ALADI CHIDUBEM
Student
Massachussets college of Pharmacy and Health Sciences
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| Date: | 10/27/2023 |
| Rotation Type: | APPE Internal Medicine |
| Comments: | |
| Patient Sex: | F |
| Patient Ethnicity: | Hispanic or Latino |
| Age: | Geriatric (65 years old +) |
| During this intervention did you collaborate with a prescriber or student prescriber?: | No |
| How many medications were involved in this intervention?: | 5 or more |
| Disease/Disorder: | Infectious Disease |
| Type of Intervention: | Other |
| Outcome of Intervention: | Other |
| Please select the following values/skills that have contributed to your growth, development or learning.: | Accountability Care giving Collaboration Empathy Integrity Problem Solving Self-awareness |
| My preceptor or pharmacist in charge has reviewed and approved this intervention prior to making any recommendations.: | Yes |
| Date: | 09/16/2022 |
| Rotation Type: | Wor/Man IPPE Institutional |
| Comments: | |
| Write Reflection Here:: | Two weeks have now passed and I must say, Institutional rotations has been quite the learning experience. There have been a lot of experiences I've been exposed to and have learned things, one thing I particularly enjoy is that a lot of the things I'm doing right now in rotation, I already learned in IPC III lab. It feels really fulfilling being able to transfer your knowledge into real life, however there was a particular activity that piqued my interest and I would say I've been most involved in and that would be learning about the smart pump and how it is used. This interested me for a lot of reasons, one of them being the way they work, and two being the sheer impact it has. I was really amazed to one see how far technology has come, and two to see how this tool could be used to positively bring about good healthcare delivery. The issue at hand was that of a prescription that was sent in. The prescription required a bolus dose of 0.1mg but that could not be entered into the smart pump only 0.2mg could be entered so the task at hand was re-entering it. My pharmacist, sensing this was a good learning opportunity for me called me over to observe the prescription and smart pump. I saw how complex they could be as we had to account for normal saline, infusion rate, bolus dose and lastly the amount of cannisters we would need to send out. My pharmacist showed me how the calculations came around to be done and how the prescription can be interpreted, to which she then showed be how to begin calibrating the smart pump. Using a smart pump allows you to enter the prescription into it so it delivers the medication intravenously at an adequate rate. With the help of my pharmacist, I was able to calibrate it correctly, she told me that since this is such a delicate issue, it needs to undergo multiple checks by other pharmacists to which they'd sign so there is some liability After doing this I felt a massive amount of accomplishment. I had almost been directly responsible in saving the life of a patient or preserving their well-being. Then it hit me that not being meticulous and being extra careful with this could potentially kill the patient. This hit me with a feeling of nervousness but it was only short-lived because I know I was built for such pressure. I plan to continue learning applying myself, and being careful with medications as I've ever been. I'm bow dealing with hospital patients and those in a long-term care facility, These are particularly delicate people Healthwise and good care must taken of them. |
We talked about the pandemic, we also glossed over treatments on the market, we also talked about the effects this pandemic had on mental health and who was the most affected by it
Trust is a central concept for safe and effective health care. Patients must trust their physicians, and health care providers must trust each other in a highly interdependent health care system. In teaching settings, supervisors decide when and for what tasks they entrust trainees to assume clinical responsibilities. Building on this concept, EPAs are units of professional practice, defined as tasks or responsibilities to be entrusted to the unsupervised execution by a trainee once he or she has attained sufficient specific competence. EPAs are independently executable, observable, and measurable in their process and outcome, and therefore, suitable for entrustment decisions. Sequencing EPAs of increasing difficulty, risk, or sophistication can serve as a backbone for graduate medical education.
| Date: | 09/02/2022 |
| Rotation Type: | Wor/Man IPPE Community |
| Comments: | |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Age: | Geriatric (65 years old +) |
| During this intervention did you collaborate with a prescriber or student prescriber?: | Yes |
| How many medications were involved in this intervention?: | 1 |
| Disease/Disorder: | Oncologic Disorder |
| Type of Intervention: | Other |
| Outcome of Intervention: | Recommendation Accepted by Provider |
| Please select the following values/skills that have contributed to your growth, development or learning.: | Accountability Care giving Collaboration Empathy Leadership Problem Solving Professionalism Integrity |
| My preceptor or pharmacist in charge has reviewed and approved this intervention prior to making any recommendations.: | Yes |
| Date: | 09/02/2022 |
| Rotation Type: | Wor/Man IPPE Community |
| Comments: | |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Age: | Geriatric (65 years old +) |
| During this intervention did you collaborate with a prescriber or student prescriber?: | Yes |
| How many medications were involved in this intervention?: | 1 |
| Disease/Disorder: | Oncologic Disorder |
| Type of Intervention: | Other |
| Outcome of Intervention: | Recommendation Accepted by Provider |
| Please select the following values/skills that have contributed to your growth, development or learning.: | Accountability Care giving Collaboration Empathy Leadership Problem Solving Professionalism Integrity |
| My preceptor or pharmacist in charge has reviewed and approved this intervention prior to making any recommendations.: | Yes |
| Date: | 09/29/2022 |
| Rotation Type: | Wor/Man IPPE Institutional |
| Comments: | |
| Patient Sex: | M |
| Patient Ethnicity: | White |
| Age: | Geriatric (65 years old +) |
| During this intervention did you collaborate with a prescriber or student prescriber?: | No |
| How many medications were involved in this intervention?: | 1 |
| Disease/Disorder: | Other |
| Type of Intervention: | Dose Recommendation |
| Outcome of Intervention: | Recommendation Accepted by Provider |
| Please select the following values/skills that have contributed to your growth, development or learning.: | Accountability Care giving Empathy Integrity Professionalism |
| My preceptor or pharmacist in charge has reviewed and approved this intervention prior to making any recommendations.: | Yes |
MyHemo, an app to assist patients manage their antiplatelet therapy
Background:
The human ingenuity in healthcare is always looking for new and improved ways to deliver healthcare. This came in the advent of pharmacogenomics, which is a groundbreaking but a relatively new area in pharmacy. With this new process, healthcare can be personalized even further, patients can now get treatment that works specifically for them. Some may ask how this is done? But this is only possible with the one thing personal to almost every human, the human genome. This allows patients to know what treatments are the least and most effective, knowing what risks the patients are exposed to because of their genetic makeup, and knowing what potential adverse effects or drug interactions are possible and how they can be avoided. We aim to develop an application where patients can have access to this information and assist them in making healthcare decisions. Pharmacogenomics is now making its way into mainstream medicine and this couldn’t come at a much better time. Healthcare professionals gain a better understanding of chronic conditions and diseases, and what type of response therapy will elicit due to genetic makeup. One particular area gaining traction is the area of antiplatelet therapy. New information has been discovered that patients may respond differently due to their genetic makeup, and this is the niche we plan to target. In an article by Phillip Bonney et al, studies indicated that different CYP450 genotype variations affect antiplatelet drug response.1 Therapy can be improved and more adverse effects that would otherwise be ignored can be avoided.
Identification of problem
Clinical practices for antiplatelet therapy remain empirically guided or based on functional assay tests.1 Empiric treatment is not always the best option in some cases as commonly used antiplatelet agents such as aspirin and clopidogrel have their own unique considerations.1 Patients on aspirin but have repeat cases of ischemic stroke are termed ‘aspirin failures’ and are then put on dual therapy with another antiplatelet agent but the mechanism of efficacy is still unclear. Whether the dual therapy was able to overcome the platelet clotting or was it simply that the aspirin was just not effective whatsoever and the secondary agent was successful? Clopidogrel undergoes a resistance phenomenon that varies between 4% to 44% which can lead to treatment failure and adverse events.1 Furthermore it has become more apparent that recurrent thrombotic events are due to platelets in a lower activation state which are less sensitive to current antiplatelet therapies that target autocrine events involved in platelet aggregation.2 Current therapies are focused on activated platelets close to the site of injury.2 In order to optimize antiplatelet therapy and reduce the risk of recurrent thrombus formation treatment needs to be more precise. Functional platelet assay tests are commonly used to determine platelet activity in selecting the appropriate antiplatelet agent. But these tests are highly variable and have minimal consistencies. These tests are also dependent on factors such as patient hematocrit and hemoglobin which can change rapidly. Genomic testing which is rapid, accurate, and low cost is an effective way to tailor antiplatelet therapy based on the individual patient. There is a lot of evidence out there for how a patient’s genetic profile can impact how they will respond to antiplatelet therapy.1
CAPE outcome/Learning objectives:
2.1. Patient-centered care (Caregiver)
2.1.2. Interpret evidence and patient data.
2.1.6. Monitor the patient and adjust the care plan as needed.
2.4. Population-based care (Provider)
2.4.1. Assess the healthcare status and needs of a targeted patient population.
2.4.2. Develop and provide an evidence-based approach that considers the cost, care, access, and satisfaction needs of a targeted patient population.
Goals:
- Initially employed for screening individuals with clotting disorders, platelet function testing has evolved to play a role in the clinical management of bleeding, offering guidance for transfusion needs.
- Create a system that securely incorporates genetic data into the application. This could entail adopting standardized genetic data formats or forming alliances with genetic testing providers. To preserve user privacy data protection laws (such GDPR and HIPAA) are followed. Give consumers the tools they need to track and keep an eye on their health metrics, including symptoms, vital signs, and drug adherence. Frequent monitoring facilitates informed decision-making and efficient management of chronic illnesses for both patients and healthcare professionals.
- Collaborate with geneticists and medical specialists to create a database of genetic markers linked to antiplatelet therapy responses. Use algorithms that examine the user's genetic information to offer tailored antiplatelet therapy recommendations based on the most recent findings in science.
- Provide tools for prescription management, dosage monitoring, and medication reminders. For many medical illnesses to be effectively managed, increasing medication adherence is essential.
- Create antiplatelet medications with greater potency to better prevent the formation of clots. Boost the effectiveness of currently available medications with creative formulations or combo treatments.
- Establish the ideal antiplatelet therapy duration for various patient groups and medical conditions. Examine safe ways to stop antiplatelet medication when it's no longer necessary.
- Antiplatelet regimens should be customized according to the unique traits, genetics, and risk factors of each patient. Create biomarkers to help determine which patients will respond best to antiplatelet treatments.
Review options/Brainstorm:
At least 2 potential ideas:
- Education resources
Educate patients, caregivers, and medical professionals in person about antiplatelet therapy, cardiovascular health, and lifestyle management through workshops and seminars.
- Monitoring platelets:
Send out alerts or visual representations according to platelet activity levels. Include a feature that allows users of the app to check the platelet function.
At least 1 advantage and disadvantage of each:
Advantage of Education resources
- Provide educational content about antiplatelet medications, including their purpose, potential side effects, and the importance of adherence. Provide information on lifestyle changes to supplement antiplatelet therapy.
Disadvantages of Education resources
- Providing comprehensive information can overwhelm users and hinder their ability to retain important information about antiplatelet medications, side effects, and lifestyle changes.
Advantages of Monitoring Platelet:
Advantages of Monitoring Platelet:
Early Problem Identification: Monitoring platelet function makes it possible to identify abnormalities or changes early on that could point to possible health problems and take prompt corrective action. By lowering the risk of diseases like clotting problems or excessive bleeding, monitoring platelet function can help prevent issues linked to excessive or inadequate platelet activity.
Disadvantages of Monitoring Platelets:
- Price and Availability: Integrating platelet monitoring functions, especially with mobile devices or specific tests, may incur additional costs. This may limit access to individuals with financial constraints or areas with limited resources.
Monitoring idea #2
monitoring plateltes:3,4:
- User Engagement Monitoring: Verify if people use the app actively. Keep tabs on user logins, usage patterns, and interaction with important features, monitor how much time users spend within the app, and lastly Track how often users access the app.
- Monitoring the safety of anti-platelet treatment via adverse events such as bleeding, is necessary. Patients can report symptoms via the app. If symptoms are alarming, a provider will connect to the patients and provide appropriate care. The bleeding risk and stent thrombosis differ between different population groups. Based on a study, east Asian patients are at higher risk of bleeding but less stent thrombosis risk compared to Western patients.3
- Provider meets routinely with patients via app video conferencing to assess the effectiveness and safety of anti-platelets
- The medication reminder feature of the app can help improve adherence and timely administration of drugs to improve health outcomes
References:
- Bonney PA, Yim B, Brinjikji W, Walcott BP. Pharmacogenomic considerations for antiplatelet agents: the era of precision medicine in stroke prevention and neuro interventional practice. Cold Spring Harb Mol Case Stud. 2019;5(2):a003731. Published 2019 Apr 1. doi:10.1101/mcs.a003731
- Jourdi, G., Lordkipanidzé, M., Philippe, A., Bachelot-Loza, C., & Gaussem, P. (2021). Current and Novel Antiplatelet Therapies for the Treatment of Cardiovascular Diseases. International journal of molecular sciences, 22(23), 13079. https://doi.org/10.3390/ijms222313079
- Marcucci R, Berteotti M, Gragnano F, et. al. Monitoring antiplatelet therapy: where are we now?. Journal of Cardiovascular Medicine 24. 2023,p e24-e35. DOI: 10.2459/JCM.0000000000001406
- Sambu N, Curzen N. Monitoring the effectiveness of antiplatelet therapy: opportunities and limitations. Br J Clin Pharmacol. 2011;72(4):683-696. doi:10.1111/j.1365-2125.2011.03955.x
Final Team Charter
Group Number: 18
Project manager: Afraa Amer
Team goals: Design a user-friendly and patient-centered application that provides information and up-to-date knowledge to patients about their pharmacogenomics profile and its related drug therapy.
Team rules: We meet on Zoom on the weekends to discuss the project. We use text messaging to communicate with each other. We decided to finish the project a week before the due date and submit it as soon as finalized.
Barriers/coping strategies:
A project is unsuccessful without effective communication so we share and listen to everyone's point of view. Meeting deadlines in a timely fashion is important. If someone does not finish on time then we talk calmly and discuss why the project is late and what can be done to make it work on time. If nothing can be managed then we can reach out to the project advisor and course coordinator.
Sign and date:
Team member: Afraa Amer 11/16/2023
Team member: Kamaljeet Kaur 11/16/2023
Team member: Muhammad Raza 11/16/2023
Team member: Chidubem Aladi 11/16/2023
I along with two other students presented on the senior citizen or aged population in worcester
201130121335_Presentation_Older_Adults.pptx (.pptx) 0.83mb I plan to continue learning applying myself, and being careful with medications as I've ever been. I'm bow dealing with hospital patients and those in a long-term care facility, These are particularly delicate people Healthwise and good care must taken of them.
| Date: | 09/28/2022 |
| Rotation Type: | Wor/Man IPPE Institutional |
| Comments: | |
| Write Reflection Here:: | As my rotations begin to come to an end, it's been nothing short of a pleasurable experience, I've been really lucky with the people in charge of my rotations. Since this is my first experience in the institutional pharmacy setting, I really appreciate the patience my preceptor, pharmacists, and technicians have shown me in helping me learn. There have been some experiences along the way that have really shown me this is what I want to do. It's been really fulfilling being able to do the things I learned in class. It gives you this feeling of being in control because you're knowledgeable on the subject. One experience that particularly sticks out to me is when I had to make a call regarding a potential adverse drug event that might have affected the patient. The patient was allergic to cephalosporins and cephalexin was prescribed. I had to make a phone call to the patient's nurse to make sure everything was okay before he took the medication. The nurse said she would check with the doctor to see if it was okay. For all we know this may not have been a true allergy, but it could have also been and caused potential harm. Being that checkpoint of patient safety felt both fulfilling and reaffirmed that this is what I wanted to continue. This being only the IPPEs I do not yet have the full control and authority pharmacists have so I already started preparing myself for more responsibility in the future. This experience also showed me how well I interact with people especially on the phone. Another experience that remains in my mind is about and seeing the collaboration between different healthcare professionals. Seeing different well knowledgeable individuals in the top of their fields discussing the optimum methods for drug delivery and patient safety made me realize that healthcare was in good hands and it made me motivated to get there. |
| Date: | 08/20/2022 |
| Rotation Type: | Wor/Man IPPE Community |
| Comments: | |
| Write Reflection Here:: | Community Pharmacy experience is something I have been curious about and am now glad I experience. I've encountered some experiences, and work with amazing people at Bouvier Pharmacy. I feel very honored to work under the wing of a professional such as Ashley Gavin. One experience that sticks out to me particularly is when I was dealing with someone that was in a group home. He was taking a lot of medications, over eight of them, and they were dosed very distinctly. I experienced feelings of anxiety because he was so old and taking so many medications so I couldn't afford to mess up on them. My evaluation on this experience was positive because it helped me realize just how important the field is and how I can positively impact people's lives and their quality of life. Me taking control of his medications and being meticulous and careful ensures he continues the receive the proper care he deserves. I plan to continue to be careful and package the medications into blisters so the patients can be adherent to medication. |
| Date: | 09/02/2022 |
| Rotation Type: | Wor/Man IPPE Community |
| Comments: | |
| Write Reflection Here:: | After a lovely 4 weeks, working with amazing people, I felt full fulfilled when my journey bouvier pharmacy came to an end . This being my first pharmacy experience, I did not know what to expect but in these 4 weeks I really grew into it. It was amazing being able to help people achieve their goal to wellness. I felt pure delight seeing the gleeful look on their faces when I helped them. What this rotation helped me realize is that I really care, even one of my pharmacists mentioned this. I'm willing to go the extra mile to help patients, be it explaining to them why they're taking their meds, seeing if I can help in an emergency etc. It was also really fulfilling being able to apply the info I learned in class into real life. Unfortunately, all good thing must come to and end but I'm really glad with this experience |
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