Independent pharmacist prescribing of statins for patients with type 2 diabetes: An analysis of enhanced pharmacist prescriptive authority in Idaho.

OBJECTIVES: This study describes the development and patients' perceptions of a community pharmacist-led, statin-prescribing service for patients with diabetes and aims to identify why patients indicated for statin therapy were not prescribed therapy at the time of pharmacist consultation. SETTING: This pilot service began in 4 community-based Albertsons Companies pharmacies located in western Idaho. Patients eligible for the statin-prescribing service had a current diagnosis of type 2 diabetes, were aged between 40 and 75 years, were currently taking medications to manage their diabetes and had no contraindications to statin therapy. PRACTICE DESCRIPTION: Due to recent law changes in Idaho, pharmacists can now prescribe statins and certain other medications without oversight from a medical provider or the need for a collaborative practice agreement. PRACTIVE INNOVATION: Patients were identified and contacted by their local community pharmacist to discuss the statin-prescribing service. Once statin therapy was initiated, patients completed a brief, 7-question survey regarding their perceptions of the service. EVALUATION: This study evaluated the following: number of patients eligible for the prescribing service, number of patients who received a pharmacist-written statin prescription, and patients' perceptions regarding the service. METHODS: Of the 64 patients screened, 18 (28%) were eligible for statin therapy. Of those eligible, 6 (33%) accepted pharmacist services and 4 patients started statin treatment. Two patients were prescribed a statin by the community pharmacist, whereas the other 2 patients contacted their primary care provider and requested a statin prescription at the pharmacist's recommendation. RESULTS: Overall, participating patients (n = 4) reported feeling comfortable and satisfied with all aspects of the protocol and their pharmacist's role as a prescriber. CONCLUSION: This pilot was the first example of community pharmacists independently prescribing statins outside of the clinic setting. The service could target an important health initiative.

On Sagnac frequency splitting in a solid-state ring Raman laser.

We report on an accurate measurement of the frequency splitting of an optical rotating ring microcavity made out of calcium fluoride. By measuring the frequencies of the clockwise and counter-clockwise coherent Raman emissions confined in the cavity modes, we show that the frequency splitting is inversely proportional to the refractive index of the cavity host material. The measurement has an accuracy of 1% and unambiguously confirms the classical theoretical prediction based on special theory of relativity. This Letter also demonstrates the usefulness of the ring Raman microlaser for rotation measurements.

Readability Assessment of Online Patient Education Material on Congestive Heart Failure.

BACKGROUND: Online health information is being used more ubiquitously by the general population. However, this information typically favors only a small percentage of readers, which can result in suboptimal medical outcomes for patients. OBJECTIVE: The readability of online patient education materials regarding the topic of congestive heart failure was assessed through six readability assessment tools. METHODS: The search phrase "congestive heart failure" was employed into the search engine Google. Out of the first 100 websites, only 70 were included attending to compliance with selection and exclusion criteria. These were then assessed through six readability assessment tools. RESULTS: Only 5 out of 70 websites were within the limits of the recommended sixth-grade readability level. The mean readability scores were as follows: the Flesch-Kincaid Grade Level (9.79), Gunning-Fog Score (11.95), Coleman-Liau Index (15.17), Simple Measure of Gobbledygook (SMOG) index (11.39), and the Flesch Reading Ease (48.87). CONCLUSION: Most of the analyzed websites were found to be above the sixth-grade readability level recommendations. Efforts need to be made to better tailor online patient education materials to the general population.

Morbihan disease complicated by dermatosis neglecta: An unique presentation.

Morbihan disease, also referred to as solid facial edema, or rosacea lymphedema, is a rare disorder that involves chronic erythema and solid edema of the cheeks, eyelids, forehead and glabella and may arise as a complication of acne vulgaris or rosacea. Of note, it may be the only initial presenting symptom of these associated diseases. Few cases have been described in the literature, as its first description by Robert Degos in 1957. The condition is characterized by its chronicity, a typical clinical appearance and the lack of specific histopathologic or laboratory findings. The condition may wax and wane but typically does not resolve without treatment. Many cases of this condition tend to be recalcitrant to therapy, with topical and oral antibiotics regimens commonly used for rosacea generally being ineffective. The disease may easily go undiagnosed, as it mimics other more common skin conditions. We present a case of originally undiagnosed Morbihan disease mistaken for an atypical allergic rash, resistant to treatment, and complicated by dermatosis neglecta.

Laser treatment of granuloma annulare: a review.

Granuloma annulare (GA) is a benign asymptomatic dermatosis that typically manifests in papules arrayed in annular arrangements. Many methods of treatment have been used with variable degrees of success, but finding a consistent and long-term treatment has proven a challenge. This study was conducted in order to review and evaluate the latest published research on the use of lasers in the treatment of GA. A systematic search of the National Library of Medicine's PubMed database was performed to identify relevant articles. Seven reports met the inclusion criteria for the review. Evidence for the use of pulsed dye laser, fractional photothermolysis, and excimer laser in the treatment of GA was found. Findings are limited by a lack of well-designed clinical trials objectively evaluating the use of lasers in the treatment of GA. The literature review found a number of case reports and case series that report successful outcomes of the use of lasers in the treatment of GA. The promising results reported in the literature, coupled with the lack of a well-designed review on this topic, reflect the importance of this article to the dermatologic literature as it emphasizes the need for larger and better-designed studies on the use of lasers to treat GA.

Exogenous ochronosis: a comprehensive review of the diagnosis, epidemiology, causes, and treatments.

Exogenous ochronosis (EO) can be an unintended psychologically troubling condition for patients who are already being treated for longer-term hyperpigmentation disorders such as melasma. Early diagnosis is key in order that the offending agent can be stopped to prevent further disfiguring discoloration. EO can be diagnosed in the right clinical setting with the aid of dermatoscopy, which can assist in early diagnosis and may negate the need for a biopsy. Laser modalities using Q-switched lasers of longer wavelengths and combination laser dermabrasion treatments have shown the most significant results with minimal adverse events. However, further large-scale studies are needed to determine optimal treatment modalities. Although considered uncommon, the incidence of EO will likely continue to increase with the growth of immigrant populations and the use of skin-lightening agents above the FDA's recommended over-the-counter concentrations, without the guidance of a dermatologist.