL in PC-3 cells. Conclusions. Nanoliposomal formulations markedly increased the solubility of PL in physiological solution. The optimized PL liposomal formulations exhibited high encapsulation efficiency, good stability and enhanced cytotoxicity toward human prostate cancer cells. Our study for the first time shows that the solubility issue of PL can be effectively addressed by nanoliposomes. The results of this study guarantee the investigation of the anti-tumor effects of PL liposomal formulations in animal experiments. Significance. Although PL is a very promising compound for cancer therapy, it is very difficult to intravascularly administer the compound to animal models of cancer due to its very poor aqueous solubility. Nanoliposomal formulations of PL dramatically improved its aqueous solubility and anti-cancer activity in vitro, which makes it practical to systematically investigate the compound in tumor-bearing animal models.
Rania A. Mekary, School of Pharmacy-Boston
Timothy R. Smith, School of Pharmacy-Boston
ABSTRACT: Project/Study Goals. The study goal was to assess the efficacy and safety of venous thromboembolism (VTE) prophylaxis among brain tumor patients undergoing craniotomy. Methods. A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that were RCTs and reported on efficacy or safety outcomes among adult brain tumor patients who underwent a craniotomy and were randomized to a prophylaxis type were selected. A pooled weighted average was calculated using the fixed- and random-effect models and depicted in Forest Plots. Heterogeneity was tested by I2 and Cochrane Q-test. Heterogeneity sources were explored by subgroup analysis or meta-regression. Publication bias was assessed via Funnel plot, Egger’s, and Beggs’ tests. Results. Patients on various prophylactic measures had a 39% lower thrombosis risk compared to controls (RR=0.61; 95%CI=0.47–0.79; P-heterogeneity=0.19; I2=28%; n=10 RCTs; fixed-effect model). Subgroup analysis indicated that unfractionated heparin alone showed a lower VTE risk than placebo (RR=0.27; 95%CI=0.10–0.73) and LMWH combined with mechanical prophylaxis showed a lower VTE risk than mechanical prophylaxis alone (RR=0.61; 95%CI=0.46–0.82); (P-interaction=0.04). Bleeding risk was higher comparing different prophylactic measures to different controls (RR=2.02; 95%CI=1.14–3.58; P-heterogeneity=0.86; I2=0 %; n=5 RCTs). While the risk of major hemorrhage was not increased by chemoprophylaxis, an increased risk of post-operative, minor hemorrhage (RR=2.20; 95%CI=1.00-4.85) was observed. Conclusions. This meta-analysis demonstrated a statistically significant VTE risk reduction among brain tumor patients receiving prophylaxis, with chemical prophylaxis showing the strongest risk reduction. Interventions in these studies were associated with an increased risk of post-operative minor hemorrhage. Significance. Our specific aim was to advance the understanding of VTE prophylaxis after craniotomy for brain tumor, in terms of efficacy and safety, by pooling together the study results in a meta-analysis. We hoped to increase the analysis power, potentially discovering new findings that could inform clinical decision making surrounding the complex and nuanced issue of VTE prophylaxis in brain tumor patients undergoing craniotomy. Interestingly, the most recent study included in this analysis was published in 2003, demonstrating a need for more up-to-date recommendations on VTE prophylaxis that we believed could be generated by detailed meta-analyzing the highest quality studies available.
Cheryl J. Babin, School of Rehabilitation Sciences
Constance A. Inacio, School of Rehabilitation Sciences
Janna Kucharski-Howard, School of Rehabilitation Sciences
ABSTRACT: Project/Study Goals. Students in entry-level doctoral physical therapy (DPT) education must develop future practice and professional skills that include mentoring of students and employees. The purpose of this educational session is to present a progressive model for developing mentoring skills in DPT students within integrated clinical education courses during the first two years of an entry level program. Components of this model that will be addressed will include mentorship, professional duty, altruism and social responsibility. Additionally, the mentoring perceptions of DPT students who are actively involved in that learning process will be presented. Methods. Through the use of the Mentor Characteristics / Skills, and Work /Organization Mentoring Culture Assessment (MCA) by Grossman and a focus group, the perceptions of Year II students involved in the development of mentoring skills were investigated. A purposeful sampling of students enrolled in the DPT Class of 2017 participated in this investigation. With voluntary participation of forty students from the class cohort, the MCA was administered. There was voluntary involvement for the focus group activity and there were five students recruited for this activity. Results. Results from the MCA showed that there was strong agreement or agreement about what is required of someone to be a good mentor. The Year II students surveyed agreed or strongly agreed that they gained new knowledge and saw potential for increasing their own growth for working as a mentor. Results of the focus group meeting provided explanations for the actions of the Year II students in the mentoring learning process and offered a clearer sense of their view of this professional behavior and skill development. Using the MCA data, the DPT students’ results were similar to Grossman’s in her work with nursing. Conclusions. As a result of our comprehensive and progressive learning in the ICE course series, our students are well prepared for full time clinical education experiences and clinical practice. Their areas of strength are professional behavior, clinical teaching, clinical skills, and personal confidence. They receive feedback well and are comfortable with the roles related to the provision of feedback – both the receiver and the sender. They recognize what it takes to be a mentor and to be a productive mentee. They recognize what is necessary in the workplace to allow mentorship to be a successful approach with individuals. Significance. Accreditation standards and the expectations of clinical practice frame mentoring development as an essential skill to allow individuals to fulfill their professional duty through self and peer assessment and in preparation as future clinical educators. Through the development of mentoring skills, students recognize what is necessary in the workplace to allow mentorship to be a successful approach with individuals. The breadth of this experience serves as a solid preparation for a life-long mentoring commitment.
Alicia P. Kelley, School of Physician Assistant Studies-Boston
Bathri Vajravelu, School of Physician Assistant Studies-Boston
ABSTRACT: Project/Study Goals. The primary goal of this project was to determine whether using a flipped classroom model improved performance and student preference compared to traditional lecture format in the cardiovascular section of a Clinical Medicine course.
Methods. The study incorporated 6 lectures; 3 flipped and 3 traditional. Interested students were requested to take the pre-test and the post-test quizzes on Blackboard and an online opinion survey. Students were pre-tested prior to delivery of topics for all 6 lectures. For flipped lectures, the students were provided ~20min online PowerPoint presentations using iSpring prior to the in-class lecture/activity. During the in-class time, clinical cases were presented and students participated using Turning point/Clicker software. Traditional lectures were delivered via PowerPoint in the classroom. Students improvement in knowledge, measured as a difference between the pre-test and the post-test scores were tested for statistical significance using students t-test and compared between the two teaching models. The results of the opinion survey are presented as percentages. Results. The results indicate that both the standard lectures and the flipped classroom improved the knowledge of the students in the topic area, measured by a change in their mean score (change score). The change score of flipped classroom is significantly higher compared to the change score of the standard lectures. From the results of the opinion survey, we inferred, majority of the participants felt the flipped classroom was easier to pay attention to (58%), resulted in superior retention (62%), and the short PowerPoint lectures posted were effective in improving their knowledge (92%). Conclusions. From the results of this study, we conclude that both the standard lectures and the flipped classroom model are effective and beneficial models of education to teach cardiovascular medicine in PA school. However, students perform better and feel they can pay more attention and retain more information with the flipped method of teaching compared to standard lectures. Significance. There is not much research in the use of flipped classrooms in PA education to establish if flipped classrooms improve student learning. It is essential to find a method of instruction that is effective, interactive and that caters to the needs of students with different paced learning. Flipped classroom, if implemented thoughtfully and with great attention, can promote student interest, engagement and knowledge retention. Further research ought to be performed to determine if this model can be extrapolated to other areas of study within PA education.
Rania A. Mekary, School of Pharmacy-Boston
Timothy R. Smith, School of Pharmacy-Boston
ABSTRACT: Project/Study Goals: To examine the effect of prophylactic antibiotics on post-craniotomy meningitis. Methods: PubMed, EMBASE, and Cochrane databases were searched through October 2014 for randomized controlled trials (RCTs) that evaluated the effect of prophylactic antibiotics on post-craniotomy meningitis. Studies were included if they : 1) were RCTs conducted on neurosurgical craniotomy patients, 2) included patients who were randomly assigned to prophylactic antibiotics or placebo, and 3) reported data on post-craniotomy meningitis infections. Articles were excluded if they were not in English, did not report meningitis as a separate complication, did not explicitly state the type of antibacterial prophylaxis, or reported <15 patients. Pooled effect estimates were calculated using fixed- and random-effects models. Results: Seven studies with 2365 patients were included in the final analysis. All studies were randomized controlled trials with different antibiotic regimens. Prophylactic antibiotic use reduced the rate of post-neurosurgical meningitis, with a pooled Peto Odds ratio of 0.34 (95% CI: 0.18; 0.63). Cochran’s Q test indicated no significant heterogeneity among studies (I2 =0%; P-for heterogeneity =0.44). Subgroup analysis based on gram-negative coverage, blinding design, and study quality demonstrated no statistically significant difference among these groups (P > 0.05 for all). A meta-regression on surgery duration (P=0.52) and on antibiotics duration (P=0.59) did not show significant differences in the results among studies. Conclusions: This meta-analysis shows that prophylactic antibiotic use significantly decreases post-craniotomy meningitis infections. Significance: Despite the debate on whether or not clean wounds should require antibiotic prophylaxis for surgery, our meta-analysis clearly shows that prophylactic antibiotic use is indeed protective against post-craniotomy meningitis.
Anela Stanic, School of Pharmacy-Boston
ABSTRACT: Project/Study Goals: To compare HIV-infected patients at Boston Health Care for the Homeless Program (BHCHP) who consistently had permanent stable housing to patients who were not permanently stably housed with respect to: HIV laboratory values, utilization of clinical services including visits to primary care providers (PCP), clinic nurses (RN), and admissions to medical respite facility as well as the length of stay (LOS) at the medical respite. Methods: Electronic medical records of 482 patients were screened. Eligibility criteria included: age >/=18, HIV/AIDS diagnosis, use of BHCHP medical services, at least two documentations of housing status within the same year, and HIV viral load (HVL) in June 2013. Patients were grouped in either permanent stable housing (PSH) group or non-permanent stable housing (non-PSH) group. Outcomes included undetectable HVL, CD4 counts, and clinical service utilization. Group characteristics were compared using T-test or Gamma regression for continuous and Chi-square or Fisher’s Exact tests for categorical measures. Multivariable and propensity-weighted analyses were used to adjust for group differences. Results: 208 of 482 (43%) of charts were reviewed. 88 patients (42%) had PSH and 120 (58%) were non-PSH patients. More PSH patients had undetectable HVL (75% vs. 60%). Difference remained significant in multivariable analysis. PSH patients had higher mean CD4 counts (562 vs. 465 cells/mm3, p=0.035), and higher mean CD4% (28% vs. 23%, p=0.006), both of which remained significant in multivariable analysis. The number of PCP visits was not significantly different. The frequency of RN visits in PSH group was less than a half of that in non-PSH group. PSH patients had fewer admissions to medical respite and their LOS was shorter. Propensity-weighted analyses confirmed the findings of multivariable analyses. Conclusions: Subjects with permanent stable housing showed significantly better HIV laboratory values. Utilization of clinical services was also different across housing groups. Although frequency of PCP visits was similar, the frequency of visits to RNs and utilization of medical respite facility were significantly lower in subjects with permanent stable housing. Therefore, permanent stable housing is likely to benefit patients' clinical status as well as appropriate utilization of medical services. Multivariable and propensity weighted approaches were used to address possible confounding. Along with unadjusted analysis, all three methods showed similar results. Significance: Previous studies evaluated only individual outcomes in association with housing status, and defined housing status based on a single point assessment. This study investigated the relationship between housing and multiple outcomes in homeless HIV patients and it assessed housing status at multiple time points during the one year period. Despite the possibility of not capturing all changes of housing status, we found that patients with permanent stable housing had significantly better HIV laboratory values and more appropriate utilization of clinical services. Hence, permanent stable housing is associated with better clinical outcomes and more optimal utilization of clinical services.
Ann L. Charrette, School of Physical Therapy
Jeffrey Fong, School of Pharmacy-Worcester/Manchester
Karen S. Lamson, Library and Learning Resources
ABSTRACT: Project/Study Goals: Goals of the study were to investigate the effects of intensive exercise program on endurance, activity level, and gait speed while cultivating the social and emotional well-being of people with chronic moderate to severe ABI, acquired brain injury. Methods: This was a single group pre-post intervention study. Participants received a 6 week high intensity exercise group intervention for 60-90 minutes, 3 days/week assisted by personal trainers under physical therapist supervision. Measures (6 Minute Walk Test, High-level Mobility Assessment Tool and 10 Meter Walk Test, 10MWT) were collected at baseline, post-intervention, and 6 weeks later. Repeated measures T test and the Wilcoxon Signed Ranks Test were used. Results: Post-intervention improvements were achieved on average on all three outcome measures and greater than the minimal detectable change for this population. 10MWT outcomes indicate that three participants transitioned from low to high ambulatory status and maintained the change six weeks later. Conclusions: Intensive exercise is associated with improvements in impairment and activity limitation measures (endurance, activity level, and gait speed) immediately post-intervention and six weeks later. Challenges to sustainability of exercise programs for people with chronic moderate to severe ABI remain. Twenty-eight (out of 39) residents of Supportive Living Inc. now work out alongside each other despite barriers to exercise. Significance: People living with chronic moderate to severe ABI can: improve endurance, move from low to high ambulatory status, and demonstrate the ability to achieve advanced gait with just six weeks of intensive exercise.
Lisa A Conboy, New England School of Acupuncture
Kai-Yin Hsu, New England School of Acupuncture
Meredith St. John, New England School of Acupuncture
ABSTRACT: Project/Study Goals: Gulf War Illness (GWI) is a Complex Medical Illness characterized by multiple symptoms, including fatigue, sleep and mood disturbances, cognitive dysfunction, and musculoskeletal pain affecting veterans of the first Gulf War. No standard of care treatment exists. Our study group with has tested the effectiveness of acupuncture for GWI symptoms, and is currently executing two follow up granted project considering mechanisms of change and program evaluation/feasibility. ClinicalTrials.gov registration number NCT01305811. Methods: This Army-funded pragmatic Randomized Clinical Trial tested the effects of individualized acupuncture treatments offered in extant acupuncture practices in the community; practitioners had at least 5 years of experience plus additional training provided by the study. Veterans with diagnosed symptoms of Gulf War Illness were randomized to either six months of biweekly acupuncture treatments (group 1, n=52) or 2 months of waitlist followed by weekly acupuncture treatments (group 2, n=52). Measurements were taken at baseline, 2, 4 and 6 months. The primary outcome is the SF-36 physical component scale score (SF-36P) and the secondary outcome is the McGill Pain scale. Results: Of the 104 subjects who underwent randomization, 85 completed the protocol (82%). A clinically and statistically significant average improvement of 9.4 points (p=0.03) in the SF-36P was observed for group 1 at month 6 compared to group 2, adjusting for baseline pain. The secondary outcome of McGill pain index produced similar results; at 6 months, group 1 was estimated to experience a reduction of approximately 3.6 points (p=0.04) compared to group 2. Conclusions: Individualized acupuncture treatment of sufficient dose appears to offer clinically and statistically significant relief of physical disability and pain for veterans with Gulf War Illness. Significance: This study supports the use of individualized acupuncture treatments for the management of GWI symptoms. Our results are in concordance with numerous other studies indicating that acupuncture is a widely available, safe, effective, and cost-effective option for the treatment of other diseases and syndromes with similar presentations to GWI with high usability in veteran populations. Given this research, it is likely that acupuncture treatment may be an effective, safe, low-cost treatment option for our returning military as well as civilian populations impacted by chronic multi-symptom illness and its co-morbidities.
Jennifer Goldman, School of Pharmacy-Boston
ABSTRACT: Objective: To describe the studies evaluating the efficacy and safety of new insulin glargine 300 U/mL (Gla-300) as a basal insulin in the treatment of type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Data Sources: A literature search of MEDLINE was conducted (January 2008-June 2015) using the terms U300, Gla-300, and insulin glargine 300 units/mL and supplemented with congress abstracts published in 2014 and 2015. Study Selection and Data Extraction: All English language studies assessing the efficacy and/or safety of Gla-300 were evaluated. Data Synthesis: The efficacy and safety of once-daily Gla-300 has been compared with insulin glargine 100 U/mL (Gla-100) in the EDITION trials.. Gla-300 consistently demonstrated glycemic control comparable to Gla-100; a mean (standard error) change in glycated hemoglobin A1c of −1.02% (0.03) with both Gla-100 (n = 1235) and Gla-300 (n = 1239) was seen in a patient-level meta-analysis. Gla-300 was associated with comparable or reduced nocturnal hypoglycemia. There is also some evidence for less weight gain with Gla-300 compared with Gla-100, despite a higher insulin dose. Gla-300 was well tolerated. Conclusions: These results suggest that Gla-300 may have a place as an alternative, long-acting basal insulin for patients with T1DM or T2DM, with the possibility for improved tolerability. Significance: With the rise in diabetes and Insulin resistance the use of concentrated insulin to meet glycemic goals has increased dramatically. With the expanded number concentrated insulin products available there is a potential for dosing errors which can cause danger for patients. It is essential the pharmacists who are responsible for dispensing concentrated insulin products can educate both patients and prescribers on the correct dosing and use of the device to prevent medication errors. It is also critical to understand the pharmacokinetic and pharmacodynamics differences between the U100 insulins and the concentrated insulins to ensure the most appropriate insulin is utilized.
Judy Cheng, School of Pharmacy-Boston
ABSTRACT: Project/Study Goals: Limited data exist regarding IV diuretics for the outpatient treatment of volume overload in HF patients. This study sought to evaluate the effectiveness of intravenous (IV) diuretic treatment for volume management in heart failure (HF). Methods: We analyzed 60 consecutive patients with chronic HF and clinical evidence of worsening congestion who received a bolus and 3-h IV infusion of furosemide at an outpatient HF clinic. Diuretic dosing was derived from the maintenance oral loop diuretic dose with a standardized conversion algorithm. Outcomes included urine output during the visit, weight loss at 24 h, and hospitalization and mortality at 30 days. Safety outcomes included hypokalemia and worsening of renal function. Outcomes were analyzed across subgroups defined by maintenance diuretic dose and ejection fraction (EF). Results: The median age of the cohort was 70 years, and the median daily loop diuretic dose was 240 mg oral furosemide or equivalent. Twenty-six patients (43.3%) were women, and 36 (60%) had an EF <45%. For the entire cohort, the median urine output and 24-h weight loss were 1.1 l and 1.1 kg, respectively. Outcomes were similar across patients with varying maintenance diuretic doses (<40 mg, 40 to 160 mg, 160 to 300 mg, or >300 mg of furosemide or equivalent) and in patients with reduced or preserved EF. Transient worsening of renal function and hypokalemia occurred in 10 patients (8.9%) and 4 patients (3.5%). Conclusions: Short courses of IV diuretics for volume management in patients with HF were safe and associated with significant urine output and weight loss across a wide range of maintenance diuretic doses and EF. Significance: This strategy and multidisciplinary approach may provide an alternative to hospitalization for the management of selected HF patients, and improving patient quality of life and reduce healthcare cost.
Marie Dacey, School of Arts and Sciences
Carly Levy, School of Arts and Sciences
Delia Anderson, School of Arts and Sciences
ABSTRACT: Project/Study Goals: This study was a survey of interprofessional education (IPE) at MCPHS over the last seven academic years (2009-2016). The researchers were initially funded by the Association of Prevention and Research (APTR) in 2008 to develop and implement an IPE project. Additional funding was provided, through a 2015 APTR IPE Institute Evaluation sub-grant, to chronicle the growth of IPE at MCPHS University since this initial project, in order to advance shared IPE definitions, competencies, and resources specifically in prevention and population health. The study was approved by the MCPHS Institutional Review Board (#IRB121015D). Methods: Researchers reviewed available information related to MCPHS IPE since 2009, including the goals of the MCPHS/IPE Plexus. They developed a Qualtrics survey, which queried faculty engagement in IPE activities, including: 1) whether projects met professional accreditation requirements, 2) if content included prevention and population health topics, 3) barriers to participating in IPE and, 4) intentions regarding future IPE involvement. Qualitative comments were also solicited. The survey was open to all faculty for two weeks in January, 2016. Quantitative data analysis included descriptive summary of faculty engagement and IPE activities, including chi square comparisons of department and faculty rank representation. Results: Responses: 126 faculty (21%); IPE Participants: 77 faculty; Program descriptions: 57. No significant difference (p=0.062) in MCPHS school representation. Junior faculty reported significantly higher IPE engagement (p=0.002). Descriptive statistics indicated: 52% involved at least five faculty; 53% took place in traditional classroom settings; 52% occurred since 2014; 47% were less than half a semester; 58% address professional accreditation requirements; inclusion of prevention and population health topics is highly variable; and only 24% are planning additional activities. Barriers included time constraints, perceived minimal administrative support and logistical challenges of organization and collaboration. Conclusions: Quantitative data analysis indicated an increase in IPE engagement since 2009; however, only one-fourth of involved faculty reported intentions to plan additional activities. There is a lack of clarity and understanding regarding the definition of IPE, suggested by the variation in program descriptions. Prevention and population health topics were not consistently included and some faculty indicated uncertainty regarding such topics. The researchers are conducting qualitative analyses of faculty input from the survey, self-study reports from schools that require IPE in their accreditation criteria, and in-depth interviews with current IPE participants, including the Worcester/Manchester IPE working group. Significance: These survey results and additional qualitative input will contribute to university-wide collaborative IPE efforts.
Carey L. Barry, School of Physician Assistant Studies-Boston
Catherine A. Taglieri, School of Pharmacy-Boston
Steven Crosby, School of Pharmacy-Boston
Joseph Ferullo, School of Pharmacy-Boston
Paul Kiritsy, School of Pharmacy-Boston
Bathri N. Vajravelu, School of Physician Assistant Studies-Boston
Ricky B. Thumar, School of Physician Assistant Studies-Boston
Alice Randor, School of Physician Assistant Studies-Boston
ABSTRACT: Project/Study Goals: The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) advocates for interprofessional education (IPE) for physician assistant (PA) education. Various approaches to IPE in healthcare curricula have been described. In PA education, limited data exists that describes IPE implementation as it relates to student preparedness to engage in collaborative activities after graduation. The purpose of this study was to assess and compare attitudes toward IPE among PA and pharmacy students in a large scale simulation activity using a modified Readiness for Interprofessional Learning Scale (RIPLS) total score and sub-scale. Methods: A total of 387 students (100 PA/287 pharmacy) participated in an IPE simulation activity. PA students were assigned patient cases to evaluate, diagnose, formulate a treatment plan, and generate a written prescription to present to the pharmacy students in the mock pharmacy laboratory. Students collaborated in groups of 2-3 to resolve clinical issues and provide optimal patient care. Students were invited to participate in a modified RIPLS survey both before and after the IPE simulation activity via Qualtrics. Mann-Whitney U test was applied to test for significant differences between the groups’ RIPLS scores. Results: A total of 301 students participated in the pre-activity survey and 142 students participated in the post-activity survey. PA students scored significantly higher than the pharmacy students on 3/4 RIPLS sub-scales and the total RIPLS score (p=0.001). The IPE simulation activity significantly increased 2/4 of the RIPLS sub-scale scores and the total RIPLS score of the participating students. Pharmacy students showed a significant improvement on the total RIPLS score (p=0.04), whereas the PA students’ score improvement was not statistically significant (p=0.09). Conclusions: Physician assistant students appear to value interprofessional education opportunities more than pharmacy students overall. After participating in an IPE simulation activity the pharmacy students attitudes toward IPE improved significantly. Significance: These findings support continued development and inclusion of IPE opportunities for PA and pharmacy students to prepare them for future interprofessional practice.
Susan A. Krikorian, School of Pharmacy-Boston
ABSTRACT: Project/Study Goals: Gabapentin is used in the management of peripheral neuropathy and post-herpetic neuralgia. It is excreted predominately through the kidney as an unchanged drug. Reduced renal function requires dosing adjustment to avoid toxicity. The goal of this study is to determine whether proper dosage adjustments are routinely made for gabapentin in patients with renal impairment. Methods: A three-month retrospective review of hospitalized patients receiving gabapentin for Peripheral Neuropathy and Post-Herpetic Neuralgia was conducted at our Institution. All patients with a Creatinine Clearance <=59 mL/min, using the Cockcroft Gault equation for renal function, were included in the analysis. Data regarding the patient's clinical status, laboratory findings, and gabapentin dosing were collected from the electronic medical records. Evaluation of appropriate gabapentin dosing was based on the drug manufacturer's dosing guidelines. Results: One-hundred and forty-five patients with impaired renal function were included in the Study. Dosage adjustments were made in 38% of these patients; the remainder were prescribed unadjusted doses. It was found that 62% of all patients had inappropriate dosing. All patients with inappropriate dosing received higher than recommended doses of gabapentin which ranged from 120 to 500% of the manufacturer’s recommended dose. Conclusions: A wide range of consistent overdosing errors were common among patients with renal impairment receiving gabapentin for Peripheral Neuropathy and Post-Herpetic Neuralgia. Significance: Renal function should be determined in all patients receiving gabapentin, and manufacturer’s dosing guidelines should be followed to avoid adverse drug reactions.
Monina R. Lahoz, School of Pharmacy-Worcester/Manchester
Paula Evans, School of Pharmacy-Worcester/Manchester
Irena Bond, Division of Library and Learning Resources
ABSTRACT: Project/Study Goals: To assess the effectiveness of an interactive, hands-on, three-lesson series in enhancing older adults’ health information literacy (HIL) skills, specifically, (1) ability find reliable online health information, and (2) ability to assess the reliability and accuracy of online health information. Methods: Faculty members and students from a school of pharmacy built a mobile computer classroom, comprised of 17-inch laptop computers, to present a 3-lesson series at local senior centers. The lessons were derived from the National Institute on Aging’s “Helping Older Adults Search for Health Information Online: A Toolkit for Trainers”: Lesson 1 - Introduction to MedlinePlus; Lesson 2 - MedlinePlus: Drugs and Supplements, Medical Encyclopedia; and Lesson 3 - Evaluating Health Websites. Pre-lesson, post-lesson, and follow-up surveys were administered to assess the effectiveness of each lesson and the lesson series in enhancing older adults' HIL skills. Results: Twenty-eight lessons (Lesson 1 =10, Lesson 2 = 9, Lesson 3 = 9) were presented at 5 senior centers. The lessons increased older adults’ confidence in (1) finding reliable online health information (35.3% were confident/very confident pre-Lesson 1, 72.5% pre-Lesson 2, 100% on all post-lesson and follow-up surveys), (2) evaluating the reliability of online health information (23.5% pre-Lesson 1, 96.2% post-Lesson 3, 100% follow-up), and (3) evaluating the accuracy of online health information (29.4% pre-Lesson 1, 96.1% post-Lesson 3, 94.8% follow-up). They also increased older adults’ use of MedlinePlus (32% pre-Lesson 1, 67% pre-Lesson 2, 96% pre-Lesson 3, 100% follow-up). Conclusions: Offering interactive, hands-on lessons to older adults at senior centers was a worthwhile and effective strategy for enhancing older adults’ HIL skills. Through the lessons, older adults also learned about the features and how to navigate the MedlinePlus website, an online source that provides reliable and up-to-date information on health, drugs, and dietary supplements. Significance: Older adults are oftentimes targets of online health scams and fraudulent health claims. They also take multiple prescription and over-the-counter drugs, supplements, and herbals, thus, they are at increased risk for drug interactions and adverse side effects. Enhancing the HIL skills of older adults empowers them to manage their health. Furthermore, educating older adults about MedlinePlus is a strategy for achieving Goal 1 of the National Action Plan to Improve Health Literacy - Develop and disseminate health and safety information that is accurate, accessible, and actionable. MedlinePlus offers authoritative, reliable, up-to-date, and free health information in easy-to-understand language.
Terrick A. Andey, School of Pharmacy-Worcester/Manchester
ABSTRACT: Project/Study Goals: (i) Investigate ESC8 anticancer activity in triple negative breast cancer (TNBC) and non-TNBC cells as a single or combination treatment; (ii) Prepare, characterize, and optimize lipid-conjugated estrogenic derivative (ESC8) lipid nanocarriers for oral delivery; (iii) Investigate the pharmacokinetic properties of ESC8 nanocarriers in rats; (iv) Investigate the antitumor activity of ESC8 lipid nanocarriers in a mouse-model of TNBC; (v) Determine the molecular mechanisms mediating the antitumor activities of ESC8 lipid nanocarriers. Methods: The in vitro cell viability, Caco-2 permeability, and cell cycle dynamics of ESC8-treated TNBC cells were investigated. ESC8 was formulated as liposomes, solid lipid nanoparticles (SLNs), and nanostructured lipid carriers (NLCs) and characterized for size, zeta potential, entrapment efficiency, size stability, and tumor biodistribution. Pharmacokinetic modeling of plasma concentration-time course data was carried out following intravenous and oral administration in Sprague-Dawley rats. In vivo efficacy investigation of ESC8-SLNC was carried out in Nu/Nu mice bearing MDA-MB-231 TNBC as xenograft tumors and the molecular dynamics modulating tumor growth inhibition were analyzed by western blot. Results: In vitro ESC8 inhibited TNBC and non-TNBC cell viability with IC50 ranging from 1.81 to 3.33 μM. ESC8 was superior to Tamoxifen and Cisplatin in inhibiting MDA-MB-231 cell viability; 2.0 μM ESC8 enhanced Cisplatin cytotoxicity 16-fold. Half-life of intravenous ESC8 was 14.63±2.95 h in rats. ESC8-SLN was orally bioavailable (47.03%), and at 10 mg/kg/day, x14 days, p.o. inhibited breast tumor growth by 74% (P<0.0001, vs control) in mice bearing MDA-MB-231 cells as xenografts; when given in combination with Cisplatin (2.0 mg/kg/biweekly, x2 weeks, IV), tumor growth was inhibited by 87% (P=0.0002, vs ESC8-SLN; 10 mg/kg/day, x14 days, p.o). ESC8-SLN decreased expression tumor survival protein markers. Conclusions: Our study demonstrates the broad anticancer properties of ESC8 in triple negative and non-triple negative breast cancer. Significantly, tailoring ESC8 for oral administration was achieved by formulating them into SLN with translational relevance as demonstrated by the inhibition of tumor growth either as single treatment or with Cisplatin. The molecular mechanisms defining these anticancer effects were outlined. Significance: This study demonstrates the promising prospect of ESC8-SLN as a candidate for adjuvant and/or neoadjuvant therapy in triple negative breast cancer.
Alejandro Pino-Figueroa, School of Pharmacy-Boston
Mark Bohlke, School of Pharmacy-Boston
Timothy J. Maher, School of Pharmacy-Boston
ABSTRACT: Project/Study Goals: Lepidium meyenii (Maca), a Peruvian plant, has been used as a folk medicine for centuries. A pentane extract of its hypocotyls has been demonstrated to have neuroprotective effects in vitro and in vivo. Recent studies have also indicated that Maca extracts and their active constituents, macamides, act as inhibitors of fatty acid amide hydrolase (FAAH). FAAH is the enzyme responsible for the degradation of endocannabinoids, resulting in the termination of their signaling. The aim of this study was to demonstrate and characterize the FAAH inhibitory effect of the most abundant macamide, N-benzylpalmitamide, and its natural analog, N-(3-methoxybenzyl)palmitamide. Methods: Each compound was tested at concentrations between 1 and 100 µM, using an FAAH inhibitory activity assay, which is a fluorescence-based method. The enzyme kinetics study was used to demonstrate the inhibitory mechanism of N-(3-methoxybenzyl)palmitamide on FAAH. LC-MS/MS analysis was used to demonstrate if N-(3-methoxybenzyl)palmitamide is a substrate of FAAH by showing degradation. Results: The test compounds caused a concentration-dependent inhibition of FAAH. The pre-incubation study revealed that N-benzylpalmitamide and N-(3-methoxybenzyl)palmitamide inhibit FAAH in a time-dependent manner. A 120 min pre-incubation caused a significant increase in the % inhibition of FAAH by 100 µM N-(3-methoxybenzyl)palmitamide. The enzyme kinetics study indicated that N-(3-methoxybenzyl)palmitamide is likely an uncompetitive inhibitor. LC-MS/MS analysis determined that N-(3-methoxybenzyl)palmitamide is a substrate of FAAH since it undergoes hydrolysis by FAAH. Conclusions: The results of this study indicated that N-(3-methoxybenzyl)palmitamide is a promising inhibitor of FAAH. Significance: The results of this study indicate that N-(3-methoxybenzyl)palmitamide could potentially offer a good alternative for the treatment of pain, inflammation and CNS degenerative disorders.
Sarah K. McCord, Division of Library and Learning Resources
Robin A. Harvan, School of Arts and Sciences
ABSTRACT: Project/Study Goals: The overall intent of this study was to conduct a systematic review focused on impact evaluations, such as behavioral changes or improved clinical outcomes, of interprofessional clinical informatics training in both educational and practice settings. Investigators reviewed relevant studies of methods and results of impact evaluations in two settings: competency-based interprofessional education; and team-based collaborative clinical practice. Methods: Systematic searches of the professional literature were conducted in MEDLINE, CINAHL, ERIC, PsycInfo (APA), and EMBASE. Searches employed controlled vocabularies unique to each database for maximum retrieval and reproducibility. A hand search also conducted on a review of interprofessional collaborative practice and education. Candidate articles were screened for potential inclusion twice for each of the review objectives. Inter-rater reliability, as measured by Cohen’s Kappa, was determined after the first screen, and remaining candidate articles were subjected to a second full-text screen. Articles were included in the final analysis if, after both screenings, reviewers agreed that the articles met all inclusion criteria. Results: Systematic searching resulted in the identification of 1287 related to current methods and results of impact evaluation of competency-based interprofessional clinical informatics education (Objective 1), while 335 related to impact evaluation of collaborative clinical practice using clinical informatics (Objective 2). Of the 1287 articles identified relating to Objective 1, 17 studies remained after both screenings and were included in the narrative synthesis. Of the 335 articles identified for Objective 2, 6 studies remained after review of the full text of the articles. The narrative syntheses evaluated article content using the Kirkpatrick Four Levels model of training evaluation. Conclusions: Evidence to support impact evaluation of competency-based interprofessional clinical informatics education in collaborative care clinical practice remains limited. More rigorous evaluation research studies are needed to demonstrate the impact of competency-based interprofessional clinical informatics education. Significance: For interprofessional clinical informatics education to impact practice, the two must be linked. Our findings have implications for curriculum design across a range of disciplines, and point out the need for higher level assessment of student competencies in the use of clinical informatics in collaborative, interpreofessional settings.
Tammy L. Gravel, School of Nursing-Worcester
Amanda M. Morrill, School of Pharmacy-Worcester/Manchester
Sheila Seed, School of Pharmacy-Worcester/Manchester
Karen S. Lamson, Division of Library and Learning Resources
ABSTRACT: Project/Study Goals: The goal of the interprofessional collaborative was to support student learning across the health disciplines with the knowledge, skills and competencies requisite to care for Veteran's. Methods: The annual conference brought together several experts in the area of Veteran's Care to include; students, faculty , students, legislators and outside experts. The panel addressed several contemporary issues related to Veteran's care such as; access to care, appropriate assessment, mental health issues, traumatic brain injury as well as care of women Veteran's. An unfolding case was used following the panel discussion to reinforce student learning through interprofessional collaboration around care of a particular Veteran client. Following the conference, students were asked to complete a reflection on the impact of the program on their clinical practice. Results: Aggregate survey data for the recent 2014 Veteran’s Care Collaborative demonstrates a positive impact on both the Worcester and Manchester campuses for all participants; students and faculty. The most notable contribution noted by participants was the contemporary health care needs of Veteran's to include access to care. Data from the survey also suggests the interprofessional collaboration will enhance clinical practice as a student and as a future health professional. Conclusions: The Veteran’s Care Collaborative has provided education to a total of 106 interprofessional health care students over 2 years. Survey tool responses demonstrated a positive result which included improving attendee insight into the unique care needs of our Veteran population. Many of these health professional students positive inroads in caring for our Veterans as they continue on in their clinical experience as a student and then as an independent clinician. The collaborative targets the Worcester and Manchester campuses follow up surveys which query participants on the impact of the education on actual patient care, as well as interprofessional collaboration. Significance: In 2014 there were 21.8 million Veterans’ in the US; many of these individuals have participated in multiple conflicts and/or wars. These individuals who have sacrificed so much deserve the very best health care our country can provide. Interprofessional collaboration can enhance the care of our Veteran population, regardless of where they choose to receive care. Many clinicians regardless of their discipline may be challenged to complete appropriate evidence based assessments and develop treatment strategies for Veterans who have a variety of unique health care needs.
Jennifer Tebbe-Grossman, School of Arts and Sciences
Joanne Doucette, Division of Library and Learning Resources
ABSTRACT: Project/Study Goals: Study authors were interested in the impact on student learning through using a TED eBook that approached health care delivery and its quality primarily through emphasizing social determinants of health in an interdisciplinary biosocial global health course. How would incorporating the eBook into the classroom. Enhance or deter student learning in the class. Impact the general use of electronic devices in class. Impact whether students would use additional features offered by an eBook. Reveal student attitudes about eBooks. Impact faculty team members' level of comfort with technology in the classroom. Methods: Electronic device civility was discussed with class members during the first class. The eBook was taught with readings from a print text and from online sources in three class sessions where interprofessional faculty (political science/American Studies/andragogy specialist and technology specialist) interacted with each other and class members. A pre-survey of students gathered information about their backgrounds, previous use of eBooks, the eBook platforms where they purchased the book, and the electronic devices they used in classes to read the book and to retrieve additional online readings. A post-survey explored questions regarding the impact on student learning in using the eBook. Results: Results of the study included: students were divided in relation to previous eBook reading; most students read eBooks on their tablet or laptop; students generally used features offered by the TED eBook not available when reading a print book; two-thirds if given a choice preferred to read a print book; if an eBook cost over $40.00 nearly all students would find a less expensive way to read the book; unanimous agreement that learning was enhanced with using the TED eBook in class given other choices that also included not affected, distracted, hindered. Conclusions: Through pre- and post- surveys and class discussion students were positive about reading the TED eBook. The attitudes expressed in discussions showed that their feelings were related to how this eBook was constructed and to the content of the eBook. The students appreciated the author’s advocacy of emphasizing social and environmental conditions that contribute to health or that cause disease and his incorporation of technological clinical interventions that enhanced caregiving and equity in health delivery. Students noted in the last of the class meetings on the eBook that they especially learned from the interdisciplinary interactions among the three faculty. Significance: The instructor offering the course reported a higher level of comfort with learning through an eBook as well as with different learning experiences that the class shared in using other forms of online technology. The instructor was also more comfortable with the use of electronic devices in the classroom and with discussion of electronic device civility among members of the classroom learning community. The individual instructor's experience and attitudes expressed by students applied to the discussion of electronic devices in classrooms in literature on this subject related to higher education learning.
Terrick A. Andey, School of Pharmacy-Worcester/Manchester
ABSTRACT: Project/Study Goals: (i) Provide voluntary online assessments to first year PharmD students to gauge the general level of student comprehension of topics taught in pharmaceutical calculation. (ii) Provide students with real time feedback on their preparedness for an exam based on their performance in the voluntary online assessment. (iii) Analyze student performance data obtained from the voluntary online assessment and correlate it with exam scores. (iv) Investigate areas of student weakness in understanding pharmaceutical calculations from voluntary online assessment results and address such areas appropriately. Methods: Course delivery: Concepts in Pharmaceutical Calculations were delivered to 285 first year PharmD students in Worcester and Manchester campuses. Voluntary online assessments: Four different sets of assessments in multiple choice format covering the topic taught were posted on Blackboard for students to attempt. Real time grades were obtained by the students upon completion of the assessment. Examination administered: Two examinations each of which counted towards 10 percent of the course grade were administered 4 weeks apart. The examinations were scored and the results compared to the voluntary online review data. Data analysis: Data were analyzed using IBM SPSS software (IBM Corporation, Armonk, NY). Results: Out of 285 students, 202 (70.9%) participated in at least one online assessment; 85 (29.1%) did not participate in any assessment. Of those who participated, 29.5%, 8.8%, 8.8%, and 23.9% participated in 1, 2, 3 and 4 assessments respectively. 40.7%, 31.2%, 13.0%, 9.5%, and 5.6% of the students had grades A, B, C, D, and F respectively in the combined exams. Student who participated in assessments had a greater percentage of A and B exam grades (73% and 78% respectively) compared to those in the same grade level who did not participate in the assessment (A's = 27%; B's = 22%). The number of assessments taken correlated positively to the combined exam. Conclusions: All students were provided the means to participate in the voluntary online assessment. Students who participated obtained feedback on their performance; they were also afforded the opportunity to seek clarification of concepts from the professor on their perceived problem areas. The results of this study show that students who participated in Blackboard assessments were much prepared and performed at a higher level in the pharmaceutical calculation exam. Significance: Online assessment of student using Blackboard is a viable tool for enhancing academic performance.
William McCloskey, School of Pharmacy-Boston
Susan Jacobson, School of Pharmacy-Boston
Kathy Zaiken, School of Pharmacy-Boston
Trisha Lapointe, School of Pharmacy-Boston
Caroline Zeind, School of Pharmacy-Boston
Judy Cheng, School of Pharmacy-Boston
Anela Stanic, School of Pharmacy-Boston
Snehal Bhatt, School of Pharmacy-Boston
Matthew Machado, School of Pharmacy-Boston
Dorothea Rudorf, School of Pharmacy-Boston
Timothy Maher, School of Pharmacy-Boston
ABSTRACT: Objectives: To assess the value of a regional residency/fellowship showcase to program directors and to identify important candidate characteristics that programs were seeking. Methods: We surveyed 44 pharmacy residency/fellowship directors or their representatives who participated in a regional showcase at MCPHS University. Demographic information, perceived benefits, and satisfaction with the showcase were assessed, along with questions aimed at identifying important candidate characteristics that programs were seeking. The survey instrument used a 5 point scale, with a score of 1 being low and 5 being high. The survey was distributed at the showcase and was collected at the end of the program or completed on-line. Results: Forty-one (93%) directors or their representatives completed the survey. Most (88%) represented PGY 1 or 2 residencies. Large teaching hospitals (51%), small community hospitals (15%), and pharmaceutical industry (10%) were the most common organizations represented. Benefits identified included: reaching many students from the region (95%), no fee (85%), meeting candidates in person (68%), convenient location (66%), and networking with colleagues (51%). Most respondents rated the communication skills and professionalism of students they met as 3 or 4. Work experience, academic ability, leadership roles and performance on Advanced Pharmacy Practice Experiences rotations were the main characteristics both residencies and fellowships used for identifying strong candidates. Research experience was also considered highly by fellowships. Most respondents were highly satisfied with the showcase and all would recommend it to others. Participants suggested a larger venue in the future. Implications: A regional School of Pharmacy residency/fellowship showcase is valued by program directors.
Carolyn Friel, School of Pharmacy-Worcester/Manchester
Irena Bond, Library and Learning Resources
Monina Lahoz, School of Pharmacy-Worcester/Manchester
ABSTRACT: OBJECTIVES: To improve 6th grade students' (1) ability to find and evaluate health information web sites, and (2) knowledge of lead poisoning. METHOD: Four community organizations collaborated to deliver a health information literacy (HIL) curriculum to sixth grade students in an underserved middle school: MCPHS University, Worcester Art Museum (WAM), City of Worcester-Department of Inspectional Services, and Worcester Public School System. The curriculum had five components developed around a community health issue, lead poisoning. It included a series of interactive sessions and field trips to solve fictional lead poisoning “medical mystery cases” involving artists whose artworks were on display at the WAM. Achievement of project goals was assessed using age-appropriate pre- and post-program surveys. Only the responses of 42 students who completed both surveys were included in the data analyses. Data were analyzed using SPSS. RESULTS: On almost all survey questions, significant differences were found between pre- and post-program surveys (p<.05), such as percentage of students who (1) would search MedlinePlus to answer a health question (pre=2.4%, post=50.0%), (2) correctly identified each of the 4 of 5 criteria for evaluating health websites (e.g., information is current [pre=23.8%, post=71.4%]), (3) correctly identified the picture of peeling paint that may contain lead (pre=60.6%, post=83.3%), (4) correctly identified pictures of 5 items that may contain lead (e.g., old paint [pre=64.3%, post=100%]) and 4 items that may not contain lead (e.g., crayons [pre=33.3%, post=4.8%]), and (5) wrote one correct symptom of lead poisoning (pre=7.1%, post=61.9%). CONCLUSION: This project illustrated the feasibility of developing and delivering an HIL program to school children through collaboration of public and private entities that shared a common interest.
Alejandro Pino-Figueroa, School of Pharmacy-Boston
Mark Bohlke, School of Pharmacy-Boston
Timothy J. Maher, School of Pharmacy-Boston
ABSTRACT: Objectives: The extract of the Peruvian plant Lepidium meyenii (Maca) has been shown to possess neuroprotective activity in vitro and in vivo. The involvement of the endocannabinoid system has been shown to be a possible mechanism of action. The aim of this study was to determine and characterize the indirect cannabinergic activity of natural alkamides and one synthetic derivative in an in vitro model using human recombinant enzymes responsible for the endogenous degradation of endocannabinoids. Methods: 12 natural alkamides and one derivative were assayed for inhibitory activity using fatty acid amide hydrolase (FAAH) and monoacyl glycerol lipase (MAGL) activity assay methods. Different enzyme-inhibitor pre-incubation times and Lineweaver-Burk plots were used to determine the mechanism of inhibition. Results: The 12 tested alkamides showed significant (p<0.05) concentration- and structure-dependent inhibitory properties on FAAH at concentrations from 1 to 100 µM. The four most active inhibitory alkamides were N-benzylamide of linoleic acid and the N-(3-methoxybenzyl)amides of oleic, linoleic and linolenic acids. Replacement of the 3-methoxybenzyl group with a more strongly H-bond accepting N-(3-pyridylmethyl) group significantly increased the inhibitory activity (p<0.05). All tested compounds were not able to show significant MAGL inhibitory activity at the assayed concentrations. The assays were validated using standard FAAH and MAGL inhibitors. Implications: These results suggest a potential application of alkamides present in Lepidium meyenii (Maca) or new synthetic alkamide derivatives as FAAH inhibitors. FAAH inhibitors have been suggested as a therapeutic approach for the treatment of pain, neurodegeneration, depression and anxiety through local activation of the endocannabinoid system.
Reema Zeineldin, School of Pharmacy-Boston
ABSTRACT: Purpose: Cisplatin is a commonly used chemotherapeutic agents in ovarian cancer treatment. However, ovarian cancer patients frequently develop resistance to cisplatin. This resistance may be due to the formation of multicellular aggregates or spheroids, which could reduce cisplatin penetration to ovarian cancer cells, thus contributing to resistance to therapy. Rac1 is a signaling molecule that contributes to adhesion and motility of cancer cells, including spheroids, which has been found to be overexpressed in ovarian cancer. Our goal is to evaluate if inhibiting Rac1 with NSC23766 may enhance the cytotoxic effect of cisplatin to ovarian cancer cells grown in the laboratory as monolayers or as multicellular aggregates, i.e. spheroids. Methods: The ovarian cancer cell line OVCA429 was used in this experiment. These cells were grown in two different kinds of 96-well plates. They were grown into monolayer adherent cells in regular 96-well plates, and were grown into multicellular aggregates or spheroids in 96-well ultra-low attachment plates. Cells were treated for 48 hours with varying concentration of cisplain (0, 30, 100, 300, 1000, and 3000 µM) with or without treatment with 50 µM of the Rac1 inhibitor, NSC23766. A cytotoxicity assay was used to measure the viability of OVCA429 cells. Results: For OVCA429 adherent cells, the addition of NSC23766 increased the cytotoxicity of cisplatin at all concentrations. This increase in cytotoxicity was statistically significant at cisplatin concentration of 300 µM. For OVCA429 spheroids, the addition of NSC23766 increased the cytotoxicity of cisplatin at all concentrations below 2400 µM. This increase was statistically significant at cisplatin concentrations of 300 µM and 1000 µM. Conclusion: The Rac1 inhibitor, NSC23766, enhanced cytotoxicity of cisplatin to both adherent and spheroid OVCA429 cells. These findings support a new combination therapy of a Rac1 inhibitor with cisplatin that may potentially improve the survival rates of ovarian cancer patients.
Dorothea Rudorf, School of Pharmacy-Boston
Stephen Kerr, School of Pharmacy Boston
Anela Stanic, School of Pharmacy Boston
Lori Rainchuso, Forsyth School of Dental Hygiene
ABSTRACT: Objectives: Based on the results of a university-wide faculty survey to investigate incorporation of oral health (OH) into our Pharmacy curriculum, OH concepts were integrated in the syllabus of a required PharmD course, Virology & Antiinfectives (V&A). Student exposure to and knowledge about OH, its relevance in the V&A course, and effectiveness of this interprofessional Pharmacy – Dental Hygiene project was evaluated. Methods: A comprehensive clinical case study integrating relevant OH issues with specific bacterial, viral, and fungal infection topics was developed. Prior to the in-class case discussion led by Pharmacy and Dental Hygiene faculty, students were surveyed about previous exposure to /knowledge of OH issues and their perceived relevance to pharmacy education. After the case discussion, students evaluated the effectiveness of the learning experience. The associations were evaluated using Fisher’s exact test. Results: 207 (69%) of 300 students completed the survey. One third had either prior exposure to or knowledge in OH issues. 71% indicated the case discussion improved their OH knowledge and helped integrate concepts learned in the course. This perception was not significantly associated with prior knowledge of OH issues. 125 (62%) considered the case discussion as an effective teaching technique, and 110 (55%) stated that it improved their critical thinking and problem solving skills. 171 (85%) agreed that OH plays a role in V&A, and 126 (63%) felt OH should be required in all PharmD practice courses. Of 70 students with prior OH knowledge, 53 (79%) agreed the case discussion advanced their knowledge. Conclusion: Incorporation of OH in the V&A course is relevant, and an interprofessional case-study is an effective teaching and learning tool. Furthermore, engaging pharmacy students in collaborative clinical decision-making and face-to-face interaction with other health care professionals meets the new ACPE standards/ IPE guidelines requiring interprofessional health care delivery and communication.
Timothy Hudd, School of Pharmacy Boston
Enrique Seoane-Vazquez, School of Pharmacy-Boston
ABSTRACT: Purpose: The objective of this study was to measure the impact and effectiveness of a student led interactive educational session on clinician knowledge of inhaler devices for COPD. Methods: A five item pre / post questionnaire using a 5‐point Likert scale was prepared and validated using expert opinion. Questions assessed each participant’s level of confidence with using a metered dose inhaler (MDI) and various dry powdered inhalers (DPIs). Participants rated their level of confidence when educating patients on important aspects of therapy such as appropriate technique, associated adverse effects, and differences between MDIs and DPIs. Additionally, participants were asked to rate the perceived benefit from the session. Pre and post differences were assessed using paired t-test (statistical significance =0.05). Results: Seven nurse clinicians with an average of 10.7 years (SD ±9.9 years) of practice experience participated. Improvement was reported in each area of assessment: differences between (MDIs) and (DPIs) [pre 2.86±1.21 vs. post 5.00±0.00 (p= 0.002)]; proper inhalation technique - MDI [pre 4.00 ± 1.15 vs. post 5.00 ±0.00 (p= 0.031)]; proper inhalation technique - DPI [pre 3.43 ±1.13 vs post 5.00 ±0.00 (p= 0.005)]; and on possible adverse effects of treatment [pre 3.14 ±0.90 vs post 4.43 ±0.53 (p= 0.002 )]. All nurses considered educational presentations provided by pharmacy students to be beneficial (pre and post = 5.00 ±0.00]. Conclusion: Post-survey responses suggest clinicians were more confident in their knowledge of inhaler devices and in their ability to educate patients on appropriate technique following an educational session led by PY3 PharmD students.
Kristeen Perry, Forsyth School of Dental Hygiene
Linda Boyd, Forsyth School of Dental Hygiene
Abstract: PURPOSE: The purpose of this study was to explore dental hygiene students’ perspectives on the method of daily clinical grading versus formative feedback and summative (comprehensive patient case competency, CPCC) assessment which is used in other health care disciplines. SIGNIFICANCE: A literature search revealed a limited number of studies of clinical assessment methods used to assess student competency. The most common methods discussed were daily clinical grading and fulfillment of patient requirements. However, it remains unclear this is an effective approach for ensuring competency. METHODS: Based on the literature a BSDH program developed a method of formative and summative assessment (CPCC) for clinical curriculum. A survey was developed to gather student perspectives on the change from daily clinical grading to formative/summative assessment. The survey was distributed to a convenience sample of dental hygiene students (n=48) at the end of fall and spring semesters, anonymous, and conducted in an online survey tool. RESULTS: The response rate was 100% (n=48). Responses to the following statements were as follows: I felt like formative feedback allowed for more collaboration with clinical faculty than the daily grading format, 98% (n=47) agreed/strongly agreed. Formative feedback encourages me to ask questions to enhance my learning, 98% (n=47) agreed/strongly agreed. When asked about summative assessment in the form of patient care competency (CPCC), 98% agreed/strongly agreed; Summative CPCCs were an appropriate method to evaluate my abilities to provide evidence-based dental hygiene care. The main advantage cited: I feel like formative feedback opened more doors for questions and hands-on help from clinical instructors and there was less pressure so it was easier to ask faculty questions regarding patient care and know what's expected of you before being graded. Overall 83% (n=40) preferred the formative/summative assessment vs. 15% who preferred daily grading. DISCUSSION: Upon initial implementation of the change in grading format students felt uncomfortable asking questions because they were used to ‘losing points’ in the daily clinical grading system. Students quickly came to value the opportunity to ask questions to learn and improve their patient care skills prior to summative assessment. CONCLUSION: Based on student comments daily grading makes them reluctant to ask questions which is a necessary part of learning. Finding a balance between creating a safe environment where students can learn and assessing competence to ensure graduates can provide quality care is challenging, but this small study suggests formative and summative assessment system may facilitate student learning.
Katherine Carey, School of Pharmacy-Worcester/Manchester
Evan Horton, School of Pharmacy-Worcester/Manchester
Jason Cross, School of Pharmacy-Worcester/Manchester
ABSTRACT: Objective: To develop and evaluate Pharmacy Boot Camp (PBC), a longitudinal experience to improve pharmacy resident teaching skills. Methods: Pharmacy Boot Camp was evaluated during the 2011/2012 residency year at an academic medical center. Four PGY-1 pharmacy practice residents participated in weekly teaching sessions with approximately 100 advanced pharmacy practice experience students. Each resident led approximately one hour-long PBC each month, utilizing a variety of active learning strategies throughout the year. During each PBC, students assessed the residents using a survey aimed to evaluate teaching using the best practices model. Residents were surveyed at year end to determine the benefits of the experience. Results: Student evaluation results were consistently high (median 4 “agree” to 5 “strongly agree” for all best practices) and did not change significantly from the first to the final teaching session. Resident survey results demonstrated that PBC improved their teaching skills. Responses varied on the importance of demonstrating enthusiasm and expertise in their PBC topics, difficulty in developing learning objectives and creating the lecture session. All agreed that they very often used the feedback obtained from student evaluations when preparing subsequent teaching activities. Implications: We developed a longitudinal experience that residents found valuable for improving teaching skills. Student experience was positive overall and allowed for additional high quality didactic sessions during APPE rotations. Other residency programs could easily implement our longitudinal teaching experience.