Heart Failure: A Class Review of Pharmacotherapy.

A recent guideline update for the treatment of heart failure has created the need for a new look at the medication classes and trials related to the disease. The authors focus on pharmacological options available for treating the problem.

The Synergy of Mediation and Lifestyle Medication: A New Horizon in Mental Health Treatment.

Mental health conditions range from mood disturbances like depression and bipolar disorder to anxiety and psychotic disorders, eating disorders, and ADHD. Treatment plans traditionally involve pharmaceutical interventions. However, the emerging concept of lifestyle medicine can be an additive strategy for mental health management. The primary aim of this article is to dive into the use of medication in treating different mental health disorders and also highlight lifestyle changes, such as dietary adjustments and physical activity, as a means to enhance mental well-being, mitigate medication side effects, and address comorbid side effects like diabetes and obesity. The comprehensive approach of lifestyle medicine is presented as a promising complementary option, aiming for better symptom control and improved quality of life alongside medication in managing complex mental health conditions.

Catching ZZZs: A Summary of the Most Common Herbal Medications Taken for Insomnia.

Insomnia is caused by a myriad of factors and can be very disruptive to a person's quality of life and health. When people see a health care provider, often a thorough assessment occurs and people are given various treatment options that include lifestyle interventions, medications, and/or cognitive behavior therapy. There are also many people that may choose to take over the counter or herbal medications as a remedy for insomnia. While there are many supplements that claim to have sleep benefits, clinical data supporting such claims are not always present. This article will briefly discuss the three most common herbal supplements taken for insomnia: melatonin, valerian, and lavender.

Herpes zoster meningitis with multidermatomal rash in an immunocompetent patient.

A case of herpetic rash in an immunocompetent patient is described, which was present in multiple dermatomes at the same time. First, patient was thought to have immunodeficiency, but further workup turned out to be negative for it. Patient also had pleocytic lymphocytosis in cerebrospinal fluid, which was suggestive of viral meningitis. Later, the patient responded well to the acyclovir therapy and was discharged home without any sequel. This case illustrates the need for emergency physicians to be extra vigilant for involvement of other dermatomes in case a patient presents with herpetic rash in 1 dermatome because patients with multidermatomal/disseminated herpetic rash need to be started on airborne isolation in addition to contact precautions to prevent the transmission of disease in health care settings.

Empowering People with Diabetes: Role of Continuous Glucose Monitor Systems.

Continuous glucose monitoring in a person with diabetes who is embracing lifestyle changes can be greatly impactful in numerous ways. There are many factors that have been identified to affect blood glucose, and for someone who may be implementing the six pillars of lifestyle medicine, their blood sugar may require closer monitoring. Lifestyle medicine interventions may lead to improved glucose levels or even remission. The continuous glucose monitor allows people to see glucose levels, trends, and how rapidly their glucose levels are rising or dropping, empowering them to make connections with how they feel and how their actions are impacting their blood sugar, as well as giving information about how medications may need to be adjusted or deprescribed. CGM, when appropriately used, can help determine how to best manage diabetes, optimize outcomes, minimize risks, and empower the person and healthcare team.

Economic impact and health care utilization outcomes of diabetes self-management education and support interventions for persons with diabetes: a systematic review protocol.

OBJECTIVE: The aim of this systematic review is to summarize and synthesize existing research on the economic impact of diabetes self-management education and support. INTRODUCTION: Diabetes self-management education and support is an essential component of diabetes care, yet it continues to be underutilized. A gap exists regarding the true measured economic impact of this intervention. INCLUSION CRITERIA: This review will consider studies that report the measured economic impact and health care utilization of diabetes self-management education and support for persons with diabetes or their caregivers. The inclusion criteria are as follows: quantitative studies providing measured data on the economic outcomes and health care utilization of diabetes self-management education and support interventions that include at least one of the Association for Diabetes Care and Education Specialists Seven Self-Care Behaviors. METHODS: The review will search the following databases: MEDLINE Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions; Embase; Scopus; CINAHL; ERIC, Cochrane Database of Systematic Reviews; and the Cochrane Register of Controlled Trials. Additionally, a search of gray literature will be performed using Google Scholar. Date limitations will be from January 2006 to May 2020. Two members of the research team will independently screen abstracts and full texts, and extract data. The screening process will be described using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Articles will be assessed for risk of bias using the JBI critical appraisal tools. Data will be narratively summarized. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42020166743).

Vitamin D: Do We Need More Than Sunshine?

There is an astounding amount of conversation and research about vitamin D. It carries many claims, and there is controversy as to what adequate levels should be, how to ensure reaching appropriate serum levels, and what the consequences are of vitamin D insufficiency. This article describes the role of vitamin D, reviews some of the evidence, and provides the current recommendations for vitamin D supplementation, including if a daily walk in the sun is the most appropriate prescription or do we need something more?

Economic Impact and Health Care Utilization Outcomes of Diabetes Self-Management Education and Support Interventions for Persons With Diabetes: A Systematic Review and Recommendations for Future Research.

PURPOSE: Value-driven outcomes are important because health systems determine sustainability of diabetes self-management education and support (DSMES) programming. Health care utilization and clinical outcomes are critical factors when considering the impact of DSMES programs. OBJECTIVE: The aim of this systematic review was to describe studies that report on the economic and health care utilization outcomes of diabetes self-management programs. METHODS: A systematic literature review was performed in multiple databases. Studies reporting economic and health care utilization outcomes related to DSMES and including 1 or more of the ADCES7 Self-Care BehaviorsTM from January 2006 to May 2020 were included. Eligible articles needed to compare the intervention and comparison group and report on economic impact. The methodological quality was assessed with the Joanna Briggs Institute Critical Appraisal Checklist specific to each individual study design. RESULTS: A total of 22 of 14 556 articles published between 2007 and 2020 were included. Cost benefits varied, and there were considerable methodological heterogeneity among design, economic measures, population, perspective, intervention, and biophysical outcomes. CONCLUSION: DSMES interventions may positively impact economic outcomes and/or health care utilization, although not all studies showed consistent benefit. This review highlights an evidence gap, and future health economic evaluations are warranted.

Is There a Prescription to Treat Pediatric Obesity?

Pediatric obesity is complex-in every way. The pathogenesis, which is a result of a multitude of factors combined with social and environmental factors makes it a crisis with overwhelming challenges. It is difficult to treat pediatric obesity; however, guidelines attempt to clarify how to approach treatment. These strategies are mostly interventions in lifestyle because only 1 medication is approved for treating obesity in children. The approach to the treatment of pediatric obesity will need to be a one that relies on the available data, a continued drive for additional research and publication, sharing of practice experience, and continued efforts at prevention.

Constipation Treatment: A Review.

Constipation seems like a ubiquitous condition, something people of all ages experience and many complain about. It is often associated with infrequent bowel movements; however, in reality, constipation has a wide array of symptoms including hard stools, feeling of incomplete evacuation, abdominal discomfort, bloating, distension, excessive straining, sensation of anorectal blockage, or need for manual maneuvers during defecation. Determining the cause of the constipation is essential to ensure the appropriate treatment approach. The patient evaluation consists of collecting subjective and objective information. Constipation has many different treatment options, with many treatments available as over-the-counter products as well as prescription medications. For most types of constipation, nonpharmacological and dietary changes are typically recommended as first-line treatment. Prescription medications are available with indications for specific types of constipation. Both nonpharmacological and pharmacological interventions have a key role, and follow-up is important to ensure treatment is appropriate and adequate.

Language: A Powerful Tool in Promoting Healthy Behaviors.

Words have the capacity to empower or devastate someone. Although a "rose by any other name" may "still be a rose," if language is not precise and thoughtful in taking into consideration perceptions, values, biases, and culture of people, it may influence the patient, thereby potentially leading to negative patient outcomes. Health promotion interventions include teaching and empowering people to embrace the components of lifestyle medicine utilizing a variety of approaches. An essential part of the intervention is how the message is delivered, specifically the language used to deliver the message. In this article, the implications of language on patient outcomes and suggestions on how to rephrase language with potential negative connotations are described.

Pharmacologic Management of Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune inflammatory disease of the joints, which can result in permanent cartilage and bone damage. Although the exact cause of RA is unknown, there are many risk factors that have been associated with RA. When RA occurs, the immune system mistakenly attacks healthy synovial and connective tissue. Available treatment options work to reduce inflammation or slow the disease progression. The American College of Rheumatology published guidelines for the treatment of rheumatoid arthritis in 2015, with an update expected in late 2019/early 2020. Nonpharmacologic therapy for patients with RA includes rest, occupational and physical therapy, and weight reduction and use of assistive devices, as necessary. Pharmacologic options include nonsteroidal anti-inflammatory drugs, corticosteroids, disease-modifying antirheumatic drugs, antitumor necrosis factor agents, and interleukin receptor antagonists.

Description of a transitions of care and telemedicine simulation lab activity.

BACKGROUND AND PURPOSE: Transitions of Care (ToC) is an important clinical practice area requiring trained health care professionals, but there is limited literature describing ToC in the didactic curriculum. The purpose of this study was to describe and evaluate a ToC telemedicine simulation activity in a doctor of pharmacy curriculum. EDUCATIONAL ACTIVITY AND SETTING: A one-hour lecture and simulation activity was incorporated into a second-year course. Student teams participated in discharge and telemedicine encounters with standardized patients (SPs). Six medication-related problems (MRPs) were incorporated into the activity. Activity documents were collected to identify student competency. FINDINGS: Fifty-nine student pharmacists in 16 teams participated. All teams accurately identified five of the six MRPs. Fourteen teams (87.5%) accurately identified the sixth MRP after completion of the telemedicine encounter. Six teams (62.5%) completed the discharge medication list accurately and completely. All teams provided medication education, and 93.8% (n = 15) of teams identified follow-up was needed. Ten teams utilized effective interview sequence and structure during both encounters. Activity challenges included resources, financial support and SP training. SUMMARY: Case-based learning and the use of simulation has good evidence supporting its use in education. Utilizing these techniques to reinforce concepts may be a beneficial way for students to be trained effectively to deliver impactful ToC services.

The Report of the 2018-2019 Professional Affairs Standing Committee: The Role of Educators in Pharmacy Practice Transformation.

The 2018-2019 Professional Affairs Committee examined the potential roles and needs of clinical educators (faculty and preceptors) in leading transformation in pharmacy practice. The committee was charged to (1) discuss the potential roles and responsibilities of faculty and preceptors leading transformation and enhanced patient care services in pharmacy practice; (2) describe factors, including clinician well-being and resilience, which may influence faculty and preceptor involvement in practice transformation and the enhancement of patient care services; and (3) recommend how the efforts and successes of faculty and preceptors involved in pharmacy practice transformation can be replicated and recognized as well as identify the types of continuing professional development (CPD) that should be available to enable the influence and implementation of patient care services. This report provides a framework for addressing the committee charges by examining the roles of advocacy, collaboration, continuing professional development, and clinician resilience and well-being. The committee provides a revision to a current AACP policy regarding continuing professional development as well as several recommendations to AACP and suggestions to colleges and schools of pharmacy pertaining to the committee charges.

Jazzin' Healthy: Interdisciplinary Health Outreach Events Focused on Disease Prevention and Health Promotion.

OBJECTIVES: Health-related disparities are a significant public health concern. In conjunction with a university concert series, healthcare professionals and students provided education, clinical services, and preventive care using an interdisciplinary approach to a primarily African American cohort. The objective was to assess cardiovascular risk factors and readiness to change health-related behaviors. METHODS: Six outreach events were conducted over 3 years by an interdisciplinary team including pharmacy, medicine, nursing, nutrition, occupational therapy, public health, optometry, and health information technology. Clinical services, such as health screenings for glucose, blood pressure, cholesterol, and body fat along with counseling on the results and smoking cessation behavioral counseling, were provided. Education initiatives addressed bone health, heart disease, HIV risk, nutrition, and access to physician care. Preventative care included vaccinations and eye exams. RESULTS: There were 285 participants that were predominantly African American (95.8 %), female (71.5 %), and age within 55-64 years (45.1 %). Hypertension (50.8 %) and obesity (65.1 %) were the most common cardiovascular risk factors. Of those advised to make health behavior changes, 76.4 % reported they planned to make changes within 1 month. CONCLUSION: These interdisciplinary outreach events provided health information and access to care in a novel setting and led to a high rate of planned health behavior changes.

Role of glucagon-like peptide 1 receptor agonists in management of obesity.

PURPOSE: Published data on the weight loss effects of glucagon-like peptide 1 (GLP-1) receptor agonists are reviewed, with a focus on data from clinical trials. SUMMARY: Obesity is a significant health problem in the United States (an estimated 69% of U.S. adults are overweight and nearly 35% are obese), and few drugs have proven safety and efficacy as adjuncts to lifestyle modification for weight management. GLP-1 receptor agonists are used for glycemic control in patients with type 2 diabetes and have been studied for their weight loss effects in patients with and without diabetes; these agents produce weight loss benefits through their effects on satiety and gastric emptying. In December 2014, the liraglutide product Saxenda (Novo Nordisk) became the first GLP-1 receptor agonist approved by the Food and Drug Administration (FDA) for use in long-term weight management. Results of clinical trials that evaluated the effects of GLP-1 receptor agonist therapy on weight and body mass index indicated outcomes comparable or superior to those achieved with the use of other antiobesity agents. As a class, GLP-1 receptor agonists have a generally more favorable safety profile than several other antiobesity agents; transient, mild-to-moderate gastrointestinal symptoms were the most frequently reported adverse effects in clinical trials. CONCLUSION: Originally marketed for glycemic control in type 2 diabetes, GLP-1 receptor agonists have been found effective for weight reduction in patients with and without type 2 diabetes. Liraglutide is currently the only GLP-1 receptor agonist approved by FDA for obesity treatment.

Isolation and characterization of Oya virus a member of Simbu serogroup, family Bunyaviridae, isolated from Karnataka, India.

During a study on Japanese encephalitis (JE) from Kolar district of Karnataka state, India in 1986; two virus isolates were obtained in infant Swiss albino mouse from a pig and a human serum sample. For characterization of these virus isolates, they were propagated in Vero CCL-81 cells. These virus isolates were screened for flaviviruses (Japanese encephalitis, West Nile, Dengue, Kyasanur forest disease) and Alphavirus (Chikungunya) by RT-PCR and found to be negative. Further these they were screened for bunyaviruses using genus-specific primers. A virus isolate from a human sample was sequenced using next generation sequencing; which identified it as Oya virus, Simbu group of the genus Orthobunyavirus of the family Bunyaviridae. Phylogenetic analysis of L, M, S (N and NSs) revealed its close association with Chinese strain of Oya virus in Simbu serogroup with the distance of 6.5>4.2>3.2% for nucleotides and 2.4>0.8>0.0% for the amino acid of L>M>S segments respectively. Based on the PCR results; an isolate from pig sample was also confirmed as Oya virus. This study was strengthened by findings of IgG antibody positivity against Oya virus in retrospective serum samples of suspected febrile illness cases from this area by an indigenously developed ELISA. Oya virus positivity was also recorded in human samples collected from Karnataka using nested RT-PCR. This is the first report of the presence of Oya virus in human samples. Further studies are needed to determine disease-causing potential in humans.