Adaptation and Validation of the Fresno Test of Competence in Evidence-Based Medicine in Doctor of Pharmacy Students.

Objective. To adapt and validate an instrument assessing competence in evidence-based medicine (EBM) in Doctor of Pharmacy students. Methods. The Fresno test was validated in medical residents. We adapted it for use in pharmacy students. A total of 120 students and faculty comprised the validation set. Internal reliability, item difficulty, and item discrimination were assessed. Construct validity was assessed by comparing mean total scores of students to faculty, and comparing proportions of students and faculty who passed each item. Results. Cronbach's alpha was acceptable, and no items had a low item-total correlation. All of the point-biserial correlations were acceptable. Item difficulty ranged from 0% to 60%. Faculty had higher total scores and also scored higher than students on most items, and 8 of 11 of these differences were statistically significant. Conclusion. The Pharm Fresno is a reliable and valid instrument to assess competence in EBM in pharmacy students. Future research will focus on further refining the instrument.

A polypill for all? Critical review of the polypill literature for primary prevention of cardiovascular disease and stroke.

OBJECTIVE: To evaluate the efficacy and safety of the polypill for prevention of cardiovascular disease (CVD) and stroke and to present literature related to the polypill components (statin, aspirin, antihypertensive) for primary prevention of CVD and stroke. DATA SOURCES: A literature search was conducted in MEDLINE (1948-January 2011) and EMBASE (1974-January 2011) using the terms polypill and Polycap. When limited to clinical trials, systematic reviews, or meta-analyses, 7 studies were identified. Bibliographies of pertinent review articles and studies were scanned for additional references. A similar search was conducted to identify literature related to the use of polypill components for primary prevention of CVD and stroke. STUDY SELECTION AND DATA EXTRACTION: Studies that evaluated the hypothetical benefits of a polypill and controlled trials that assessed a formulation of the polypill related to prevention of CVD and stroke were included. Studies were assessed for efficacy, safety, drug interactions, and clinical pharmacokinetics. DATA SYNTHESIS: An initial study to predict benefit estimated that a hypothetical polypill would reduce diastolic blood pressure by 11 mm Hg and low-density lipoprotein cholesterol (LDL-C) by 70 mg/dL, thus reducing the relative risks of CVD and stroke by 88% and 80%, respectively. One clinical trial in patients at low risk for CVD and stroke found that diastolic blood pressure was reduced by 1.6 mm Hg and LDL-C was reduced by 17.7 mg/dL, correlating with 44% and 21% reduction in the relative risks of CVD and stroke, respectively. Studies in higher risk patients reported reductions in systolic blood pressure of up to 28.8 mm Hg and in LDL-C of up to 54 mg/dL, correlating with 62% and 60% relative reduction in risks of CVD and stroke, respectively. CONCLUSIONS: Polypill study results have been more modest than originally theorized. However, results show promise in patients at higher risk for CVD and stroke.

Pharmacy student impact on inappropriate prescribing of acid suppressive therapy.

OBJECTIVE: To examine the impact that having pharmacy students on internal medicine patient care teams had on inappropriate prescribing of acid suppressive therapy (AST). METHODS: In this observational cohort study, internal medicine patients who received care from teams with a pharmacy student were compared to patients who received care from teams without a pharmacy student. The primary endpoint was proportion of patients on inappropriate AST. RESULTS: The overall proportion of patients receiving inappropriate AST was 24.4%. There was no significant difference between patients seen by teams with a pharmacy student and those seen by teams without a pharmacy student. The proportion of patients discharged with new inappropriate AST prescriptions was lower after pharmacy student review, though not significantly (6.1% vs. 9.4%, p = 0.07). Pharmacy student reviews shortened the median duration of inappropriate AST by 1.5 days (6 vs. 8.5 days, p = 0.025). CONCLUSIONS: Patient care teams on which pharmacy students performed medication reviews had a reduced duration of inappropriate use of AST in patients.

Effect of intraperitoneal and intravenous administration of cholecystokinin-8 and apolipoprotein AIV on intestinal lymphatic CCK-8 and apo AIV concentration.

CCK and apolipoprotein AIV (apo AIV) are gastrointestinal satiety signals whose synthesis and secretion by the gut are stimulated by fat absorption. Intraperitoneally administered CCK-8 is more potent in suppressing food intake than a similar dose administered intravenously, but the reason for this disparity is unclear. In contrast, both intravenous and intraperitoneally administered apo AIV are equally as potent in inhibiting food intake. When we compared the lymphatic concentration of CCK-8 and apo AIV, we found that neither intraperitoneally nor intravenously administered CCK-8 or apo AIV altered lymphatic flow rate. Interestingly, intraperitoneal administration of CCK-8 produced a significantly higher lymphatic concentration at 15 min than did intravenous administration. Intraperitoneal injection of apo AIV also yielded a higher lymphatic concentration at 30 min than did intravenous administration. Intraperitoneal administration of CCK-8 and apo AIV also resulted in a much longer period of elevated CCK-8 and apo AIV peptide concentration in lymph than intravenous administration. Furthermore, enzymatic activity of dipeptidyl peptidase IV (DPPIV) and aminopeptidase was higher in plasma than in lymph during fasting, and so, satiation peptides, such as CCK-8 and apo AIV in the lymph, are protected from degradation by the significantly lower DPPIV and aminopeptidase activity levels in lymph than in plasma. Therefore, the higher potency of intraperitoneally administered CCK-8 compared with intravenously administered CCK-8 in inhibiting food intake may be explained by both its higher concentration in lymph and the prolonged duration of its presence in the lamina propria.