Optimizing optimization: A six-year quality improvement project focused on students' APPE preferences.

Problem Description: The advanced pharmacy practice experience (APPE) component of the entry-level doctor of pharmacy degree program is essential in contributing to student pharmacists' education. Establishing an optimization process to assist students in matching to their highest preferred clinical sites is extremely important.

Quality Improvement Methods: The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences uses a fourth year APPE match process designed to yield the best possible matches for the entire class while being perceived as fair and relatively easy to navigate.

A longitudinal quality improvement program to optimize experiential education's ability to develop trusted independent pharmacist practitioners.

Problem Description: To meet the evolving role of today's pharmacist, student pharmacists need to be given independent responsibilities that increase in rigor as they advance through the curriculum and be able to practice both autonomously and as part of an interprofessional team. Quality improvement methods: The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) experiential programs office undertook a 20-year process of developing independence for students. Students faced increasing challenges and responsibilities as they moved through experiential practice settings, with constant, cyclic adjustments made in response to feedback.

Cultivating a Culture of Reflection Among Pharmacy Students Through Storytelling.

To hold a storytelling event and assess its effect on Doctor of Pharmacy (PharmD) students' perspectives on and attitudes toward reflection. Story Slam, a four-hour storytelling competition, was incorporated into the spring semester of the first professional year of a PharmD program. The event featured short first-person stories told by faculty members as well as students.

Trisomy 22 with holoprosencephaly: a clinicopathologic study.

Trisomy 22 (47, XY, +22) was found at 17 weeks gestation in one fetus of a twin gestation. The karyotypes of both parents and of the other twin were normal. Abnormal prenatal findings included maternal pre-eclampsia, fetal growth retardation, and progressive intracranial sonolucency of the trisomic fetus.

Sinusoidal fetal heart rate pattern during cardiopulmonary bypass.

A gravida 3, para 2 woman underwent an emergency mitral valve replacement at 24 weeks' gestation. A sinusoidal fetal heart pattern was recorded throughout cardiopulmonary bypass. This pattern persisted despite a pump flow maintained at 31 ml/m2 min and an intravenous infusion of phenylephrine to maintain the mean systemic arterial pressure at 50 mm Hg.

In utero diagnosis of congenital diaphragmatic hernia by CT amniography.

Congenital diaphragmatic hernia (CDH) was diagnosed using CT following intraamniotic contrast medium injection. Computed tomographic amniography may be helpful when the sonographic diagnosis of CDH is uncertain or prenatal surgical repair is being considered.

The effect of thigh muscle reconditioning by electrical stimulation on urodynamic activity in SCI patients.

Various forms of electrical stimulation are being used more frequently for bladder and muscle rehabilitation following spinal injury. Fifteen patients with spinal cord injury underwent a four to eight week period of thigh muscle reconditioning by surface electrical stimulation. The accumulated effects of this program on bladder function were assessed by urodynamic evaluation before and after the test period.

Pharmacokinetics of magnesium sulfate in the sheep model.

The pharmacokinetic parameters of MgSO4 were followed in the pregnant sheep model following intravenous dosages of MgSO4 comparable to those used in the therapy of the preeclamptic woman. Hemodynamic parameters, including maternal arterial pressure, central venous pressure, systemic vascular resistance, pulmonary artery pressure, heart rate, cardiac output, cardiac index, rate pressure product, stroke volume, stroke index, blood gases, fetal arterial pressure, heart rate, and blood gases, all remain stable during the infusion of MgSO4. Biochemical changes accompanying MgSO4 infusion in these doses were evaluated.

Neurofibromatosis and spontaneous hemothorax in pregnancy: two case reports.

Two cases of spontaneous hemothorax in pregnant women with neurofibromatosis are reported. Effects of pregnancy on the clinical course of neurofibromatosis are known to include worsening of cutaneous lesions, increased incidence of hypertension, and renal artery rupture. However, vessel wall rupture into the pleural cavity in areas of vascular neurofibromatosis is previously unreported.

Thromboembolic complications of pregnancy.

Physiologic changes in clotting parameters and venous flow during pregnancy increase the likelihood of deep venous thrombosis. Conditions that place the pregnant patient at a higher risk include a previous history of thromboembolic disease and surgery or bedrest for any reason during the pregnancy. In the high-risk patient, prophylactic therapy with low-dose heparin is advised beginning around the 34th week of pregnancy and continuing until 4-6 weeks after delivery.

Placental passage and uterine effects of fentanyl.

Using the chronic maternal-fetal sheep preparation, 27 pregnant ewes were studied to determine the effects of intravenous fentanyl on maternal and fetal physiology, with particular reference to its placental passage, and its effects on uterine blood flow and uterine tone. Three doses of fentanyl were studied--50, 75, and 100 micrograms. Maternal and fetal arterial blood was collected for determination of fentanyl levels.

The maternal and fetal cardiovascular effects of epidural morphine in the sheep model.

Interest in the use of epidural narcotics for analgesia has been widespread since the demonstration of opiate receptors in the spinal cord in the mid nineteen-seventies. Recently, several studies have attempted to evaluate the effectiveness of epidural narcotics for the relief of pain in labor and after cesarean section. Using the chronically catheterized maternal-fetal sheep model, we injected 5 mg of preservative-free morphine into the epidural space.

Malignant lymphoma of the small intestine in multiple family members: association with an immunologic deficiency.

Four cases of malignant lymphoma all in male members of a family are described. In three of the affected individuals the primary tumor arose in the small intestine and in the other the site of origin was the retroperitoneum. Immunologic studies were carried out on the two surviving patients and on all other living members of their families.

Practicability of ultrasonography for assessing fetal age and weight in early pregnancy.

This study was conducted to evaluate (1) the feasibility and accuracy of the B-Scan technique for measuring biparietal diameter (BPD) in utero, (2) the accuracy of the B-Scan technique for predicting fetal age and weight, and (3) parameters of fetal growth in pregnancies of less than 21 weeks's gestation. Forty-one subjects underwent diagnostic ultrasonography before induction of therapeutic abortion with Prostaglandin F2alpha. Following abortion, fetal crown-to-rump length (CRL), crown-to-heel (CHL), BPD, and fetal weight were measured directly.