Changes in Arkansans' attitudes toward pharmacist involvement and regulation of medical cannabis following its availability in Arkansas.

BACKGROUND: Pharmacists are likely to encounter questions from patients regarding medical cannabis (MC). This serves as an opportunity for pharmacists to provide reliable medical information about MC dosing, drug interactions, and impact on preexisting health conditions. OBJECTIVES: This study examined changes in perceptions of the Arkansan community toward MC regulation and pharmacist involvement in MC dispensing after MC products became available in Arkansas. METHODS: A longitudinal, self-administered online survey was conducted in February 2018 (baseline) and September 2019 (follow-up). Baseline participants were recruited through Facebook posts, emails, and printed flyers. Participants from the baseline survey (N = 1526) were invited to participate in the follow-up survey. Paired t tests were used to determine changes in responses, and multivariable regression analysis was used to identify factors associated with follow-up perceptions. RESULTS: Participants (n = 607, response rate 39.8%) started the follow-up survey, resulting in 555 usable surveys. The largest group of participants was 40-64 year old (40.9%). The majority were female (67.9%), white (90.6%), and reported past 30-day cannabis use (83.1%). Compared to baseline, participants preferred less regulatory control of MC. They were also less likely to agree that pharmacists helped improve MC-related patient safety. Participants favoring less MC regulation were more likely to report 30-day cannabis use and perceived cannabis to have low health risk. Past 30-day cannabis use was also significantly associated with disagreement that pharmacists improve patient safety and are well-trained to provide MC counseling. CONCLUSION: After MC product availability, Arkansans' attitudes changed toward less MC regulation and less agreement with the pharmacist's role in improving MC safety. These findings call for pharmacists to better promote their role in public health safety and demonstrate their knowledge concerning MC. Pharmacists should advocate for an expanded, active consultant role in dispensaries to improve safety of MC use.

Arkansas community's attitudes toward the regulation of medical cannabis and the pharmacist's involvement in Arkansas medical cannabis.

OBJECTIVES: This study explored the attitudes of the Arkansas community toward medical cannabis (MC) regulation and the role of pharmacists in dispensing MC before the product became available and examined whether participants' demographics (e.g., age, gender) and characteristics (e.g., history of cannabis use) were associated with these attitudes. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: Using social media, a university research registry, and posted flyers, we invited residents of Arkansas to participate in the self-administered online survey study during a 3-month period, February to April, in 2018. OUTCOME MEASURES: Five questions that inquired about participants' attitudes toward MC regulation and pharmacists' roles regarding MC use. RESULTS: Participants (n = 1343) who completed at least 1 of the 5 questions were included. The majority were aged 40-64 years (52.2%), female (69.1%), and white (88.7%). Most participants reported a history of cannabis use (81.8%) and possession or intention to apply for an MC card (52.9%). Among the conditions approved for MC use, pain (20.3%), arthritis (15.4%), and posttraumatic stress disorder (14.5%) were reported frequently. Likewise, prescription use for mood disorders (46.1%) and pain (37.4%) were also reported. In multivariable regression analyses, participants' history of cannabis use was associated with a preference for lesser oversight of MC, disagreement with MC being available through a pharmacy only, and disagreement on whether MC should be regulated before it is legalized for recreational use (all P < 0.001). It was also associated with a decrease in agreement that pharmacists are well-trained to improve patient safety (P < 0.001) and counsel patients regarding appropriate MC use (P = 0.032). CONCLUSION: Participants who had previously used cannabis were in favor of fewer restrictions and negatively perceived pharmacists' involvement in ensuring appropriate dispensing and MC use. The findings may highlight the need for Arkansas pharmacists to explore alternative ways to promote the safe and proper MC use.

Qualitative Analysis of Pre and Postpromotion/Tenure Review Processes Employed by US Pharmacy Schools.

OBJECTIVE: Policies related to prepromotion/tenure reviews and postpromotion/tenure reviews are critical to faculty advancement and retention. The objective of this study is to describe the utilization, timing, and application of such policies as described within promotion and/or tenure documents from US colleges/schools of pharmacy. METHODS: PT documents were collected from internet searches and/or contact with administrators at each institution. Qualitative content analysis was used to systematically review policies related to pre and postpromotion/tenure reviews. Policies were reviewed for required vs optional status, timing, possible outcomes, and other characteristics. RESULTS: PT documents were analyzed from 121 (85%) colleges/schools. Of these, 26% included policies for prepromotion review of nontenure-track faculty, while 45% included pretenure reviews for tenure-track faculty. The majority of prereviews were required (65% and 91%, respectively) and conducted after 3 years in rank on average. Only 22 (18%) included postpromotion/tenure reviews, with most (17, 77%) conducting reviews after a prespecified time in advanced rank (mean 3.9 years). Potential negative consequences of postpromotion/tenure reviews were more frequently described than potential rewards. CONCLUSION: This analysis of promotion and/or tenure documents revealed that pre/posttenure reviews were more commonly employed than pre/postpromotion reviews. Documents most frequently described potential negative consequences that may result from unsatisfactory postpromotion/tenure reviews. Academic leaders should consider the implications of these trends within their own institutions and how their own policies may be improved to create clearly articulated, fair, and parallel processes for both tenure-track and nontenure-track faculty.

Teaching Through the Student Lens: Qualitative Exploration of Student Evaluations of Teaching.

OBJECTIVE: The purpose of this study is to use feedback from student evaluations of teaching (SETs) to define and describe themes associated with perceived teaching effectiveness. METHODS: We retrospectively analyzed SETs for instructors in required didactic courses from one academic year using qualitative content analysis. The analysis included student responses to the following questions: "Describe the strongest aspect of the instructor's teaching." and "What could the instructor do to improve his/her teaching effectiveness?" RESULTS: Five themes were developed from 4683 coded segments and are described with example quotations. These themes included clarity of instruction and learning activities, alignment of learning and assessment activities, examples that offer practice or demonstrate relevance, engaging learning environment, and concern for student learning and success. Aspects of each theme are described with example coded segments. CONCLUSION: These themes and supportive quotes offer a deeper understanding of the student perspective on similar ideas that are present throughout the teaching and learning literature and represent broad aspects of teaching, such as material design, in-class practices, and interpersonal characteristics. These themes can provide guidance for specific domains of faculty development in teaching.

Unpacking the Use of Therapy-Speak in Scholarly Writing.

Pharmacy faculty have begun to adopt therapy-speak, which are common words and phrases derived from mental health services, more frequently in both informal modes of communication as well as in scholarly and creative efforts. In this Commentary, we consider the use of this trendy, idiomatic language in scholarly writing and characterize potential problems with its clear and lasting interpretation. Conversely, we also examine how contemporary language can be used to enhance scholarly writing by engaging members of the Academy with an interesting writing style. Finally, we challenge pharmacy faculty to carefully consider how and when such language can be used to communicate in a clear and straightforward style that creates interest among readers.

Strengthen Academic Pharmacy by Protecting Self-Expression.

Pharmacy, including academic pharmacy, is affected by several important issues. Additionally, we deal with these issues in a society that is increasingly polarized in beliefs and siloed in interactions. Within this important juncture, pharmacy faculty may be prone to employ restrictions on freedom of expression, particularly around viewpoints they do not endorse. This tendency will likely have unintended effects and inhibit the ability of the profession to find solutions to its current challenges. We implore the Academy to actively work to increase viewpoint diversity, open inquiry, and academic freedom.

Analysis of Teaching-Related Criteria Within Promotion and Tenure Documents from US Pharmacy Schools.

OBJECTIVE: To describe teaching-related criteria within promotion and tenure (PT) guidance documents from US-based colleges/schools of pharmacy. METHODS: PT guidance documents were retrieved from college/school websites or via electronic mail. Institutional characteristics were compiled using available online data. Using qualitative content analysis, a systematic review of PT guidance documents was conducted to identify how teaching and teaching excellence were considered in decision of promotion and/or tenure at each institution. RESULTS: PT guidance documents were analyzed from 121 (85%) colleges/schools of pharmacy. Of these, 40% included a requirement that faculty must achieve excellence in teaching for promotion and/or tenure, though excellence was infrequently defined (14% of colleges/schools). Criteria specific to didactic teaching were most frequently included (94% of institutions). Criteria specific to experiential (50%), graduate student (48%), postgraduate (41%), and interprofessional (13%) teaching were less frequently included. Institutions frequently required student (58%) and peer (50%) evaluations of teaching to be considered in PT decisions. Most institutions acknowledged many teaching accomplishments as examples indicating teaching success rather than strictly requiring specific criteria to be fulfilled. CONCLUSION: Teaching-related criteria within PT criteria of colleges/schools of pharmacy often lack clear guidance regarding quantitative or qualitative requirements for advancement. This lack of clearly specified requirements may result in faculty members' inability to self-assess for readiness for promotion and inconsistent application of criteria in PT decisions by review committees and administrators.

Guidance for Qualitative Research Manuscripts in Pharmacy Education.

The goal of this Best Practice Review is to support researchers in successfully preparing and publishing qualitative research in pharmacy education. Standard practice from the literature and journals' guidance from related fields were reviewed, and recommendations and resources applicable to qualitative research in pharmacy education were compiled for researchers planning to conduct and publish qualitative research. This review provides recommendations, not requirements, for publication in the Journal and is intended to be a guide, especially for authors and reviewers relatively new to the field of qualitative research. Additionally, researchers planning to publish their qualitative research are advised to review available best practices and standards, such as the Consolidated Criteria for Reporting Qualitative Research checklist and the Standards for Reporting Qualitative Research. Given the diverse methodology of qualitative research, it is important for authors to provide sufficient details and justifications of selected methods for transparency and to report collected results in a manner that allows reviewers and readers to adequately assess the validity of their study and the applicability of the findings.

Comparison of the effects of energy drink versus caffeine supplementation on indices of 24-hour ambulatory blood pressure.

BACKGROUND: Cardiovascular events associated with energy drink consumption have been reported, but few data exist to delineate the hemodynamic effects of energy drinks. OBJECTIVE: To compare the effects of an energy drink versus caffeine supplementation on blood pressure (BP) indices as measured by 24-hour ambulatory BP monitoring (ABPM). METHODS: Healthy, nonsmoking, normotensive volunteers (aged 18-45 years) taking no medications were enrolled in a single-center, open-label, 2-period crossover pilot study. During each study period, subjects received either an energy drink (Red Bull Energy Drink, each dose containing 80 mg of caffeine and 1000 mg of taurine in an 8.3-oz serving) or a control (compounded caffeine solution, each dose containing 80 mg of caffeine solution in 8 oz of bottled water) at 0800, 1100, 1500, and 1900 hours and underwent 24-hour ABPM. The study periods were separated by a washout period (4-30 days). Mean 24-hour, daytime, and nighttime systolic (SBP), diastolic (DBP), and mean arterial (MAP) BP; BP load; and percent nocturnal dipping were compared between study periods. RESULTS: Nine subjects (5 females, mean [SD] age 27.7 [5.0] years) completed the study. Mean 24-hour SBP (123.2 vs 117.4 mm Hg, p = 0.04), DBP (73.6 vs 68.2 mm Hg, p = 0.02), and MAP (90.1 vs 84.8 mm Hg, p = 0.03) were significantly higher during energy drink supplementation versus caffeine supplementation. Daytime DBP (77.0 vs 72.0 mm Hg, p = 0.04) also was significantly higher with the energy drink versus caffeine supplementation. Trends in higher daytime SBP (127.0 vs 121.9 mm Hg, p = 0.05) and MAP (93.6 vs 88.6 mm Hg, p = 0.05) were recorded with energy drink supplementation versus caffeine supplementation. Nighttime SBP and DBP loads were significantly higher with the energy drink, but nocturnal dipping did not differ significantly between study periods. CONCLUSIONS: Single-day energy drink supplementation increased mean 24-hour and daytime BP compared to caffeine control in this pilot study. Additional research is warranted to better understand the hemodynamic effects of energy drink consumption.

Impact of health screening and education on knowledge of coronary heart disease risk factors.

OBJECTIVES: To evaluate the effects of a community health screening and education intervention on knowledge of coronary heart disease (CHD) risk factors and participation in health-promoting behaviors. DESIGN: Descriptive, exploratory, nonexperimental study. SETTING: Little Rock, AR, from July 2007 to December 2007. PARTICIPANTS: 56 participants recruited from two community health screenings. INTERVENTION: Prescreening written questionnaire to determine baseline knowledge of CHD risk factors. Participants underwent risk factor screening (lipid profile, blood glucose, body mass index [BMI], and blood pressure) and received tailored education. A postscreening telephone questionnaire was administered 4 to 8 weeks later. MAIN OUTCOME MEASURES: Participant knowledge of CHD risk factors and participation in health-promoting behaviors pre- and postscreening. RESULTS: Of the 56 participants enrolled, 45 (80.4%) completed the postscreening telephone survey. Compared with prescreening responses, participants showed significantly greater postscreening knowledge of healthy values for CHD risk factors, including blood pressure (P = 0.02), fasting blood glucose (P = 0.03), fasting total cholesterol (P < 0.01), and BMI (P < 0.01). Following the screening, 20 (44.4%) participants had consulted their primary care provider and 31 (68.8%) made at least one healthy behavior change. Approximately one-half of participants reported changing eating habits, and 5 (11.1%) reported increased exercise. CONCLUSION: These results demonstrate that community-based health screening and education interventions can effectively promote public health knowledge and empower participants to engage in health-promoting behaviors.

Exploring factors associated with scholarly writing among US pharmacy practice faculty.

OBJECTIVES: This study explored intrinsic facilitators (i.e., grit, self-efficacy, and writing motivation) and barriers associated with scholarly output as measured by self-reported publications among US pharmacy practice faculty. METHODS: A cross-sectional study design was used to gather information regarding scholarly writing output and intrinsic facilitators and barriers among US pharmacy practice faculty using an online self-reported survey. The survey link was distributed via email between October and November 2017. The Grit-S, New Generalized Self-Efficacy Scale (NGSE), and Scholarly Writing Motivation Scale (SWMS) were used to measure grit, self-efficacy, and writing motivation, respectively. Perceived barriers, self-reported quantity of publications, and demographics were also collected. A structural equation modeling (SEM) approach was used to determine effects of perceived barriers and each intrinsic factor on self-reported total publications. RESULTS: N = 208 participants were included in the analyses. The average number of self-reported annual publications was 1.88. Participants who reported having higher than average numbers of annual publications (n = 85, 40.9%) more frequently held a PhD degree and were more frequently in the tenure track, compared to those with annual publications less than the average (n = 123, 59.1%). The majority of both groups reported being employed in public institutions. Lack of time for scholarly writing was the highest perceived barrier and lack of knowledge about technical writing/English mastery was the lowest. All three SEM models consistently showed that perceived barriers were negatively associated with numbers of self-reported publications. However, only scholarly writing motivation according to SWMS was positively associated with the numbers of self-reported publications. CONCLUSIONS: Writing motivation and barriers to scholarly writing are shown to have a significant impact on scholarly output. These factors can be identified and should be appropriately addressed by colleges/schools of pharmacy to enhance scholarly activities among pharmacy practice faculty.

Analysis of Research and Scholarship Criteria Within Promotion and Tenure Documents of US Pharmacy Schools.

Objective. To describe criteria for evaluating faculty scholarship within the promotion and tenure guidance documents of US schools and colleges of pharmacy.Methods. Promotion and tenure documents were obtained from the websites of US pharmacy schools or requested via electronic mail, and institutional characteristics were collected from publicly available online data. A qualitative content analysis was conducted to systematically catalogue document characteristics and criteria for promotion and tenure.Results. Promotion and tenure guidance documents from 121 (85%) of 142 pharmacy schools were analyzed. Institutions were 55% public and equally distributed across Carnegie institutional classifications as well as geographic and extramural funding stratifications. Publications (94%) and grants and contracts (87%) were the most frequently included criteria for faculty advancement. More than 50% of schools recognized the criteria within promotion and tenure guidance documents but did not explicitly require faculty to achieve them before receiving promotion and/or tenure. For institutions that required publications for advancement, the most frequently required criterion was publication in peer-reviewed journals (47%). Few schools (22%) documented a specific number of required publications.Conclusion. This analysis provides a comprehensive review of scholarship criteria in academic pharmacy promotion and tenure guidance documents. There was wide variability among scholarship criteria, and documents often lacked specific language defining scholarship requirements. As a result, faculty may find the documents less helpful for self-assessment and preparation toward promotion and/or tenure. These benchmark data can assist pharmacy faculty and administrators in developing and revising promotion and tenure guidance documents to include clear criteria and better align with peer institutions.

The Power of Peer Mentoring to Support Women Pharmacy Faculty Personally and Professionally.

Regardless of a faculty member's career stage, effective mentoring is critical for successful professional development and a thriving academic career. Traditional mentor-mentee relationships can be effective but may present challenges for some faculty depending on their individual needs and institutional resources. The use of peer mentoring circles, where group members serve as both mentor and mentee, may provide additional resources and benefits to faculty at all career stages and appear especially beneficial for women faculty because of their focus on interconnectedness and collaboration. However, literature is scarce regarding effective mentoring strategies for women pharmacy faculty. As members of one women faculty-only peer mentoring circle, we describe our experiences using this mentoring strategy and offer recommendations for other faculty members considering this approach.

Advancing Pharmacy Education and Workforce Development Amid the COVID-19 Pandemic: Report of the 2020-2021 AACP Academic Affairs Committee.

EXECUTIVE SUMMARY The 2020-2021 Academic Affairs Committee was charged to (1) Read all six reports from the 2019-20 AACP standing committees to identify elements of these reports that are relevant to your committee's work this year; (2) Determine what changes made in colleges and schools of pharmacy during the COVID-19 pandemic should be continued to advance pharmacy education; (3) Develop a realistic model for colleges and schools of pharmacy to share resources to meet the curricular needs of member schools; (4) Create strategies by which colleges and schools of pharmacy can meet current and future workforce development needs particularly in light of the changes in healthcare delivery as a result of the COVID-19 pandemic; (5) Identify salient activities for the Center To Accelerate Pharmacy Practice Transformation and Academic Innovation (CTAP) for consideration by the AACP Strategic Planning Committee and AACP staff. This report provides an overview of changes made in schools and colleges of pharmacy implemented in response to the COVID-19 pandemic that may be continued to advance pharmacy education; a realistic model for colleges and schools of pharmacy to share resources to meet the curricular needs of member schools; and strategies by which schools and colleges of pharmacy can meet current and future workforce development needs, particularly in light of the changes in healthcare delivery as a result of the COVID-19 pandemic. The committee is proposing one policy statement for consideration by the 2021 AACP House of Delegates, four suggestions for consideration by schools and colleges of pharmacy (including two endorsements for suggestions from the 2020-21 Argus Commission), and one recommendation for consideration by AACP for CTAP to implement and oversee.

Positioning the Scholarship of Teaching and Learning Squarely on the Center of the Desk.

The scholarship of teaching and learning (SOTL) is one of four traditionally defined domains of research. Yet faculty members who pursue the SOTL may feel disadvantaged because of its relatively low perceived value by many institutions. Thus, interested faculty members may relegate the SOTL to a limited, secondary line of research and instead pursue other types of research that appear to be more highly valued by the institution. This commentary explores the benefits to the institution when the SOTL is expressly valued and purposefully supported. We advocate for a multifaceted approach by which pharmacy education leaders can examine how the SOTL is valued, encouraged, and supported through organizational structure and policy. Approaches to solidify and communicate the institutional value of the SOTL are discussed. Specific attention to ensure the SOTL is represented in rewards and incentive systems, such as the college or school's promotion and tenure policies, may empower faculty members to pursue success in this area of research.

A cross-sectional analysis of self-reported scholarly publications among United States pharmacy practice faculty.

INTRODUCTION: The objectives of this study were to provide an estimate of self-reported peer-reviewed publications and evaluate characteristics associated with publication rates among pharmacy practice faculty within United States (US)-based colleges and schools of pharmacy. METHODS: An online survey instrument was distributed to pharmacy practice faculty via email listserv. Information regarding faculty members' publication histories, faculty position, institutional characteristics, and faculty demographic characteristics was gathered. Descriptive statistics were used to characterize participants, and t-tests and analysis of variance were used for comparisons among groups. RESULTS: Two hundred and nine pharmacy practice faculty were included. The majority were female (67%), white (81%), and from public institutions (66%). Academic ranks were well-represented. Reporting higher percent time spent in research, employment at public institutions, and having earned a doctor of philosophy (PhD) degree were all significantly associated with higher total number of publications and a higher annualized publication rate. Tenure track faculty who were not yet tenured had higher annual publication rates than faculty who were tenured or in non-tenure track positions. The overall annual publication rate was 2.0 ± 2.1 publications per year. CONCLUSIONS: Characteristics such as being in a tenure track position, holding a PhD, spending more time in research, and employment within a public institution were all associated with a higher publication rate. These self-reported data from pharmacy practice faculty also indicate an increase in the average number of scholarly publications per year from previously reported estimates.

Beta-adrenergic antagonists in hypertension: a review of the evidence.

OBJECTIVE: To evaluate the effects of beta-adrenergic antagonist therapy on cardiovascular and cerebrovascular outcomes in the treatment of hypertension. DATA SOURCES: Literature searches were conducted using MEDLINE (1966-August 2009), International Pharmaceutical Abstracts (1970-August 2009), and Cochrane Database of Systematic Reviews (until third quarter 2009) to locate clinical trials and meta-analyses comparing beta-blocker therapy with placebo or other antihypertensive agents in patients with hypertension. Bibliographies from relevant research and review articles were reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data sources were reviewed. Articles describing original research with cardiovascular or cerebrovascular outcomes and/or death as either primary or secondary endpoints were included. Articles describing the use of beta-blocker therapy for conditions other than hypertension were not included. DATA SYNTHESIS: Five placebo-controlled studies and 10 active-controlled studies were reviewed. In addition, 11 meta-analyses were evaluated. Placebo-controlled trials of beta-blockers in hypertension provide evidence of reduced risk for stroke, cardiovascular events, and heart failure. Only 2 studies comparing beta-blockers with other antihypertensives found significant benefit with beta-blockers. However, the majority of meta-analyses comparing beta-blockers with other antihypertensive agents show increased risk for stroke with beta-blockers, and some data suggest increased risk for cardiovascular events and all-cause mortality. The majority of data results from studies of atenolol, and many studies employed combination antihypertensive therapies, which often included thiazide diuretics. CONCLUSIONS: Overall, data supporting beta-blockers as preferred therapy in hypertension are inadequate. Although most negative cardiovascular and cerebrovascular outcomes of beta-blockers were associated with atenolol therapy, data supporting other beta-blockers in hypertension are lacking.

Evaluation of community health screening participants' knowledge of cardiovascular risk factors.

OBJECTIVES: To assess knowledge of cardiovascular disease (CVD) risk factors among a group of health screening participants and to compare knowledge between participants with high and low CVD risk. DESIGN: Cross-sectional pilot study. SETTING: Jonesboro, AR, during June 2007. PATIENTS: 121 adult volunteers participating in a community health screening. INTERVENTION: 34-item self-administered written questionnaire. MAIN OUTCOME MEASURES: Ability to identify CVD risk factors and healthy values for CVD risk factors and the differences in these abilities between participants with high and low CVD risk. RESULTS: Participants demonstrated good knowledge of traditional CVD risk factors such as high blood pressure, high cholesterol, lack of exercise, and overweight or obese status. Knowledge of other CVD risk factors and healthy values for major CVD risk factors was limited. Participants with high CVD risk were significantly more likely to correctly identify high triglycerides as a CVD risk factor and to identify healthy values for fasting blood glucose and total cholesterol compared with participants with low CVD risk. CONCLUSION: Overall, participants lacked knowledge of the risk factor status and healthy values for many CVD risk factors. Participants with high CVD risk may have better knowledge of some CVD risk factors than participants with low CVD risk. These findings highlight the need for more education to improve knowledge in both risk groups.

A communications module to reinforce motivational interviewing concepts.

BACKGROUND AND PURPOSE: Motivational interviewing (MI) is a patient-centered method of communicating that can be used to improve medication adherence. However, it can be difficult to teach and learn. This paper describes the creation of a stand-alone introductory MI module for second-year pharmacy students and its transformation to a module intended to reinforce content after the addition of a new MI-based course in the first year. It compares student competence in MI skills between the two modules (introductory versus reinforcement). EDUCATIONAL ACTIVITY AND SETTING: In 2012 and 2013, an introductory MI module was delivered to second year pharmacy students. In 2014, a course grounded in MI principles was introduced in the first year of the curriculum, with the module in the second year modified to reinforce those principles. All second-year students' MI skills were assessed with an objective structured clinical examination (OSCE) case. Overall case scores and individual item scores were compared before and after the addition of the course using assessment data from two years before and after the change. FINDINGS: Overall case scores (81.9% vs. 86.9%, p = 0.001) significantly improved after the introduction of the new course. Items related to MI skills also improved significantly. Scores for general communication items were not different. SUMMARY: After the introduction of the new MI-based first-year course, students performed better on items specifically related to MI in an OSCE case. This model can serve as a useful example of how to introduce MI skills and reinforce these skills later in the curriculum.

Candesartan cilexetil effectively reduces blood pressure in hypertensive children.

BACKGROUND: The angiotensin-receptor blocker candesartan cilexetil is a well-tolerated antihypertensive agent with demonstrated benefits in adults with hypertension. However, there are few data supporting its use in children with hypertension. OBJECTIVE: To determine the efficacy and tolerability of candesartan cilexetil in the treatment of pediatric hypertension. METHODS: In an open-label, uncontrolled pilot study, hypertensive pediatric patients were eligible for participation if untreated systolic and/or diastolic blood pressure (BP) exceeded the 95th percentile for sex, age, and height. Patients underwent a 7-day washout period prior to initiation of weight-based dosing of candesartan cilexetil (2-8 mg daily). The dose was doubled after 7 days of therapy if inadequate antihypertensive response was determined by clinic-measured casual BP monitoring (CBPM) and home BP monitoring (HBPM). Three methods of BP measurement were compared before and after 2 weeks of treatment with the final dose of candesartan cilexetil: CBPM, HBPM, and 24-hour continuous ambulatory BP monitoring (ABPM). Self-reported adverse effects and clinical laboratory analyses were used to determine tolerability. RESULTS: Eleven patients (mean age 14.2 y) received a final candesartan cilexetil median daily dose of 8 mg (0.13 mg/kg, range 2-16 mg). Study treatment resulted in significant reductions in systolic and diastolic BP as measured by CBPM (-7.4%, p = 0.03 and -5.9%, p = 0.01, respectively) and by ABPM (-6.0%, p = 0.03 and -10.8%, p = 0.006, respectively), but no significant reductions as measured by HBPM. No clinically significant changes in laboratory measures were observed, and patients reported nonspecific mild adverse effects. CONCLUSIONS: Candesartan cilexetil effectively reduced BP as demonstrated by CBPM and ABPM measurements and was well tolerated in this group of hypertensive children.