Validation of an Empathy Scale in Pharmacy and Nursing Students

Objective. To validate an empathy scale to measure empathy in pharmacy and nursing students.Methods. A 15-item instrument comprised of the cognitive and affective empathy domains, was created. Each item was rated using a 7-point Likert scale, ranging from strongly disagree to strongly agree. Concurrent validity was demonstrated with the Jefferson Scale of Empathy – Health Professional Students (JSE-HPS).Results. Reliability analysis of data from 216 students (pharmacy, N=158; nursing, N=58) showed that scores on the empathy scale were positively associated with JSE-HPS scores (p<0.001). Factor analysis confirmed that 14 of the 15 items were significantly associated with their respective domain, but the overall instrument had limited goodness of fit.Conclusions. Results of this study demonstrate the reliability and validity of a new scale for evaluating student empathy. Further testing of the scale at other universities is needed to establish validity.     

Assessment of Korean Pharmacy Students’ Empathy Using the Jefferson Scale of Empathy

Objective. To validate the Korean-translated Jefferson Scale of Empathy-Health Professions Student version (JSE-HPS) and to investigate the empathy levels of pharmacy students in South Korea.Methods. The JSE-HPS and the Interpersonal Reactivity Index (IRI) were administered to 452 pharmacy students in their second and third years at 5 Korean universities. Confirmatory factor analysis (CFA), correlations, and one-way ANOVAs were conducted for data analyses.Results. The final sample size comprised 447 responses. The 3-factor model of the JSE-HPS was confirmed by CFA and the convergent validity was also supported by its correlations with the IRI subscales. The overall mean score was 80.3. Pharmacy students enrolled in women’s or private universities reported significantly higher levels of overall empathy than their counterparts in co-ed or national universities.Conclusion. Our findings empirically support the psychometric soundness of the Korean JSE-HPS for pharmacy students.     

Impact of an Aging Simulation Game on Pharmacy Students’ Empathy for Older Adults

Objective. To evaluate changes in empathy and perceptions as well as game experiences among student pharmacists participating in an aging simulation game.Methods. First-year student pharmacists participated in an aging simulation game. Changes were measured pre/post-activity using the Kiersma-Chen Empathy Scale (KCES) and Jefferson Scale of Empathy – Health Professions Scale (JSE-HPS) for empathy and the Aging Simulation Experience Survey (ASES) for perceptions of older adults’ experiences and game experiences. Wilcoxon signed rank tests were used to determine changes.Results. One hundred fifty-six student pharmacists completed the instruments. Empathy using the KCES and JSE-HPS improved significantly. Of the 13 items in the ASES, 9 significantly improved.Conclusion. Simulation games may help students overcome challenges demonstrating empathy and positive attitudes toward elderly patients.     

Impact of a workshop about aging on the empathy scores of pharmacy and medical students

Objective. To measure changes in pharmacy and medical students’ empathy scores after a 40-minute workshop during which students observed and discussed a theatrical performance about the challenges of aging.Methods. First-year pharmacy and medical students (n = 187 and n = 183, respectively) participating in the workshop observed and discussed a 10-minute performance in which students enacted problems and concerns faced by elderly patients. The Jefferson Scale of Empathy (JSE) was administered just prior to the workshop (pretest), immediately afterward (posttest 1), and 7 or 26 days afterward (posttest 2).Results. Empathy increased significantly from pretest to posttest 1 for students of each profession (p <0.01). Improvement in empathy scores declined by the time the JSE was readministered to pharmacy students 7 days later and to medical students 26 days later (posttest 2). Similar patterns of improved and declining empathy were found when the data were analyzed by gender and medical student specialty interest (ie, primary vs non-primary care specialties).Conclusion. Empathy scores increased but were not sustained for both pharmacy and medical students after a brief workshop on aging that required limited personnel resources.     

Measuring empathy in pharmacy students

Objective. To validate the Jefferson Scale of Empathy-Health Profession Students version (JSE-HPS) in pharmacy students.Methods. The JSE-HPS (20 items), adapted from the original Jefferson Scale of Empathy for use among students in the healthcare professions, was completed by 187 first-year pharmacy students at Midwestern University Chicago College of Pharmacy.Results. Two factors, “perspective-taking” and “compassionate care,” emerged from factor analysis in this study, accounting for 31% and 8% of the variance, respectively. These factors are similar to the prominent ones reported in previous research involving physicians and medical students, supporting the construct validity of this instrument for pharmacy students. In the current study, mean JSE-HPS score was comparable to those reported for medical students, and consistent with previous findings with medical students and physicians. Women scored significantly higher than men.Conclusions. Findings support the construct validity and reliability of the JSE-HPS for measuring empathy in pharmacy students.     

Training Malaysian Pharmacy Undergraduates with Knowledge and Skills on Smoking Cessation

Objective. To evaluate the feasibility of an online training module, Certified Smoking Cessation Service Provider (CSCSP), developed for practicing pharmacists to equip pharmacy students with knowledge necessary for smoking cessation counseling and to assess the changes in student knowledge and skills regarding smoking cessation following training.Design. Sixty third-year and 80 fourth-year pharmacy undergraduates (N=140) were given access to an online module, the main intervention in the study. Two linkable questionnaires were administered to assess students’ preintervention and postintervention knowledge. For the third-year students, an additional role-play training component was incorporated, and student skills were assessed during week 14 with an Objective Structured Clinical Examination (OSCE).Assessment. Preintervention and postintervention knowledge assessments were completed by 130 (92.8%) students. Sixty-six students scored above 50% for the knowledge component postintervention, compared to 13 at preintervention, demonstrating significant improvement (x2(1, N=130)=32, p=0.003). All third-year students completed the intervention, and 66.7% were able to counsel excellently for smoking cessation, scoring more than 80%.Conclusion. The CSCSP online module developed for practicing professionals was found suitable for equipping pharmacy undergraduates with knowledge on smoking cessation topics. The module, along with role-play training, also equipped students with knowledge and skills to provide smoking cessation counseling.     

Active-Learning Diabetes Simulation in an Advanced Pharmacy Practice Experience to Develop Patient Empathy

Objective. To develop and integrate an active-learning diabetes simulation into an advanced pharmacy practice experience to improve pharmacy students’ empathy toward patients with diabetes mellitus.Design. Students simulated the experience of having diabetes mellitus by conducting activities commonly prescribed to those with this disease state for 7 days, after which they submitted a standardized diabetes log and narrative reflection. Interpretive phenomenology design with thematic analysis was used to determine the impact of this experience on the students.Assessment. As shown in student reflections, 95% developed empathy, 97% found the experience beneficial, and 67% improved their ability to relate to and counsel patients. Most (95%) found difficulty adhering to the regimen. On average, students consumed 179 grams of carbohydrates per day and exercised 5 days or 215 minutes per week. Additionally, 69% decided to modify their personal habits to become healthier.Conclusions. Inclusion of the 7-day active-learning exercise greatly impacted student pharmacists’ self-reported empathy toward and ability to relate to patients with diabetes mellitus. Completion of this experience may result in long-lasting personal behavior modifications.     

The Effect of Using Simulation for Training Pharmacy Students on Correct Device Technique

Objective. To assess the effect of using simulation in pharmacy student training on correct device technique.Methods. A single-blinded, repeated measures, parallel group design study was conducted in 2011, involving all final-year pharmacy students in year 5 (final year) enrolled in the Clinical Pharmacy and Therapeutics course. Students were assessed on device technique at baseline based on previously published checklists for Diskus (DIS), Turbuhaler (TH), and pressurized Metered Dose Inhaler (pMDI). Students were randomly assigned to 2 groups: Intervention A, which included supervised hands-on education in groups and peer assessment/education; and Intervention B, which included supervised hands-on education in groups, peer assessment/education, and a simulated scenario counseling real asthma patients. The simulation involved groups of 6 students counseling 3 asthma patients on inhaler device technique. The counseling involved verbal information and physical demonstration until the patient performed all steps correctly. Student assessments on device technique were repeated 1 week postintervention.Results. At baseline, none of the students in Intervention A (n=54) or Intervention B (n=55) performed correct technique for any of the 3 devices. One week following the intervention, a significantly higher proportion of students in Intervention B demonstrated correct technique for the Diskus, Turbuhaler, and pMDI (60.0%, 70.9%, and 69.1%, respectively) than did students in Intervention A (27.8%, 40.7%, and 42.6%, respectively, p<0.005).Conclusion. Engaging pharmacy students with real asthma patients in a simulated scenario involving correct device technique education resulted in better device technique demonstration skills among students.     

Pharmacy Students’ Ability to Identify Plagiarism After an Educational Intervention

Objective. To determine if an educational intervention in a doctor of pharmacy (PharmD) degree program increases pharmacy students’ ability to identify plagiarism.Methods. First-year (P1), second-year (P2), and third-year (P3) pharmacy students attended an education session during which types of plagiarism and methods for avoiding plagiarism were reviewed. Students completed a preintervention assessment immediately prior to the session and a postintervention assessment the following semester to measure their ability.Results. Two hundred fifty-two students completed both preintervention and postintervention assessments. There was a 4% increase from preintervention to postintervention in assessment scores for the overall student sample (p<0.05). The mean change was greatest for P1 and P2 students (5% and 4.8%, respectively).Conclusion. An educational intervention about plagiarism can significantly improve students’ ability to identify plagiarism.     

Positive association of personal distress with testosterone in opiate-addicted patients

Clinical studies report that substance addictions are associated with sociocognitive impairments. Regarding opiate-addicted patients, the few existing studies point to deficits in empathic abilities. Previous research suggests that testosterone might be a relevant biomarker of these impairments. The authors aimed to investigate whether opiate-addicted patients show specific impairments in emotional (empathic concern, personal distress) and cognitive empathy compared to healthy controls. Furthermore, the authors aimed to assess possible associations of testosterone levels with impaired empathic abilities in the patients' group. In this cross-sectional study, 27 opiate-addicted, diacetylmorphine-maintained patients (21 males, age mean 41.67 years, standard deviation 8.814) and 31 healthy controls (23 males, age mean 40.77 years, standard deviation 8.401) matched in age, sex, and educational level were examined. Cognitive and emotional empathy were measured via the German version of the Interpersonal Reactivity Index and salivary testosterone levels were assessed. The authors found higher personal distress scores (p < 0.01, d = 0.817) and higher testosterone (p < 0.001, d = 1.093) in the patients' group compared to controls. Moreover, a positive correlation was found between testosterone and personal distress among the patients' group (r = 0.399, p < 0.05). Opiate-addicted patients show specific impairments in emotional empathy, namely higher personal distress, which has clinical implications regarding social cognition rehabilitation and relapse prevention. The current data point toward testosterone as a possible biomarker for these sociocognitive impairments and suggest that high personal distress and high testosterone during withdrawal are possible markers for severe opiate addiction.     

Consumer-led mental health education for pharmacy students

Objective

To evaluate a consumer-led teaching intervention to reduce pharmacy students'' stigma towards depression and schizophrenia, and improve attitudes toward providing pharmaceutical care for consumers with mental illness.

Design

Third-year bachelor of pharmacy degree students were given a series of mental health lectures, undertook supervised weekly placements in the community pharmacy setting, and attended a tutorial led by trained mental health consumer educators.

Assessment

A previously validated 26-item survey instrument was administered at baseline, 6 weeks postintervention, and 12 months postintervention, and 3 focus groups were conducted. Survey instruments were completed by 225 students at baseline, 230 students postintervention, and 228 students at 12 months. Students'' stigma decreased (p < 0.05) and their attitudes toward the provision of pharmaceutical services to consumers with a mental illness showed significant improvements (p < 0.05). These improvements were maintained at the 12-month follow-up. Four themes emerged from the focus groups: knowledge and experience of mental illness, mental health stigma, impacts on attitudes and self-reported behavior, and the role of the pharmacist in mental healthcare.

Conclusions

Consumer-led education for pharmacy students may provide a sustainable reduction in stigma and improve attitudes towards providing pharmaceutical services to consumers with a mental illness.     

Levofloxacin-based triple therapy vs. quadruple therapy in second-line Helicobacter pylori treatment: a randomized trial

BACKGROUND: Levofloxacin has been shown to be effective in Helicobacter pylori eradication. Two 10-day levofloxacin-based triple therapies were compared with standard 7- and 14-day quadruple regimens in second-line treatment. METHODS: Two hundred and eighty consecutive patients who failed to respond to standard triple therapy (clarithromycin, amoxicillin, rabeprazole) were randomly assigned to four groups: (1) levofloxacin 500 mg o.d., amoxicillin 1 g b.d., rabeprazole 20 mg b.d. for 10 days (LAR, n = 70); (2) levofloxacin 500 mg o.d., tinidazole 500 mg b.d., rabeprazole 20 mg b.d. for 10 days (LTR, n = 70); (3) tetracycline 500 mg q.d.s., metronidazole 500 mg t.d.s., bismuth salt 120 mg q.d.s., rabeprazole 20 mg b.d. for 7 days (7TMBR, n = 70); and (4) for 14 days (14TMBR, n = 70). Helicobacter pylori status and side-effects were assessed 6 weeks after treatment. RESULTS: The eradication rate was 94% in the LAR group and 90% in the LTR group in both intention-to-treat and per protocol analyses. Helicobacter pylori eradication was achieved in 63 and 69% of the 7TMBR group and in 69 and 80% of the 14TMBR group in intention-to-treat and per protocol analysis, respectively. Side-effects were significantly lower in the LAR and LTR groups than in the 14TMBR group. CONCLUSION: Ten-day levofloxacin-based therapies are better than standard quadruple regimens as second-line option for H. pylori eradication.     

The effects of the subchronic feeding of the organophosphate famphur to rats.

Famphur was mixed in the feed and fed to 190 rats at three dosage levels: 1, 3, and 25 ppm. The rats were killed after 45 or 90 days exposure and one group receiving 25 ppm Famphur for 90 days was maintained on a Famphur-free diet and killed after 42 days. Famphur did not cause a significant change in food intake or weight gain of the rats. It did cause a marked reduction (p < 0.05) in plasma cholinesterase activity at 25 ppm in all groups except male rats at 45 days, in whole blood cholinesterase at 3 and 25 ppm, and in brain cholinesterase at 25 ppm. Plasma glutamic oxalacetic transaminase, glutamic pyruvic transaminase (GPT), and alkaline phosphatase activities were normal in all animals except for a slight but statistically significant (p < 0.05) increase in GPT activity of female rats in the 3- and 25-ppm 90-day treatment group. Hematological and postmortem examinations revealed no abnormal findings except for a significant (p < 0.05) increase in the packed cell volume of female rats exposed to 3 ppm for 45 days.     

An intervention to increase alcohol treatment engagement: a pilot trial

Objectives

Previous research has documented the difficulty individuals with alcohol use disorders have initiating alcohol treatment. This study assessed the feasibility of a brief, cognitive–behavioral intervention designed to increase treatment initiation among individuals with alcohol use disorders.

Methods

This randomized controlled trial included 196 participants who screened positive for a possible alcohol use disorder on the Alcohol Use Disorders Identification Test. Randomly assigned intervention participants were administered a brief cognitive–behaviorally-based intervention by telephone designed to modify beliefs that may interfere with treatment-seeking behavior. Beliefs about treatment and treatment-seeking behavior were assessed postintervention.

Results

Participants receiving the intervention had significantly improved their attitudes toward addiction treatment (p < .002) and increased their reported intention-to-seek treatment (p < .000) postintervention. Further, intervention participants were almost three times more likely to attend treatment within a 3-month period (odds ratio = 2.60, p < .025) than participants in the control group.

Conclusions

A brief, cognitive–behavioral intervention delivered by telephone and focused on modifying treatment-interfering beliefs holds promise for increasing alcohol treatment seeking among individuals in need.     

High-fidelity patient simulation series to supplement introductory pharmacy practice experiences

Objective

To introduce a high-fidelity simulation series into a 5-year doctor of pharmacy (PharmD) curriculum to demonstrate a hybrid model for introductory pharmacy practice experience (IPPE) delivery.

Design

Fourth-year pharmacy students at a satellite campus participated in a 6-week high-fidelity patient simulation series in which small groups of students worked with members of a patient care team to care for patients in the following scenarios: asthma exacerbation, acute decompensated heart failure, and infective endocarditis with a subsequent anaphylactic reaction to the antibiotic. Fourth-year pharmacy students at the main campus who did not participate in the simulation served as a comparator group.

Assessment

Students'' scores on a knowledge-based post-simulation quiz were significantly higher than scores on the presimulation quiz (p < 0.05). Knowledge retention was significantly higher among the simulation participants than students in the comparator group (p = 0.004). The majority (76%) of students felt more confident “making clinical recommendations to a healthcare provider” after completing the simulation series (p = 0.01).

Conclusion

High-fidelity patient simulation is an effective active-learning strategy to augment IPPEs that allows students to apply clinical skills in a realistic but low-risk patient care setting.     

Comparison of Answer-Until-Correct and Full-Credit Assessments in a Team-based Learning Course

Objective. To assess the impact of awarding partial credit to team assessments on team performance and on quality of team interactions using an answer-until-correct method compared to traditional methods of grading (multiple-choice, full-credit).Methods. Subjects were students from 3 different offerings of an ambulatory care elective course, taught using team-based learning. The control group (full-credit) consisted of those enrolled in the course when traditional methods of assessment were used (2 course offerings). The intervention group consisted of those enrolled in the course when answer-until-correct method was used for team assessments (1 course offering). Study outcomes included student performance on individual and team readiness assurance tests (iRATs and tRATs), individual and team final examinations, and student assessment of quality of team interactions using the Team Performance Scale.Results. Eighty-four students enrolled in the courses were included in the analysis (full-credit, n=54; answer-until-correct, n=30). Students who used traditional methods of assessment performed better on iRATs (full-credit mean 88.7 (5.9), answer-until-correct mean 82.8 (10.7), p<0.001). Students who used answer-until-correct method of assessment performed better on the team final examination (full-credit mean 45.8 (1.5), answer-until-correct 47.8 (1.4), p<0.001). There was no significant difference in performance on tRATs and the individual final examination. Students who used the answer-until-correct method had higher quality of team interaction ratings (full-credit 97.1 (9.1), answer-until-correct 103.0 (7.8), p=0.004).Conclusion. Answer-until-correct assessment method compared to traditional, full-credit methods resulted in significantly lower scores for iRATs, similar scores on tRATs and individual final examinations, improved scores on team final examinations, and improved perceptions of the quality of team interactions.     

Evidence for time-dependent interactions between ritonavir and lopinavir/ritonavir plasma levels following P-glycoprotein inhibition in Sprague-Dawley rats

The interaction between verapamil, a P-glycoprotein (P-gp) inhibitor, with ritonavir and lopinavir/ritonavir (LPV/r) after acute and chronic treatment was investigated in rats. Rats were divided into 4 groups, viz. Group 1: ritonavir, 20 mg/kg/d (n=18), group 2: ritonavir, 20 mg/kg/d plus verapamil 5 mg/kg/d (n=18), group 3: LPV/r, 80 and 20 mg/kg/d (n=17) and group 4: LPV/r, 80 and 20 mg/kg/d plus verapamil 5 mg/kg/d (n=18). Blood samples were collected after decapitation on days 1, 7 and 21. Lopinavir and ritonavir plasma levels were simultaneous determined by a validated LC/MS/MS method. The lower limit of quantification for both ritonavir and lopinavir was 0.078 μg/ml. Verapamil significantly increased ritonavir plasma levels, administered as monotherapy, following acute (p<0.005) and chronic treatment (day 21) (p<0.005). During acute (but not chronic) LPV/r treatment, verapamil also increased the lopinavir levels (p<0.05). A time or exposure dependent pharmacokinetic interaction was thus observed between verapamil and ritonavir whether administered alone or after the lopinavir-ritonavir combination (LPV/r). This interaction occurred most prominently after acute treatment, and became less pronounced over time. This study indicates the importance of a longer time frame to investigate enzyme based drug interactions in rat models.     

Evaluating the Potential Impact of Pharmacist Counseling on Medication Adherence Using a Simulation Activity

Objective. To evaluate the impact of counseling in a simulated medication adherence activity.Design. Students were randomized into 2 groups: patient medication monograph only (PMMO) and patient medication monograph with counseling (PMMC). Both groups received a fictitious medication and monograph. Additionally, the PMMC group received brief counseling. A multiple-choice, paper-based survey instrument was used to evaluate simulated food-drug interactions, adherence, and perceptions regarding the activity’s value and impact on understanding adherence challenges.Assessment. Ninety-two students participated (PMMC, n=45; and PMMO, n=47). Overall, a significantly higher incidence of simulated food-drug interactions occurred in the PMMO group (30%) vs the PMMC group (22%) (p=0.02). Doses taken without simulated food-drug interactions were comparable: 46.2% (PMCC) vs 41.9% (PMMO) (p=0.19). The average number of missed doses were 3.2 (PMMC) vs 2.8 (PMMO) (p=0.55). Approximately 70% of the students found the activity to be valuable and 89% believed it helped them better understand adherence challenges.Conclusion. This activity demonstrated the challenges and important role of counseling in medication adherence.     

Assessing Empathy and Self-Efficacy Levels of Pharmacy Students in an Elective Diabetes Management Course

Objective. To assess the impact of a 6-week patient/provider interaction simulation on empathy and self-efficacy levels of diabetes management skills in third-year pharmacy students.Design. Pharmacy students enrolled in a diabetes elective course were paired to act as a patient with diabetes or as a provider assisting in the management of that patient during a 6-week simulation activity. After 3 weeks, students switched roles. The simulation was designed with activities to build empathy.Assessment. The Jefferson Scale of Empathy (JSE) and a self-efficacy survey were administered to assess change in empathy and confidence levels from baseline to the end of the activity. Completion of the activity resulted in significant improvement in total JSE scores. Additionally, significant improvements in overall self-efficacy scores regarding diabetes management were noted.Conclusion. The 6-week patient/provider interaction simulation improved empathy and self-efficacy levels in third-year pharmacy students.