Background: Implantable cardioverter-defibrillators (ICDs) can be life-saving devices, although they are expensive and may cause complications. In 2013, several professional societies published joint appropriate use criteria (AUC) assessing indications for ICD implantation. Data evaluating the clinical application of AUC are limited. Previous registry-based studies estimated that 22.5% of primary prevention ICD implantations were “non-evidence-based” implantations. On the basis of AUC, we aimed to determine the prevalence of “rarely appropriate” ICD implantation at our institution for comparison with previous estimates. Methods: We reviewed 286 patients who underwent ICD implantation between 2013 and 2016. Appropriateness of each ICD implantation was assessed by independent review and rated on the basis of AUC. Results: Of 286 ICD implantations, two independent reviewers found that 89.5% and 89.2%, respectively, were appropriate, 5.6% and 7.3% may be appropriate, and 1.8% and 2.1% were rarely appropriate. No AUC indication was found for 3.5% and 3.4% of ICD implantations, respectively. Secondary prevention ICD implantations were more likely rarely appropriate (2.6% vs. 1.2% and 3.6% vs. 1.1%) or unrated (6.0% vs. 1.2% and 2.7% vs. 0.6%). The reviewers found 3.5% and 3.4% of ICD implantations, respectively, were non-evidence-based implantations. The difference in rates between reviewers was not statistically significant. Conclusion: Compared with prior reports, our prevalence of rarely appropriate ICD implantation was very low. The high appropriate use rate could be explained by the fact that AUC are based on current clinical practice. The AUC could benefit from additional secondary prevention indications. Most importantly, clinical judgement and individualized care should determine which patients receive ICDs irrespective of guidelines or criteria.

Background: The rigor of the Doctor of Pharmacy (PharmD) curricula is reflected in its math- and science-heavy prerequisite requirements. As such, it is critical to evaluate whether students perceive high school coursework and experiences as adequate preparation for PharmD programs. Methods: Pre-professional and professional PharmD students from three institutions completed a survey assessing satisfaction with high school preparation, including math and science education, skill development, and exposure to pharmacy-related experiences. Results: A total of 148 responses were analyzed; 72% identified as female and 81% as White (non-Hispanic/Latino). Most respondents reported satisfaction with their high school math (80.4%) and science (82.4%) education, and 73.7% felt academically prepared for pharmacy school. Additionally, 79.8% were satisfied with skills gained in high school. Experiences such as attending pharmacy-related events (81.1%), contact with healthcare professionals (87.8%), and prior employment (85.2%) were widely viewed as beneficial. Students highlighted communication, problem-solving, and time management as key skills developed. However, gaps were noted in study strategies, presentation abilities, and time management. Conclusions: Students generally felt well-prepared academically and skill-wise for PharmD programs. Expanding pharmacy-related exposure and targeted skill development opportunities in high school may further enhance readiness for future pharmacy students.