Comparing perceptions of student abilities in diabetes self-management education and support among students, faculty and patients.

BACKGROUND AND PURPOSE: Diabetes self-management education and support (DSMES) equips patients with diabetes with the knowledge needed for appropriate management. The purpose of this study was to compare perceptions of student confidence/aptitude held by students, pharmacy faculty preceptors, and patients regarding student teaching of a DSMES class. EDUCATIONAL ACTIVITY AND SETTING: The study was a prospective assessment of fourth-year ambulatory care advanced pharmacy practice experience students. Students taught a single DSMES class and evaluated their confidence using a 14-item survey before and after the class. Patients who participated in the class and a pharmacy faculty observer completed the same instrument. Responses were compared using Friedman and Wilcoxon signed-rank tests, as appropriate. FINDINGS: Twenty-six students completed the survey. Overall, students' self-perceived confidence scores significantly increased for all questions after teaching the DSMES class (P < .001 for all questions). Confidence scores among students and faculty preceptors were similar with no significant differences in perceived confidence. There were some significant differences found among student and patient scores, with patients assessing student's perceived self-confidence higher than the students on three items (P < .05). SUMMARY: Student pharmacists' perceptions of their own confidence and abilities improved from before to after teaching a DSMES class. Student and faculty preceptor confidence scores were similar. There were few differences between student and patient confidence scores, with patients rating students highly on their perceived confidence in teaching a DSMES class. Patient feedback is important to consider when evaluating student confidence and abilities.

Facilitation of a multisite student topic discussion series using web-based conferencing technology.

INTRODUCTION: While technology's use and impact in the classroom setting is well-documented in literature, use during experiential education is less defined. Our objectives were to assess the change in clinical knowledge and application skills following a multisite topic discussion (TD) series using web-based conferencing technology during ambulatory care advanced pharmacy practice experiences (APPEs) and to assess student perceptions of learning through use of this modality. METHODS: A multisite TD series was created using web-based conferencing technology for students assigned to a clinical faculty member's ambulatory care APPE. Five topic discussions were conducted during each five-week rotation block covering disease states integral to ambulatory care practice. Pre- and post-assessments were administered to assess student learning and a survey was administered to assess student perceptions of learning. RESULTS: A total of 151 students were invited to participate in the study with 114 (75.5%) included in the final analysis. Overall student performance improved significantly from 53.3 ± 12.7% on the pre-assessment to 65.8 ± 14.3% on the post-assessment, with student performance on the post-assessment improving significantly in all topic areas. Students perceived that the TD series enhanced their learning and ability to apply clinical information while creating an online learning community. CONCLUSIONS: The addition of a multisite TD series using web-based conferencing technology successfully enhanced student knowledge. Student perceptions of this new web-based learning community were positive overall, despite some technological limitations. The results of this study support the use of web-based conferencing technology to enhance student learning during APPEs.

Impact of Student Pharmacists Teaching a Diabetes Self-Management Education and Support Class.

Objective. To evaluate student pharmacists' knowledge of diabetes and self-perceptions of aptitude and confidence before and after teaching a diabetes self-management education and support (DSMES) class. Methods. Students enrolled in an advanced pharmacy practice experience (APPE) in ambulatory care were randomly assigned to the intervention group (taught a DSMES class) or control group (did not teach a DSMES class) between June 2016 to April 2018. Students self-assessed their aptitude and confidence using a 14-item pre- and post-intervention survey instrument. Additionally, participants completed a 10-item diabetes knowledge evaluation at baseline and during week three or four of the APPE. Results. Forty-six students participated in the study (26 students in the intervention group and 20 in the control group). Students in the intervention cohort demonstrated a significant improvement in their knowledge score (81.8% post-intervention vs 68.4% pre-intervention). Students in the control cohort did not experience a significant change in knowledge scores from pre- to post-intervention evaluation (70.0% vs 74.1%). The intervention cohort achieved a significantly greater improvement in confidence scores compared to the control group (11.8 vs 6.7 increase in scores, respectively). Conclusion. A student pharmacist team-taught DSMES class resulted in significant improvement in diabetes knowledge, aptitude, and confidence. Student pharmacist participation in a DSMES class may improve knowledge and enhance confidence, while offering an opportunity to advance the pharmacy practice model in ambulatory care.

Management of Benign Prostatic Hyperplasia in Older Adults.

Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a nonmalignant adenomatous overgrowth of the periurethral prostate gland commonly seen in aging men. Historically, it has been assumed that the pathophysiology of lower urinary tract symptoms in men is the result of bladder outlet obstruction associated with prostate enlargement. Symptoms such as urinary hesitancy, incomplete bladder emptying, dribbling or prolonged urination, nocturia, urinary urgency, and/or urge incontinence are common. Understanding the differential diagnosis and ordering appropriate laboratory tests are essential in accurately identifying a BPH diagnosis. Management can be broken down into medical or pharmacological and surgical therapies. This article aims to provide an overview of BPH and its management in older adults.

Liraglutide: A Glucagon-Like Peptide-1 Agonist for Chronic Weight Management.

OBJECTIVE: To review the efficacy and safety of liraglutide 3.0 mg for weight loss. DATA SOURCE: A literature search was performed using PubMed and MEDLINE from 2000 to 2016. The following key terms were used alone or in combination: glucagon-like peptide-1 agonist, liraglutide, obesity, overweight, and weight loss. Additional supporting literature was identified utilizing the reference lists of the preceding articles. STUDY SELECTION: Analyzed studies were published in English and investigated use of liraglutide and its impact on weight loss. DATA EXTRACTION: Clinical studies with a primary focus of liraglutide use in weight loss were included in this review. Author consensus determined final study inclusion. DATA SYNTHESIS: Management of obesity centers on behavior modification that includes diet and exercise; however, pharmacologic therapy may be used. Several studies have indicated that GLP-1 receptor agonists promote weight loss in patients with type 2 diabetes mellitus (T2DM). The efficacy of liraglutide 3.0 mg as a weight-loss agent in patients with and without T2DM was established in three SCALE™ clinical trials. Liraglutide 3.0 mg was generally well tolerated during clinical trials. Common adverse events were typically related to the gastrointestinal system (i.e., nausea, vomiting). CONCLUSION: Based on available evidence, liraglutide 3.0 mg appears to be a safe and effective addition to the pharmacologic armamentarium available for chronic weight management in the general population. However, there are limited data within the geriatric population. Clinicians should consider liraglutide's cost, route of administration, and concomitant drug therapy when deciding which patients are appropriate candidates for liraglutide therapy. ABBREVIATIONS: AE = Adverse events, AHA/ACC/TOS = American Heart Association/American College of Cardiology/ The Obesity Society, BMI = Body mass index, CV = Cardiovascular, FDA = Food and Drug Administration, GI = Gastrointestinal, GLP-1 = Glucagon-like peptide-1, HbA1c = Hemoglobin A1c, Kcal = Kilocalorie, LCD = Low-calorie diet, MTC = Medullary thyroid carcinoma, NHLBI = National Heart Lung and Blood Institute, NNH = Number needed to harm, PYE = Patient years of exposure, REMS = Risk Evaluation and Mitigation Strategy, SCALE™ = Satiety and Clinical Adiposity - Liraglutide Evidence in Non-diabetic and Diabetic individuals, T2DM = Type 2 diabetes mellitus.

Pharmacists role in cholesterol management: addressing challenges and barriers.

Cholesterol management is an important factor in the modification of primary and secondary cardiovascular events. Guidelines emphasize incorporation of appropriate medication therapy and lifestyle adjustments to reduce low-density lipoprotein cholesterol (LDL-C) for cardiovascular disease (CVD) risk reduction. Of note, studies and nation-wide statistics indicate many patients do not achieve their LDL-C goals. Eliminating barriers and challenges associated with cholesterol management will allow patients to reach prespecified goals for CVD risk reduction. As the nation transitions to covering more individuals, the need for additional health care providers is evident. Pharmacists are accessible and knowledgeable health care contributors who can assist in optimizing patient outcomes. This article discusses the pharmacist's role in addressing challenges and barriers in cholesterol management.

Role of interleukin-1 inhibitors in the management of gout.

Interleukin-1 (IL-1) inhibitors potentially have a role as antiinflammatory agents in refractory gout or for patients who are unable to tolerate conventional therapy, such as nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or glucocorticoids, for acute attacks. Additionally, IL-1 inhibitors may also help patients with polyarticular and tophaceous gout by making them less vulnerable to breakthrough attacks during initiation of chronic urate-lowering treatment, the mainstay of gout therapy. Because evidence highlights the role of proinflammatory cytokine IL-1 in the inflammation process during an acute gouty attack, IL-1 inhibitors are used to modulate the pathogenesis of a variety of autoinflammatory diseases, providing support for its potential role in the inflammatory process of gout. After NSAIDs, colchicine, and steroids, IL-1 inhibitors are beneficial as fourth-line therapy for acute gout attacks due to their high cost and limited clinical experience. The IL-1 inhibitors used in gout are anakinra, canakinumab, and rilonacept. Based on published evidence, anakinra has limited support in the form of anecdotal case reports to justify its use for treating gout. Canakinumab's toxic profile in clinical trials precludes its use in treating patients for gout, and rilonacept shows promise with a few well-designed studies to support its use in gout patients initiating urate-lowering treatment. When combined with current traditional therapies, these newer agents present clinicians and patients with more potential treatment options in the difficult-to-treat gout population.