Infectious complications of newer agents in the fight against diabetes.

Infectious complications have been reported with antidiabetic medications. Glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors have been associated with upper respiratory tract infections and urinary tract infections. Sodium-glucose cotransporter 2 inhibitors have been associated with lower limb amputations, urinary tract infections, genital mycotic infections, and Fournier gangrene.

Assessment of pharmacy students' patient care skills using case scenarios with a SOAP note grading rubric and standardized patient feedback.

BACKGROUND AND PURPOSE: To determine if the patient care and documentation skills of pharmacy students improve in the third professional (P3) year using a subjective, objective, assessment, plan (SOAP) note grading rubric and a standardized patient (SP) checklist rubric with SPs taking the role as evaluator during a sequential system of case scenarios. EDUCATIONAL ACTIVITY AND SETTING: During a required skills laboratory course in the P3 year at the University of Mississippi School of Pharmacy, students were evaluated with a SOAP note grading rubric and an SP checklist rubric during three consecutive SP case scenarios (hypertension, diabetes, asthma). FINDINGS: Overall, scores for the sequential case scenarios improved across all three scenarios through the use of SOAP notes (F = 96.89, p < 0.0001). For the SP evaluations, total score improved for the second and third case scenarios versus the first (F = 27.48, p < 0.0001). SUMMARY: Patient care skills of P3 pharmacy students improved during a sequential system of case scenarios using a SOAP note grading rubric and an SP checklist rubric as objectively developed evaluation tools, with SPs taking the role as evaluator.

Effect of a smoking cessation educational intervention on knowledge and confidence of pharmacy students versus community leaders.

BACKGROUND: Training programs of various intensities and durations have been implemented to assist healthcare providers and students in leading smokers in a quit attempt. While some training programs have been developed to help community leaders provide these services, the focus for community leaders has been to assist with recruitment efforts. OBJECTIVE: The objective of this study was to compare knowledge and confidence of students and community members before and after a smoking cessation educational intervention. METHODS: After approval from the institutional review board, pharmacy students and community members were recruited for two-hour educational interventions. Topics covered included smoking health risks, benefits of quitting, behavioral, cognitive, and stress-management techniques, smoking cessation medications, and how to start a formal class. Pre- and post-intervention survey instruments were given to all participants with comparisons made via Student's or Paired T-tests, as appropriate. RESULTS: Knowledge scores increased significantly (p<0.05) after the educational intervention for pharmacy students (n=30) and community members (n=8). Confidence scores increased significantly for pharmacy students (p<0.05), but not for community members. Pharmacy students had significantly greater knowledge score changes (53.7%, pre-intervention; 81.8%, post-intervention; p<0.05) versus community members (32.1%, pre-intervention; 50.1%, post-intervention; p<0.05). When comparing individual confidence questions, only scores evaluating the change in confidence for providing counseling were higher for students versus community members (2.13 vs. 1.8, respectively; p<0.05). CONCLUSIONS: Pharmacy students and community leaders exhibited increased knowledge after a smoking cessation educational intervention, and pharmacy students had increased confidence scores. All confidence scores did not change significantly for community members. Developing coalitions between healthcare providers and community leaders, focusing on the roles of each, may be productive in initiating smoking cessation programs.

Impact of a residency interest group on students applying for residency.

OBJECTIVE: To determine the impact of a faculty-directed, residency interest group on the knowledge, confidence, and preparedness about residency-related topics of third-year (P3) and fourth-year (P4) pharmacy students. DESIGN: Faculty members implemented residency interest group sessions on residency and career preparation for P3 and P4 students. Group meetings consisted of four 2- to 3-hour sessions that covered topics such as residency timeline and resources, letter of intent and CV development, proper interview techniques, and navigating the midyear clinical meeting. Residency directors throughout Mississippi, current pharmacy residents, P3 and P4 students, and other faculty members were invited to attend these sessions. ASSESSMENT: Surveys were administered prior to and after completion of the interest group sessions. Students who attended the sessions demonstrated increased knowledge, confidence, and preparedness on residency-related topics. However, non-attendees also demonstrated increased knowledge, confidence, and preparedness from baseline. CONCLUSION: The majority of students who accepted a residency position had attended at least 1 residency interest group session, suggesting this program had a positive influence.

Pterostilbene on metabolic parameters: a randomized, double-blind, and placebo-controlled trial.

Introduction. The purpose of this trial was to evaluate the effect of pterostilbene on metabolic parameters. Methods. A prospective, randomized, double-blind, and placebo-controlled study that enrolled 80 patients with a total cholesterol ≥200 mg/dL and/or LDL ≥ 100 mg/dL. Subjects were divided into four groups: (1) pterostilbene 125 mg twice daily; (2) pterostilbene 50 mg twice daily; (3) pterostilbene 50 mg + grape extract (GE) 100 mg twice daily; (4) matching placebo twice daily for 6-8 weeks. Endpoints included lipids, blood pressure, and weight. Linear mixed models were used to examine and compare changes in parameters over time. Models were adjusted for age, gender, and race. Results. LDL increased with pterostilbene monotherapy (17.1 mg/dL; P = 0.001) which was not seen with GE combination (P = 0.47). Presence of a baseline cholesterol medication appeared to attenuate LDL effects. Both systolic (-7.8 mmHg; P < 0.01) and diastolic blood pressure (-7.3 mmHg; P < 0.001) were reduced with high dose pterostilbene. Patients not on cholesterol medication (n = 51) exhibited minor weight loss with pterostilbene (-0.62 kg/m(2); P = 0.012). Conclusion. Pterostilbene increases LDL and reduces blood pressure in adults. This trial is registered with Clinicaltrials.gov NCT01267227.

A multipreceptor approach to ambulatory care topic discussions.

OBJECTIVE: To assess the impact of a multipreceptor approach to facilitating topic discussions on students' knowledge and confidence in clinical decision-making during an ambulatory care advanced pharmacy practice experiences (APPEs). DESIGN: Faculty members with relevant expertise and experience facilitated discussions with fourth-year doctor of pharmacy (PharmD) students regarding 7 ambulatory care topics. A student self-assessment survey and knowledge-assessment instrument was administered before and after discussions. ASSESSMENT: Students' examination scores increased significantly from 59.1% ± 13.9% at baseline to 76.5% ± 12.6% at the end of the 5-week experience (p<0.001). The majority of participants were comfortable making therapeutic decisions regarding medication use as it related to all discussion topics except heart failure. CONCLUSIONS: Participation in topic discussions led by faculty members with expertise and experience for each ambulatory care topic was associated with a significant improvement in knowledge-assessment scores.

Analysis of safety from a human clinical trial with pterostilbene.

Objectives. The purpose of this trial was to evaluate the safety of long-term pterostilbene administration in humans. Methodology. The trial was a prospective, randomized, double-blind placebo-controlled intervention trial enrolling patients with hypercholesterolemia (defined as a baseline total cholesterol ≥200 mg/dL and/or baseline low-density lipoprotein cholesterol ≥100 mg/dL). Eighty subjects were divided equally into one of four groups: (1) pterostilbene 125 mg twice daily, (2) pterostilbene 50 mg twice daily, (3) pterostilbene 50 mg + grape extract (GE) 100 mg twice daily, and (4) matching placebo twice daily for 6-8 weeks. Safety markers included biochemical and subjective measures. Linear mixed models were used to estimate primary safety measure treatment effects. Results. The majority of patients completed the trial (91.3%). The average age was 54 years. The majority of patients were females (71%) and Caucasians (70%). There were no adverse drug reactions (ADRs) on hepatic, renal, or glucose markers based on biochemical analysis. There were no statistically significant self-reported or major ADRs. Conclusion. Pterostilbene is generally safe for use in humans up to 250 mg/day.

Prescriber monitoring for benign prostatic hyperplasia within a family medicine clinic: a comparison of medication classes.

PURPOSE: The purpose of this study was to compare prescriber monitoring for safety and efficacy of medication classes used to treat benign prostatic hyperplasia (BPH). METHODS: This was a retrospective chart review of patients diagnosed with BPH who were prescribed medications within a family medicine clinic between January 2008 and August 2010. Patients were divided into those receiving nonselective and uroselective alpha-blockers, 5-alpha reductase inhibitors (5-ARIs), and combination therapy. A chart review was performed with regard to predetermined criteria to monitor how efficacy and adverse effects were assessed by providers in the clinic. RESULTS: A general genitourinary assessment was documented most frequently for patients receiving 5-ARIs and least frequently in patients receiving nonselective alpha-blockers. A digital rectal examination was documented in 11% of patients. Prostate-specific antigen concentrations were assessed evenly across all medication classes and documented in 47% of eligible patients. However, the American Urological Association Symptom Index and quality-of-life questions were not performed on any patients, and assessments of adverse effects were not documented. CONCLUSION: Although prescribers in a family medicine clinic recorded a general genitourinary assessment for patients receiving BPH medications, a more standardized approach is needed.

Physical assessment experience in a problem-based learning course.

OBJECTIVE: To evaluate the impact of a physical-assessment learning experience implemented in the problem-based learning (PBL) format of the third year of a doctor of pharmacy (PharmD) program. DESIGN: Students enrolled in a PBL course completed survey instruments to measure knowledge and confidence before and after participating in the learning experience. A simulation stethoscope was used to teach students abnormal pulmonary and cardiovascular sounds in 1-hour sessions for each of 12 PBL groups. ASSESSMENT: The 92 students enrolled in the PBL course completed pre- and post-experience survey instruments. Students' scores on knowledge questions increased significantly (p < 0.0001) from 40.4% ± 11.4% at baseline to 62.5% ± 13.7% and 63.1 ± 11.6%, respectively, on the 2 sets of post-experience questions. Students scored a median of 3 or 4 on a 5-point Likert scale after a learning experience on questions measuring confidence. CONCLUSION: Use of a simulation stethoscope in a physical-assessment learning experience increased pharmacy students' knowledge in performing pulmonary and cardiovascular assessment techniques.

Total and component health care costs in a non-Medicare HMO population of patients with and without type 2 diabetes and with and without macrovascular disease.

BACKGROUND: Type 2 diabetes (T2DM) is one of the most prevalent and costly chronic conditions in the United States. Macrovascular disease (MVD) remains a common and costly comorbidity in T2DM. Understanding the impact of MVD on total health care costs in patients with T2DM is of great importance to managed care organizations (MCOs). OBJECTIVE: To examine from the perspective of an MCO the impact of MVD on health care costs in patients with T2DM and in a matched comparison group of patients without diabetes. METHODS: This study involved retrospective analysis of administrative claims (eligibility, pharmacy, and medical) using data from a commercial health maintenance organization population of approximately 700,000 members in an East Coast health plan. Patients were included in this study if they (a) had 2 or more claims for T2DM ( International Classification of Diseases, Ninth Revision, Clinical Modification[ICD-9-CM] codes 250.X0 or 250.X2), or (b) had a prescription drug claim for insulin and a diagnosis of T2DM, or (c) had at least 1 pharmacy claim for an oral glycemic-modifying agent during the 12-month period from January 1, 2003, through December 31, 2003. Patients with 2 or more medical claims for type 1 diabetes (ICD-9-CM codes 250.X1 or 250.X3) were excluded from the study. A random group of comparison patients without diabetes (ICD-9 code 250.xx) were matched on age group and sex. Study patients in these 2 groups were subdivided into 4 groups based on the presence of medical claims with diagnosis codes for MVD (acute myocardial infarction, other ischemic heart disease, coronary artery bypass surgery, percutaneous transluminal angioplasty, congestive heart failure, cerebrovascular accident, peripheral vascular disease, cerebrovascular disease, and peripheral vascular disease). Direct medical costs were aggregated for 12 months after the index date for patients in all 4 groups. Bootstrapping technique was used to compare the health care costs between patients with T2DM and those without diabetes, stratified by MVD status. RESULTS: A total of 9,059 patients with T2DM were identified and were matched by age group and sex to a random group of patients without diabetes. MVD was present in 26.9% (n=2,441) of patients with T2DM versus 11.3% (n=1,027) of patients without diabetes. Patients with MVD and T2DM were, on average, a year younger than patients with MVD but without diabetes (54.55 vs. 55.55 years, P <0.001). Patients with T2DM but without MVD were nearly the same age as patients with neither diabetes nor MVD (50.44 vs. 50.59 years, P=0.092). The T2DM patients with MVD had average 12-month costs more than 3 times the costs for patients with T2DM but without medical claims with diagnosis codes for MVD--10,450 dollars versus 3,385 dollars, respectively. Pharmacy costs accounted for 29.0% and inpatient hospital costs accounted for 43.9% of total medical costs in T2DM patients with MVD versus 55.0% and 17.3%, respectively, in T2DM patients without MVD. Patients with MVD diagnoses and T2DM had total average medical costs that were 1.7 times the total medical costs for MVD patients without T2DM--10,450 dollars versus 6,090 dollars, respectively. CONCLUSIONS: The results of this analysis suggest that MVD may triple the total medical care costs in patients with T2DM. These economic consequences would appear to support the importance of interventions intended to prevent macrovascular events in patients with T2DM.