Real-World Effectiveness and Safety of Field- and Lesion-Directed Treatments for Actinic Keratosis.

Background: Real-world data for actinic keratosis treatment in the United States is lacking. Objectives: To understand real-world treatment patterns for actinic keratosis by type and modality, and compare effectiveness and safety of therapies, either alone or in combination. Methods: Medical charts of 429 patients were identified; clinical and outcome data were analyzed. Results: The first treatment after the index diagnosis was most frequently a procedure, followed by a topical agent. Treatment with 5-fluorouracil, ingenol mebutate, imiquimod, cryotherapy, or cryotherapy plus one topical (CRYO+One Topical) reduced actinic keratoses by 66.0%, 69.3%, 72.5%, 72.9%, and 73.0%, respectively; ≥75% clearance (AKCLEAR 75) was achieved in 57.1%, 72.7%, 57.1%, 62.4%, and 62.0% of those patients. Treatment effectiveness was positively correlated with the number of baseline actinic keratoses for topical and for procedural plus topical combination treatments, but not for procedural treatments alone. Adverse reactions (ARs) were more common with cryotherapy (9.7%); local skin responses (LSRs) were more common with field-directed (18.5%-43.1%) and CRYO+One Topical therapy (21.3%). Limitations: This was a retrospective study of limited duration and population size. Conclusions: The most commonly used treatments for patients with 6 or more actinic keratoses were topicals and a procedure plus topical combination, which also achieved higher rates of complete clearance than a procedure alone. ARs and LSRs were few in frequency and type.

Ranibizumab: A Review of Its Use in the Treatment of Diabetic Retinopathy in Patients With Diabetic Macular Edema.

Objective: To evaluate the pharmacotherapy role of ranibizumab, a vascular endothelial growth factor (VEGF) inhibitor, for the treatment of diabetic retinopathy (DR) in patients with diabetic macular edema (DME). Data Sources: PubMed, Science Direct, Google Scholar, and ClinicalTrials.gov searches (January 2000-May 2015) were conducted for articles published in English, and limited to clinical trials using the key words ranibizumab, DR, DME, anti-VEGF, and DR treatment. Study Selection and Data Extraction: Following PubMed, Science Direct, Google Scholar, and ClinicalTrials.gov searches, 4 clinical trials were identified and included in this review. Phase III/IV studies evaluating the clinical efficacy of ranibizumab versus placebo, ranibizumab versus laser, and ranibizumab versus other anti-VEGF agents were selected and evaluated. Data Synthesis: Ranibizumab administered to patients with DME for 12 to 36 months improved and prevented worsening of visual acuity. At month 36 the ranibizumab-treated eyes had a >2 or >3 step DR improvement compared with the sham crossover eyes. Ranibizumab was also found to be superior to laser treatment. Patients receiving ranibizumab gained 6.0 letters, improved tritan and protan color contrast thresholds, and demonstrated improved retinal sensitivity versus the subjects receiving laser treatment who lost 0.9 letters. When ranibizumab was compared with other anti-VEGF agents (aflibercept, pegaptanib, and bevacizumab), it was not always demonstrated to be significantly superior. Conclusion: Ranibizumab has been shown to be safe and efficacious for use in the treatment of DR in patients with DME. Thus, it is an alternative treatment approach to laser photocoagulation therapy.

An assessment of the relationship between pharmacy students' perceptions of their preparedness to contribute to emergency responses and their current work status.

INTRODUCTION: A study was conducted to assess if there is an association between pharmacy students' perceptions of their preparedness to contribute to emergency responses and their current work status. METHODS: A cross-sectional analysis was conducted using data from a student perception survey completed by third-year pharmacy students. The survey collected demographic information on age, gender, level of education, ethnicity, and pharmacy-related work experience. A series of Likert scale items were used to assess students' perceptions regarding their competency in specific skills areas essential for participation in emergency responses. An independent samples t-test was used to compare mean scores for Likert scale items between working and nonworking students. Multivariate linear regression models were developed to determine if work status was an independent predictor of students' self-reported competencies after adjusting for covariates. RESULTS: Sixty-six of 69 (95.7%) students completed the student perception survey. Students currently working in a pharmacy reported higher mean scores on several of the measured competencies. After covariates adjustment, current work status was associated with higher scores on self-reported competencies related to proficiency in evaluating information from patient assessment and collaborating with other individuals to develop processes related to the optimizing flow of care. CONCLUSIONS: These results suggest that students who are working tend to have more confidence in their ability to contribute to emergency responses as well as work better in a team setting. Incorporating cases related to emergency response readiness in pharmacy curriculum may be needed to enhance skills and confidence of non-working pharmacy students.