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1.
Artículo en Inglés | MEDLINE | ID: mdl-31902123

RESUMEN

Apixaban is prescribed for stroke prevention in nonvalvular atrial fibrillation (NVAF) in patients with varying degrees of renal dysfunction. While pharmacokinetic data support apixaban in severe renal impairment, clinical safety outcomes data are limited. This retrospective cohort analysis was conducted to evaluate the safety of apixaban in patients with NVAF and renal impairment. A total of 340 patients with NVAF receiving apixaban 5 mg or 2.5 mg twice daily were included for analysis; 287 preserved renal function (pRF: CrCl ≥ 25 ml/min and SCr ≤ 2.5 mg/dl) and 53 impaired renal function (iRF: CrCl < 25 ml/min and/or SCr > 2.5 mg/dl). The primary endpoint was major bleeding in patients taking apixaban 5 mg. Secondary endpoints included major bleeding with apixaban 2.5 mg and minor bleeding in both groups. There was no difference in major bleeding events in the 5 mg pRF group (4.41%) versus iRF group (3.57%) (P = 0.66). Similar rates occurred between the 2.5 mg pRF and iRF groups. Minor bleeding events were similar regardless of renal function. The incidence of bleeding in the 5 mg group was 11.45% with pRF versus 10.71% with iRF (P = 0.6). In the 2.5 mg group, bleeding incidence was 10% with pRF versus 16% with iRF (P = 0.47). There were no observed differences in bleeding between groups with pRF or iRF, regardless of apixaban dose. Because patients with severe renal impairment were excluded from original trials, this study contributes clinical safety outcomes to the limited data for use of apixaban in this patient population.

2.
J Pharm Pract ; : 897190019841738, 2019 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-30966850
3.
Curr Pharm Teach Learn ; 10(5): 571-578, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29986816

RESUMEN

BACKGROUND: Given the significant public health burden of pulmonary diseases and the vital role pharmacists play in management across the continuum of care (and within transitions in care), an elective course for pharmacy students focused on pulmonary diseases was developed. EDUCATIONAL ACTIVITY: A month-long elective course for third-year pharmacy students consisting of 12 class sessions delivered in two-hour periods three times per week, was implemented. The course was delivered using the team-based learning (TBL) format in addition to hands-on skills and simulation sessions. Knowledge and skills assessments were administered before and after completion of the course. Student perceptions of self-confidence and ability regarding management of pulmonary diseases pre- and post-course and their perceptions of the course and TBL as a teaching strategy for this course were evaluated upon course completion. CRITICAL ANALYSIS: Nine students completed the course. Mean scores on knowledge and skills assessment significantly improved after completion of the course (54.5% pre-course vs. 79.3% post-course; p < 0.05% and 60.3% pre-course vs. 93.2% post-course; p < 0.05, respectively). Student perceptions of their ability to care for patients with pulmonary diseases significantly increased, compared to pre-assessments, in all areas taught in the course (p< 0.05). Additionally, students' confidence in managing specific disease states significantly improved in all areas (p < 0.05) except for spirometry (p = 0.06). Students' knowledge, skills, and confidence regarding management of common pulmonary disease states improved following this month-long elective course delivered using a combination of TBL activities and hands-on skills sessions.


Asunto(s)
Curriculum/normas , Enfermedades Pulmonares/tratamiento farmacológico , Percepción , Estudiantes de Farmacia/psicología , Educación en Farmacia/métodos , Educación en Farmacia/normas , Evaluación Educacional/métodos , Humanos , Desarrollo de Programa/métodos , Evaluación de Programas y Proyectos de Salud/métodos , Estudiantes de Farmacia/estadística & datos numéricos
4.
Curr Pharm Teach Learn ; 10(6): 680-686, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-30025766

RESUMEN

INTRODUCTION: The purpose of this study was to assess: (1) student performance on topics taught by first and second year postgraduate pharmacy residents and (2) the quality of learning objectives and multiple choice questions prepared by pharmacy residents. METHODS: Using a retrospective cohort design, residents and students who taught or were enrolled, respectively, in the Medication Therapy Management course in years 2010 to 2012 were participants in this study. Student performance was assessed using scores earned on the individual readiness assurance tests (iRATs), team readiness assurance tests (tRATs), and course examinations. To assess the quality of the learning objectives and multiple choice questions written by pharmacy residents, criteria were established by the authors. Each learning objective and multiple choice question was then evaluated independently by two authors to determine if these criteria were met. RESULTS: Statistical differences were observed in student performance across all content areas among the three years for iRAT, tRAT, and course examination scores, with the exception of the heart failure course examination (p = 0.05; all other p-values < 0.05). A total of 20 (42%) learning objectives met all quality review criteria, while 73 (79%) of the multiple-choice questions met all quality review criteria. DISCUSSION AND CONCLUSIONS: Student performance varied significantly depending on the content, but the overall impact of resident instructors on student course performance was not educationally significant. Teaching and learning curriculum programs should focus on teaching residents to create quality learning objectives that help students focus on learning the most important course content.


Asunto(s)
Educación en Farmacia/normas , Estudiantes de Farmacia/estadística & datos numéricos , Estudios de Cohortes , Curriculum/normas , Educación en Farmacia/métodos , Evaluación Educacional/métodos , Evaluación Educacional/estadística & datos numéricos , Florida , Procesos de Grupo , Humanos , Internado y Residencia/métodos , Estudios Retrospectivos , Tennessee
5.
Pharmacotherapy ; 38(5): 555-568, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29573440

RESUMEN

Tobacco use continues to be a major cause of morbidity and mortality. Even with behavioral and pharmacologic treatment, long-term tobacco cessation rates are low. Electronic nicotine delivery systems, commonly referred to as electronic cigarettes or e-cigarettes, are increasingly used for tobacco cessation. Because e-cigarettes are widely used in this setting, health care professionals need to know if they are safe and effective. The purpose of this article is to review literature regarding use of e-cigarettes as a tool for tobacco cessation in patients who are ready to quit, as well as those who are not ready to quit, along with some selected patient populations. The safety and clinical implications of e-cigarette use are also reviewed. Small, short-term studies assessing smokers' use of e-cigarettes suggest that e-cigarettes may be well tolerated and modestly effective in achieving abstinence. High-quality studies are lacking to support e-cigarettes use for cessation in patients with mental health issues. One small prospective cohort study concluded that patients with mental health issues reduced cigarette use with e-cigarette use. Although one study found that patients with cancer reported using e-cigarettes as a tobacco-cessation strategy, e-cigarettes were not effective in supporting abstinence 6 and 12 months later. Additional research is needed to evaluate the use of e-cigarettes for smoking cessation in patients with pulmonary diseases. No data exist to describe the efficacy of e-cigarettes for smoking cessation in pregnant women. Although study subjects report minimal adverse effects with e-cigarettes and the incidence of adverse effects decreases over time, long-term safety data are lacking. Health care providers should assess e-cigarette use in their patients as part of the tobacco cessation process.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Cese del Hábito de Fumar/métodos , Cese del Uso de Tabaco/métodos , Humanos , Factores de Tiempo , Uso de Tabaco/efectos adversos , Uso de Tabaco/prevención & control
6.
J Psychosoc Nurs Ment Health Serv ; 56(4): 18-22, 2018 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-29328358

RESUMEN

A faculty team developed the 4-week Recovery-Based Interprofessional Distance Education (RIDE) rotation for graduate students in their disciplines. The evaluation team identified the Team Development Measure (TDM) as a potential alternative to reflect team development during the RIDE rotation. The TDM, completed anonymously online, was piloted on the second student cohort (N = 18) to complete the RIDE rotation. The overall pretest mean was 60.73 points (SD = 11.85) of a possible 100 points, indicating that students anticipated their RIDE team would function at a moderately high level during the 4-week rotation. The overall posttest mean, indicating student perceptions of actual team functioning, was 72.71 points (SD = 23.31), an average increase of 11.98 points. Although not statistically significant, Cohen's effect size (d = 0.43) indicates an observed difference of large magnitude. No other published work has used the TDM as a pre-/posttest measure of team development. The authors believe the TDM has several advantages as a measure of student response to interprofessional education offerings, particularly in graduate students with prior experience on health care teams. Further work is needed to validate and extend the findings of this pilot study. [Journal of Psychosocial Nursing and Mental Health Services, 56(4), 18-22.].


Asunto(s)
Relaciones Interprofesionales , Grupo de Atención al Paciente , Aprendizaje Basado en Problemas , Estudiantes del Área de la Salud , Encuestas y Cuestionarios , Conducta Cooperativa , Educación de Postgrado , Femenino , Humanos , Masculino , Proyectos Piloto
7.
Nurs Educ Perspect ; 38(6): 330-332, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29054100

RESUMEN

Graduate student attitudes (n = 28) were assessed before and after participation in interprofessional practitioner education (IPE). Twenty-eight graduate students participated (14 mental health nursing, 6 pharmacy, 4 nutrition, 4 exercise physiology); most had at least some health care experience. Posttest scores indicated gains on a majority of constructs measured. These results suggest that online-blended IPE content yields gains in team skills and attitudes. This study adds to a very small body of literature on IPE in graduate programs. More research is needed in examining online versus face-to-face delivery.


Asunto(s)
Educación a Distancia , Educación de Postgrado en Enfermería , Humanos , Relaciones Interprofesionales , Grupo de Atención al Paciente , Estudiantes
8.
J Manag Care Spec Pharm ; 23(5): 520-524, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28448781

RESUMEN

BACKGROUND: Use of high-risk medications in the elderly (HRME) and drug-disease (Rx-DIS) interactions in the elderly, as defined by the Healthcare Effectiveness Data and Information Set (HEDIS) Measures, are significantly associated with mortality, hospital admission, and need for emergency care. No published studies to date evaluate interventions to reduce the use of HEDIS-defined HRME, although many studies have postulated a beneficial effect of such interventions. OBJECTIVE: To evaluate the effect of pharmacist interventions on use of HRME and Rx-DIS interactions in the outpatient elderly population. METHODS: This retrospective cohort study was conducted in a resident-based family medicine clinic. Patients aged ≥ 65 years were prospectively screened for the use of HRME and Rx-DIS interactions before their visits with their primary care providers. If HRME or Rx-DIS interactions were noted, the clinical pharmacist sent messages to the physicians through the electronic medical record, alerting them of the findings with suggestions of safer alternative agents, if applicable. The recommendation acceptance rate was assessed and then compared with a historical control from a similar time frame. The primary outcome was assessed with a chi square analysis. Secondary outcomes were assessed with descriptive statistics, chi square test, and Fisher's exact test. RESULTS: HRME and/or Rx-DIS interactions were changed 25.9% of the time in the pharmacist intervention group compared with only 2.0% of the time in the historical control group (P = 0.001). The most frequently changed medication classes included skeletal muscle relaxants, benzodiazepines, and nonsteroidal anti-inflammatory drugs. Over 85% of the medication changes were preserved at the end of the study period. There was no difference between groups in the number of patients with HRME or Rx-DIS interactions. CONCLUSIONS: Clinical pharmacy interventions result in significant reductions in use of HRME and Rx-DIS interactions in the outpatient elderly population. Using electronic communication allows pharmacists to provide meaningful interventions for numerous patients receiving care in a high-volume family medicine clinic setting. DISCLOSURES: There was no funding or sponsorship for this study. Rowe reports personal fees from The Medicines Company, outside the submitted work. The other authors have nothing to disclose. Study concept and design were contributed by Jeter, Chamberlin, and Weddle, with assistance from Rowe and Franks. Weddle and Renwick collected the data, and data interpretation was performed by Weddle and Rowe, with assistance from Franks. The manuscript was written by Weddle and Rowe and revised by Weddle and Franks, assisted by Chamberlin. The abstract for the completed study was presented at the American College of Clinical Pharmacy Global Conference, San Francisco, California, October 2015, and the Southeastern Residency Conference, Athens, Georgia, April 2015 (platform presentation). The research-in-progress abstract was presented at the Tennessee Society of Health System Pharmacists, Nashville, Tennessee, February 2015; the American Society of Health System Pharmacists Midyear Clinical Meeting, Anaheim, California, December 2014; and the University HealthSystem Consortium Pharmacy Council, Anaheim, California, December 2014.


Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Administración del Tratamiento Farmacológico , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Pacientes Ambulatorios , Preparaciones Farmacéuticas/administración & dosificación , Estudios Retrospectivos
9.
Am J Pharm Educ ; 80(6): 97, 2016 Aug 25.
Artículo en Inglés | MEDLINE | ID: mdl-27667834

RESUMEN

Objective. To assess student preferences regarding online learning and technology and to evaluate student pharmacists' social media use for educational purposes. Methods. An anonymous 36-question online survey was administered to third-year student pharmacists enrolled in the Drug Information and Clinical Literature Evaluation course. Results. Four hundred thirty-one students completed the survey, yielding a 96% response rate. The majority of students used technology for academic activities, with 90% using smart phones and 91% using laptop computers. Fifty-eight percent of students also used social networking websites to communicate with classmates. Conclusion. Pharmacy students frequently use social media and some online learning methods, which could be a valuable avenue for delivering or supplementing pharmacy curricula. The potential role of social media and online learning in pharmacy education needs to be further explored.


Asunto(s)
Instrucción por Computador/tendencias , Educación en Farmacia/tendencias , Medios de Comunicación Sociales/tendencias , Red Social , Estudiantes de Farmacia , Instrucción por Computador/métodos , Instrucción por Computador/estadística & datos numéricos , Educación en Farmacia/métodos , Humanos , Internet/estadística & datos numéricos , Internet/tendencias , Medios de Comunicación Sociales/estadística & datos numéricos , Encuestas y Cuestionarios
10.
Arch. bronconeumol. (Ed. impr.) ; 52(1): 12-16, ene. 2016. tab, graf
Artículo en Español | IBECS | ID: ibc-147914

RESUMEN

Fundamentos: A pesar de que el reconocimiento de la importancia de la formación de los pacientes con EPOC ha crecido en los últimos años, no se está midiendo el grado de conocimiento de dicha enfermedad por falta de instrumentos específicos. El objetivo de este estudio es validar el cuestionario de conocimiento de la EPOC (EPOC-Q) de 13 ítems. Métodos: Tras la doble traducción del EPOC-Q se llevó a cabo la validación lógica y de contenido por un grupo de neumólogos expertos en EPOC y 8 pacientes con la enfermedad. La fiabilidad se estudió en un grupo independiente de 59 pacientes con EPOC grave vistos en planta o en consultas de neumología de 6 centros de varias regiones de España (Andalucía, Baleares, Castilla-La Mancha, Galicia y Madrid). Esta muestra también se usó para otras validaciones internas y externas. Resultados: El grupo tenía una media de edad de aproximadamente 70 años y una alfabetización en salud media baja. El número de respuestas acertadas fue de 8,3 (DE: 1,9), con una mediana de 8 y un rango entre 3 y 13. Los efectos suelo y techo fueron 0 y 1,5%, respectivamente. La consistencia interna del cuestionario es buena (alfa de Cronbach de 0,85) y la fiabilidad también alta, siendo el coeficiente kappa > 0,6 en todos los ítems y el coeficiente de correlación intraclase de la puntuación total de 0,84. Conclusión: El cuestionario EPOC-Q de 13 ítems es un instrumento válido, aplicable y fiable para evaluar el conocimiento de la EPOC


Rationale: Although recognition of the importance of educating chronic obstructive pulmonary disease (COPD) patients has grown in recent years, their understanding of this disease is not being measured due to a lack of specific instruments. The aim of this study was to validate the COPD-Q questionnaire, a 13-item instrument for determining COPD knowledge. Methods: The COPD-Q was translated and backtranslated, and subsequently submitted to logic and content validation by a group of COPD experts and 8 COPD patients. Reliability was studied in an independent group of 59 patients with severe COPD seen in the pulmonology ward or clinics of 6 hospitals in Spain (Andalusia, Baleares, Castilla-La Mancha, Galicia and Madrid). This sample was also used for other internal and external validations. Results: The mean age of the group was approximately 70 years and their health awareness was low-to-medium. The number of correct answers was 8.3 (standard deviation: 1.9), median 8, range 3-13. Floor and ceiling effects were 0% and 1.5%, respectively. Internal consistency of the questionnaire was good (Cronbach's alpha = 0.85) and reliability was also high, with a kappa coefficient > 0.6 for all items and an intraclass correlation efficient of 0.84 for the total score. Conclusion: The 13-item COPD-Q is a valid, applicable and reliable instrument for determining patients' knowledge of COPD


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/prevención & control , Alfabetización en Salud/métodos , Alfabetización en Salud/organización & administración , Educación del Paciente como Asunto/organización & administración , Educación del Paciente como Asunto/normas , Encuestas y Cuestionarios , Traducción , Reproducibilidad de los Resultados , Consentimiento Informado/normas
11.
Arch Bronconeumol ; 52(1): 12-6, 2016 Jan.
Artículo en Inglés, Español | MEDLINE | ID: mdl-26026685

RESUMEN

RATIONALE: Although recognition of the importance of educating chronic obstructive pulmonary disease (COPD) patients has grown in recent years, their understanding of this disease is not being measured due to a lack of specific instruments. The aim of this study was to validate the COPD-Q questionnaire, a 13-item instrument for determining COPD knowledge. METHODS: The COPD-Q was translated and backtranslated, and subsequently submitted to logic and content validation by a group of COPD experts and 8 COPD patients. Reliability was studied in an independent group of 59 patients with severe COPD seen in the pulmonology ward or clinics of 6 hospitals in Spain (Andalusia, Baleares, Castilla-La Mancha, Galicia and Madrid). This sample was also used for other internal and external validations. RESULTS: The mean age of the group was approximately 70 years and their health awareness was low-to-medium. The number of correct answers was 8.3 (standard deviation: 1.9), median 8, range 3-13. Floor and ceiling effects were 0% and 1.5%, respectively. Internal consistency of the questionnaire was good (Cronbach's alpha=0.85) and reliability was also high, with a kappa coefficient >0.6 for all items and an intraclass correlation efficient of 0.84 for the total score. CONCLUSION: The 13-item COPD-Q is a valid, applicable and reliable instrument for determining patients' knowledge of COPD.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Educación del Paciente como Asunto , Enfermedad Pulmonar Obstructiva Crónica , Encuestas y Cuestionarios , Anciano , Femenino , Humanos , Lenguaje , Masculino
13.
Am J Pharm Educ ; 79(2): 21, 2015 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-25861102

RESUMEN

OBJECTIVE: To assess the impact of awarding partial credit to team assessments on team performance and on quality of team interactions using an answer-until-correct method compared to traditional methods of grading (multiple-choice, full-credit). METHODS: Subjects were students from 3 different offerings of an ambulatory care elective course, taught using team-based learning. The control group (full-credit) consisted of those enrolled in the course when traditional methods of assessment were used (2 course offerings). The intervention group consisted of those enrolled in the course when answer-until-correct method was used for team assessments (1 course offering). Study outcomes included student performance on individual and team readiness assurance tests (iRATs and tRATs), individual and team final examinations, and student assessment of quality of team interactions using the Team Performance Scale. RESULTS: Eighty-four students enrolled in the courses were included in the analysis (full-credit, n=54; answer-until-correct, n=30). Students who used traditional methods of assessment performed better on iRATs (full-credit mean 88.7 (5.9), answer-until-correct mean 82.8 (10.7), p<0.001). Students who used answer-until-correct method of assessment performed better on the team final examination (full-credit mean 45.8 (1.5), answer-until-correct 47.8 (1.4), p<0.001). There was no significant difference in performance on tRATs and the individual final examination. Students who used the answer-until-correct method had higher quality of team interaction ratings (full-credit 97.1 (9.1), answer-until-correct 103.0 (7.8), p=0.004). CONCLUSION: Answer-until-correct assessment method compared to traditional, full-credit methods resulted in significantly lower scores for iRATs, similar scores on tRATs and individual final examinations, improved scores on team final examinations, and improved perceptions of the quality of team interactions.


Asunto(s)
Atención Ambulatoria , Educación en Farmacia/métodos , Procesos de Grupo , Aprendizaje , Estudiantes de Farmacia/psicología , Enseñanza/métodos , Curriculum , Evaluación Educacional , Humanos , Relaciones Interpersonales , Estudios Longitudinales , Estudios Retrospectivos , Encuestas y Cuestionarios
14.
Diabetes Technol Ther ; 16(3): 150-5, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24224752

RESUMEN

BACKGROUND: Patients with uncontrolled diabetes are more likely to be readmitted to the hospital. The study objective was to determine the risk of hospital admission or emergency department (ED) use in patients with severely uncontrolled type 2 diabetes mellitus based on whether their diabetes medication regimen was intensified at discharge. SUBJECTS AND METHODS: A retrospective cohort study of patients admitted to the medicine services at an academic medical center was conducted during a 9-month period. Medical records were reviewed to identify patients with type 2 diabetes mellitus and hemoglobin A1c >10% who were admitted for more than 24 h. Primary exclusion criteria included pregnancy, age >65 or <18 years, life expectancy of <12 months, hypoglycemia at admission, and new diagnosis of type 2 diabetes. Admission medication lists for patients were compared with discharge medications to determine whether the diabetes regimen was intensified. Patients whose regimen was intensified were then compared with patients whose regimen was not intensified for admissions and ED visits within 3 months after discharge. The primary end point was 90-day all-cause hospital and ED visits. RESULTS: Patients who had their regimens intensified had significantly fewer average all-cause hospital and ED visits at 90 days (0.41 vs. 0.85; P=0.044). Statistical differences were also found in 30-day all-cause visits, readmissions within 90 days, and hospital-free time. CONCLUSIONS: Patients whose home diabetes regimen was intensified at discharge were less likely to return to the hospital within 90 days compared with patients whose regimen was not intensified.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hemoglobina A Glucada/metabolismo , Hipoglucemiantes/uso terapéutico , Cooperación del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Ansiedad/etiología , Biomarcadores , Costo de Enfermedad , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/economía , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/economía , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos
15.
Ann Pharmacother ; 48(1): 54-61, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24259645

RESUMEN

BACKGROUND: On June 8, 2011, the United States Food and Drug Administration (FDA) reported safety concerns regarding statin-related myopathies and advised further restrictions on simvastatin dosing. These restrictions reduced the maximum dose for specific patient characteristics, primarily certain concomitant medications. OBJECTIVE: The purpose of this study was to compare the effectiveness of 2 different pharmacist-conducted educational interventions on appropriate simvastatin use in the primary care setting. METHODS: This retrospective cohort analysis was conducted in 2 academic medical center clinics. Patients prescribed simvastatin before June 8, 2011, requiring dosage adjustment based on labeling changes were evaluated for study inclusion. The pharmacists' interventions included: 30-minute didactic session for prescribers or patient-specific recommendation communicated with the physician during the patient's follow-up visit. Primary outcomes were the number of patients prescribed FDA-recommended simvastatin doses after pharmacist intervention and the intervention's impact on low-density lipoprotein (LDL). RESULTS: Medical record review identified 1173 patients prescribed simvastatin prior to June 8, 2011; 126 patients qualified for study inclusion. After controlling for baseline characteristics, the likelihood of patients being prescribed an appropriate dose postintervention increased if they were in the patient-specific recommendation group (odds ratio [OR] = 10.59; 95% CI = 3.43-32.69; P < .0001). LDL change occurred at a similar rate between intervention groups (P = .652). CONCLUSION: Following FDA labeling changes for simvastatin, patient-specific recommendations made by pharmacists correlated with a greater likelihood of appropriate simvastatin dosing compared with a one-time didactic education session. Patient-specific recommendations positively affect prescribing habits and making steps to improve patient safety.


Asunto(s)
Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Hipercolesterolemia/tratamiento farmacológico , Farmacéuticos , Simvastatina/administración & dosificación , Anciano , LDL-Colesterol/sangre , Femenino , Humanos , Hipercolesterolemia/sangre , Hipercolesterolemia/epidemiología , Prescripción Inadecuada/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Retrospectivos
16.
Int J STD AIDS ; 25(5): 378-9, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24104692

RESUMEN

Many patients have a few scattered angiokeratoma and we reassure them that this it is normal; however, if they are numerous, Fabry disease should be considered and the family history should be checked.


Asunto(s)
Angioqueratoma/diagnóstico , Angioqueratoma/etiología , Carcinoma de Células Escamosas/diagnóstico , Enfermedad de Fabry/diagnóstico , Neoplasias Cutáneas/diagnóstico , Adulto , Angioqueratoma/genética , Angioqueratoma/patología , Enfermedad de Fabry/genética , Humanos , Masculino , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/patología , alfa-Galactosidasa/sangre , alfa-Galactosidasa/genética
17.
Am J Pharm Educ ; 77(8): 177, 2013 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-24159218

RESUMEN

Colleges and schools of pharmacy are incorporating more team-based learning (TBL) into their curriculum. Published resources are available to assist instructors with implementing TBL and describing it in the health professions literature. The 7 core elements include: team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the 4 "S" structure for developing team application exercises (significant problem, same problem, specific answer choice, simultaneous reporting), incentive structure, and peer evaluation. This paper summarizes best practices related to implementation of TBL in pharmacy education, including courses taught using teaching teams.


Asunto(s)
Conducta Cooperativa , Educación en Farmacia , Aprendizaje , Humanos , Grupo Paritario , Solución de Problemas
18.
Am J Pharm Educ ; 77(6): 115, 2013 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-23966718

RESUMEN

OBJECTIVE: To characterize the use of team-based learning (TBL) in US colleges and schools of pharmacy, including factors that may affect implementation and perceptions of faculty members regarding the impact of TBL on educational outcomes. METHODS: Respondents identified factors that inhibit or enable TBL use and its impact on student learning. Results were stratified by type of institution (public/private), class size, and TBL experience. RESULTS: Sixty-nine of 100 faculty members (69%) representing 43 (86%) institutions responded. Major factors considered to enable TBL implementation included a single campus and student and administration buy-in. Inhibiting factors included distant campuses, faculty resistance, and lack of training. Compared with traditional lectures, TBL is perceived to enhance student engagement, improve students' preparation for class, and promote achievement of course outcomes. In addition, TBL is perceived to be more effective than lectures at fostering learning in all 6 domains of Bloom's Taxonomy. CONCLUSIONS: Despite potential implementation challenges, faculty members perceive that TBL improves student engagement and learning.


Asunto(s)
Conducta Cooperativa , Educación en Farmacia/métodos , Aprendizaje , Facultades de Farmacia , Evaluación Educacional , Docentes , Femenino , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Estados Unidos
19.
Am J Pharm Educ ; 77(6): 128, 2013 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-23966731

RESUMEN

OBJECTIVES: To enhance tobacco cessation active-learning in an ambulatory care elective course by adding hands-on experience with nicotine replacement therapy to a team-based learning (TBL) session. DESIGN: A hands-on experience that included students chewing a piece of nicotine gum was added to a TBL class session. Student pairs used a skills checklist to evaluate and give peer feedback on appropriate counseling and gum use. ASSESSMENT: Students' scores on a tobacco cessation examination were higher than those of students enrolled in the previous course in which TBL alone had been used. Based on pre- and post-experience survey responses, students' perceptions regarding their abilities to provide tobacco cessation counseling improved. Subjective student comments regarding the experience were positive. CONCLUSION: Participating in a TBL session that incorporated hands-on experience with nicotine gum in an ambulatory care elective course increased students' confidence in their ability to provide tobacco cessation counseling and provided a unique perspective on the product's characteristics.


Asunto(s)
Conducta Cooperativa , Curriculum , Educación en Farmacia/métodos , Aprendizaje Basado en Problemas , Evaluación Educacional , Humanos , Evaluación de Programas y Proyectos de Salud , Estudiantes de Farmacia , Cese del Uso de Tabaco , Dispositivos para Dejar de Fumar Tabaco
20.
Ann Pharmacother ; 47(6): 781-9, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23656751

RESUMEN

BACKGROUND: Multiple complications can arise secondary to poor control of glucose, blood pressure, and cholesterol in a patient with diabetes. OBJECTIVE: To evaluate the effect of a pharmacist-physician collaboration on attainment of diabetes-related measures of control. METHODS: This was a prospective, multicenter, cohort study. Patients were enrolled from 7 practice sites throughout Tennessee if they had been diagnosed with type 2 diabetes, were aged 18 years or older with a life expectancy greater than 1 year, and were English speaking. Pregnant women were excluded. Patients were followed for 12 months following enrollment by informed consent. The pharmacist-physician collaboration method was established prior to study initiation. Primary outcomes included hemoglobin A1c (A1C), number of patients with A1C less than 7%, and percentage of patients with A1C greater than 9%. RESULTS: Of the 206 patients enrolled, the mean age was 59.73 years, and most were male (59.71%) and white (66.02%). The A1C was reduced by an average of 1.16% (p < 0.0001). The proportion of patients with A1C less than 7% increased from 12.75% at baseline to 36.76% at study conclusion (p = 0.0002). The proportion of patients with A1C greater than 9% decreased from 34.15% to 16.50%, (p < 0.0001). CONCLUSIONS: Pharmacist-physician collaborative management at multiple practice locations and types of setting (eg, private, academic, Veterans Affairs medical center) has a positive impact on glycemic control and diabetes-related health maintenance. This was accomplished without increasing the total number of antihyperglycemic agents prescribed and without an increase in patient-reported episodes of hypoglycemia.


Asunto(s)
Conducta Cooperativa , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/terapia , Farmacéuticos , Médicos , Anciano , Estudios de Cohortes , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Estudios de Seguimiento , Hemoglobina A Glucada/normas , Humanos , Hipoglucemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Prospectivos
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