Friday, January 20, 2017

Goodbye and Good Luck!


As my rotation draws to a close, I wanted to reflect on a few of my experiences at mdBriefCase. Within a span of five short weeks, I have been able to accomplish several projects, while refining my quantitative and qualitative skills.

Major highlights included the following: 

Project
Learning Outcomes
eCME Critical Appraisal on OAB
-        Provided an opportunity to analyze a participation report
-        Learned about accreditation bodies, such as CCCEP
-        Enhanced my presentation skills
eNewsletter on Sexual Health in Older Men
-        Challenged me to write succinctly and under 1300 words!
-        Collaborated with Content Development and Marketing regarding programming and promotion prior to deployment
9 Blog Posts
-        Explored a variety of topics, including vaccinations by pharmacists and tips for pharmacy students
-        Received positive feedback from colleagues
Foot Care Module on MedSchoolforYou
-        Created a module that supports health literacy amongst patients, and boosts pharmacist confidence when assessing and recommending products for different foot conditions
eCMEs
-        Completed The Diabetes Education: A Comprehensive Review, which served as excellent preparation for the CDE
-        Also finished CMEs on pain, antispasmodics and BED to increase my general therapeutic knowledge

Looking back, each activity challenged my ability to be a malleable writer, clinician and scholar.  I sincerely appreciate all of the help and kindness I have received during my time at mdBriefCase. Special thanks to Cassandra and Mike for their wealth of knowledge and support!

Warmest Regards,

Vivian


Wednesday, January 18, 2017

All in the Family

During the summer, I had the pleasure of working at a Family Health Team (FHT) in the heart of downtown Toronto. Based on my experiences there, I truly believe that the level and quality of care from a FHT cannot be paralleled to any other, more traditional healthcare model.

There are currently 184 FHTs in Ontario, which serve over 3 million people in over 200 rural and suburban communities. FHTs aim to enhance patient access to comprehensive primary care services from various healthcare providers (HCP). Each FHT has an interdisciplinary team, which typically includes physicians, pharmacists, nurses, nurse practitioners, social workers, dietitians and other allied health professionals.  


Within this ambulatory setting, patients are seen by appointment. During my practice, chronic disease management (e.g. diabetes, hypertension, COPD), warfarin dosing, treatment of short-term illnesses (e.g. UTI) and obstetrical care were most commonly encountered on a daily basis. Certain FHTs also provide specialized services, such as smoking cessation, telemedicine and substance abuse clinics. However, the availability of these services is contingent upon the population the FHT serves. 

As a pharmacy student, my role at the FHT was multifaceted and highly collaborative. In addition to providing medication reviews and patient counseling, I became a valuable drug information resource for other members of the team. I also provided extensive medication management to several complex patients, as part of the home-visit program. 

Overall, my time at the FHT was both incredibly satisfying and rewarding. The rapid turnover of patients made each day a fresh and exciting clinical challenge. Furthermore, my communication, therapeutic and leadership skills rapidly flourished within the academic environment. Looking ahead, I really hope that the FHT model will be adopted by many other jurisdictions, so that essential health care services can be readily accessible by all.

Contact your local FHT to see if you are eligible to enroll in their patient roster!


Vivian

Friday, January 13, 2017

Putting My Best Foot Forward

Week 4 of my rotation has flown by, and it’s been an exciting one at that. I have been gearing up for the deployment of “Fancy Feet: Caring for Plantar Warts, Athlete’s Foot and Fungal Toenail Infections”. This is a foot care module I have been working on for MedSchoolForYou (MSFY), one of the education platforms from mdBriefCase. This blog will give you a behind-the-scenes look at how this module was developed!

Stage 1: Picking a Topic
  • During my first week, I brainstormed a list of therapeutic topics that would be interesting to write about and appealing to readers. After perusing the MSFY website and reflecting on my experiences in community pharmacy, I identified a knowledge gap in foot care.
Stage 2: Creating an Outline
  • Using various resources (e.g. clinical databases, minor ailments guidelines), I completed preliminary research on the foot conditions I wanted to include in the module. I then created an outline to simplify the writing process.
Stage 3: Creating a Draft
  • Writing the module’s content was a multifaceted process that consisted of researching, data synthesis and organization. I also considered the depth and breadth of information, the use of patient-friendly language and the inclusion of pictures to draw interest.
Stage 4: Editing the Draft
  • I was able to get valuable feedback from Cassandra, my preceptor, and Mike, my pharmacist mentor. Following a series of amendments, the content for the MSFY was finalized.
Stage 5: Programming
  • With the help of Mila, one of our talented Content Developers, all of the content and visual elements were programmed online. She also provided me with drafts on our hidden server to test and approve.
Stage 6: Developing a Marketing Strategy
  • In order to promote the deployment of this module, Cassandra suggested that I write this blog! Furthermore, the module will be shared on mdBriefCase’s Twitter and Facebook accounts.
Stage 7: Going Live!
  • Now that the MSFY is ready to go, all that’s left to do is launch!

Overall, developing “Fancy Feet” was an insightful opportunity to learn and collaborate within the office. I hope that readers find this module to be both useful and informative!

*Update: Fancy Feet is now live! Readers can access the module here: http://www.medschoolforyou.ca/apps/programviewer/default.aspx?section=ffc&program_id=4709&subsection=pwb*


Vivian

Friday, January 6, 2017

A Case of the Cramps - Review of eCME

To mix up the blog a bit, I’ve decided to review an eCME this time around! After looking through the rxBriefCase directory, the Role of Antispasmodics in the Self-Treatment of Abdominal Cramping and Pain caught my attention.

Based on the learning objectives alone, this topic was already interesting and relevant to my practice. At the community pharmacy I work at, patients commonly ask about gastrointestinal (GI) issues and how to optimally manage them. This program provided a comprehensive overview of functional GI disorder (with a focus on IBS), and increased my confidence in recommending an antispasmodic. Due to the sensitive nature of the condition, I also appreciated the counselling suggestions found throughout the program.


After completing the session, key learning points included:
-        The pathophysiology of functional GI disorder is multifaceted, and includes genetics, psychosocial factors, visceral hypersensitivity, inflammation and changes to bacterial flora
-        Patients with “red flags” (e.g. dysphagia, weight loss >3 kg within 6 months) should be referred to a physician
-        GI diseases can severely impair quality of life, due to the unpredictable nature of symptoms and associated emotional distress
-        Therapies for functional GI disorder are not curative, but mainly target patient-specific symptoms, such as diarrhea, constipation, abdominal cramps and pain 
-        Compared to placebo, loperamide is no more effective at reducing pain, bloating or global symptoms of IBS, and may worsen nighttime abdominal pain
-        Non-prescription antispasmodic therapies (i.e. hyoscine butylbromide, dicyclomine hydrochloride) are effective and well tolerated for abdominal pain and cramps, with a low incidence of anticholinergic side effects

As practice shifts towards pharmacy-based, minor ailments programs, pharmacists are well equipped to embrace the challenges of assessing, educating and treating a number of expanded health conditions. In line with this philosophy, this CME was an excellent illustration of how pharmacist involvement can positively impact the lives of patients with chronic, GI disease.

Vivian

Tuesday, January 3, 2017

New Year, New You

With the New Year just beginning, this is a great time for pharmacy students to reflect upon the past year and to set goals for 2017. Here are 5 New Year’s Resolutions to keep you motivated and excited for your future in pharmacy! 

1.     Complete eCMEs
·        In order to provide optimal, evidence-based care, pharmacists and pharmacy students should remain up to date with respect to their therapeutic knowledge.
·        eCMEs are an excellent way to stay abreast of current literature.  In addition, participating in accredited CME programs equip you with educational credits, which can be highly desirable when job seeking.
·        rxBriefCase offers a wide range of free, online programs for pharmacists, pharmacy students and technicians that are easily accessible and convenient!
2.     Update your curriculum vitae (CV)
·        Maintaining an updated CV is critical, especially when new career or educational opportunities arise, such as pharmacy residencies.
·        Be sure to include all of your accomplishments from the past year and provide a brief description of your role and what skills you gained from each activity.
3.     Partake in pharmacy research
·        Pharmacy research can be a very rewarding experience, especially if your project is novel and can enhance current practice.
·        In addition to collaborating with different preceptors, research provides a unique opportunity to improve your scientific writing skills, understand research principles and appreciate research ethics.
4.     Network
·        Attending a pharmacy conference, such as the Pharmacy U Conference or CSHP Professional Practice Conference, will enable you to meet fellow peers, experts, mentors and even your potential employer!
·        Conferences are also a great way to learn about the latest in drug development, research innovation and clinical practice.
5.     Seek further certifications
·        After graduation, obtaining additional certifications will distinguish you from being just another pharmacist with a PharmD. Certifications, including the Certified Diabetes Educator (CDE), Certified Geriatric Pharmacist (CGP) and Certificate in Travel Health (CTH) will allow you to become highly specialized and qualified!


Best Wishes in 2017!

Thursday, December 22, 2016

A Different Way of Writing

Throughout pharmacy school, the PharmD curriculum has encouraged a critical, systematic way of thinking. Naturally, our documentation skills, whether it be patient care plans or position papers, is structured and almost formulaic by design.

Before arriving at RxBriefCase, I dove into the wild and wonderful world of research at St. Michael’s Hospital. Within the first few days, I realized that this rotation was an immense literary feat, and my first real exposure to writing abstracts, manuscripts and a scientific protocol. Each project had its stylistic quirks, including strict word limits, required headings and specifications for formatting, defined by research journals and scientific bodies. As an example, the study protocol I created needed to follow evidence-based criteria outlined by SPIRIT, an international organization that aims to enhance the quality of clinical trial protocols. 

Now that I have settled in at RxBriefCase, I have been tasked with the creation of an eNewsletter, a critical appraisal of an eCME, a module for MedSchoolForYou and periodic updates on the pharmacy student blog. So far, these have been excellent opportunities to reflect on my writing skills (and that of others), to refine the ability to communicate succinctly and to develop patient/provider-friendly education, albeit challenging at times.

Regardless of the type of writing I encounter, a few things remain tried and true: 
1.     Landscape- know what information is out there; your work should be novel or inform change
2.     Assess- review samples of published work to identify how your piece should be written
3.     Target- be mindful of your audience and select words appropriately
4.     Edit- constantly revise, as this guides your development
5.     Reference- always cite your sources!

Have a safe and happy holiday!



Vivian

Thursday, December 15, 2016

Pinky and the Brain


In response to a rising number of deaths, the U.S. Drug Enforcement Administration (DEA) has labelled U-47700, also known by its street name ‘Pink’, as a Schedule I product under the Controlled Substances Act.1 As of November 2016, at least 46 deaths around the U.S. have been associated with the use of Pink. This includes two 13 year-old boys, who tragically overdosed on Pink obtained from teens who had ordered it online.2


Pink was previously developed in the 1970s as a potential analgesic alternative to morphine. Today, amidst a global opioid abuse crisis, it has concerningly re-surfaced as a new synthetic opioid. With principal manufacturing occurring overseas, Pink’s composition, purity and exact effects are unknown, and it is often encountered with other illicit substances, such as heroin and fentanyl. Furthermore, it can appear in a number of different forms (e.g. powders, tablets), or may be marketed as other prescription products by producers. Evidently, any quantity of Pink could be fatal.

Reports indicate that Pink’s potency is up to 8-fold that of another highly abused opioid, heroin.2 As a class, opioids bind to the mu-opioid receptors in the brain, which mediate biochemical responses associated with pleasure and reward. In the event of an opiate overdose, the body’s central nervous system is unable to regulate basic bodily functions. This can lead to slowed breathing, a decline in body temperature and a loss of consciousness. Overdosed persons may also become cyanotic, myoclonic and develop seizures. 

Naloxone, an opioid antagonist, can be used to reverse the effects of various opiates. As of June 24, 2016, naloxone was designated as a Schedule II product, enabling individuals to obtain this potentially life-saving drug from their local pharmacy without a prescription.3 Despite its proven ability to prevent opioid-related deaths, the efficacy of naloxone for Pink overdoses remains unclear. 

In light of the above, where do pharmacists fit in? As one of the most accessible, front-line health practitioners, pharmacists have the ability to recognize the signs of opioid addiction, monitor safe opioid use and refer patients for help. Now, with the advent of naloxone availability in community pharmacies, pharmacists also have a valued role in the safe distribution of and training for naloxone. For more information, please visit the following sites: CAMH, the Drug and Alcohol Helpline and The Works.

Vivian

References

1.    United States of America Drug Enforcement Administration. DEA Schedules Deadly Synthetic Drug U-47700. November 2016. Available: https://www.dea.gov/divisions/hq/2016/hq111016.shtml (accessed December 12, 2016).
2.    CBS News. Police: 2 Utah 13 year-old boys died from dangerous, new synthetic drug ‘pink’. October 2016. Available: http://www.cbsnews.com/news/police-2-utah-13-year-old-boys-died-from-dangerous-new-synthetic-drug-pink/ (accessed December 12, 2016).

3.    Ministry of Health and Long Term Care. Ontario naloxone program for pharmacies. August 2016. Available: http://www.health.gov.on.ca/en/pro/programs/drugs/opdp_eo/notices/fq_exec_office_20160817.pdf (accessed December 12, 2016).