Comparison of on-campus and hybrid student outcomes in occupational therapy doctoral education.

We compared the graduate outcomes of doctoral students in a traditional on-campus occupational therapy program with those in a hybrid program. Participants were 81 students from an on-campus program and 13 students from a hybrid program. Graduate outcomes were measured with student grade-point average (GPA) at the end of each academic year, cumulative GPA, Fieldwork Performance Exam, National Board for Certification in Occupational Therapy (NBCOT) practice exam scores, and final NBCOT pass rate. Consistent with previous research, our results revealed no significant differences on most outcome variables, suggesting that hybrid programs are an effective delivery model for postsecondary higher education. These findings may provide guidance to occupational therapy programs in curriculum design, content delivery, and program refinement and development. Replication of this study is needed with a larger sample and inclusion of qualitative data. Future studies should compare the affective domain of graduate outcomes in on-campus and online or hybrid programs.

Overview of omega-3 Fatty Acid therapies.

The triglyceride (TG)-lowering benefits of the very-long-chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are well documented. Available as prescription formulations and dietary supplements, EPA and DHA are recommended by the American Heart Association for patients with coronary heart disease and hypertriglyceridemia. Dietary supplements are not subject to the same government regulatory standards for safety, efficacy, and purity as prescription drugs are; moreover, supplements may contain variable concentrations of EPA and DHA and possibly other contaminants. Reducing low-density lipoprotein-cholesterol (LDL-C) levels remains the primary treatment goal in the management of dyslipidemia. Dietary supplements and prescription formulations that contain both EPA and DHA may lower TG levels, but they may also increase LDL-C levels. Two prescription formulations of long-chain omega-3 fatty acids are available in the U.S. Although prescription omega-3 acid ethyl esters (OM-3-A EEs, Lovaza) contain high-purity EPA and DHA, prescription icosapent ethyl (IPE, Vascepa) is a high-purity EPA agent. In clinical trials of statin-treated and non-statin-treated patients with hypertriglyceridemia, both OM-3-A EE and IPE lowered TG levels and other atherogenic markers; however, IPE did not increase LDL-C levels. Results of recent outcomes trials of long-chain omega-3 fatty acids, fibrates, and niacin have been disappointing, failing to show additional reductions in adverse cardiovascular events when combined with statins. Therefore, the REDUCE-IT study is being conducted to evaluate the effect of the combination of IPE and statins on cardiovascular outcomes in high-risk patients. The results of this trial are eagerly anticipated.

Academic pharmacy administrators' perceptions of core requirements for entry into professional pharmacy programs.

OBJECTIVES: To determine which basic and social science courses academic pharmacy administrators believe should be required for entry into the professional pharmacy program and what they believe should be the required length of preprofessional study. METHODS: An online survey was sent to deans of all colleges and schools of pharmacy in the United States. Survey respondents were asked to indicate their level of agreement as to whether the basic and social science courses listed in the survey instrument should be required for admission to the professional program. The survey instrument also included queries regarding the optimal length of preprofessional study, whether professional assessment testing should be part of admission requirements, and the respondents' demographic information. RESULTS: The majority of respondents strongly agreed that the fundamental coursework in the basic sciences (general biology, general chemistry, organic chemistry) and English composition should be required for entrance into the professional program. Most respondents also agreed that public speaking, ethics, and advanced basic science and math courses (physiology, biochemistry, calculus, statistics) should be completed prior to entering the professional program. The preprofessional requirements that respondents suggested were not necessary included many of the social science courses. Respondents were evenly divided over the ideal length for preprofessional pharmacy education programs. CONCLUSIONS: Although requirements for preprofessional admission have been changing, there is no consistent agreement on the content or length of the preprofessional program.

National survey of pharmacists about coronary heart disease, hypercholesterolemia, nonprescription statintherapy, and pharmacists' services.

OBJECTIVE: To determine the beliefs and attitudes of pharmacists about the significance of high blood cholesterol, coronary heart disease (CHD), nonprescription statin therapy for patients at moderate risk for CHD, and their role in support of cholesterol-lowering treatments in patients. DESIGN: Cross-sectional survey. SETTING: Nationwide sample of licensed pharmacists in ambulatory practice in the United States drawn randomly from databases of the American Pharmacists Association. PARTICIPANTS: 104 independent pharmacists and 169 chain pharmacists. INTERVENTION: Web-based survey. MAIN OUTCOME MEASURE: Respondents' indication of strong agreement with questionnaire statements (selecting 8, 9, or 10 on a 10-point scale). RESULTS: The survey found that 75% and 61% of pharmacists believed strongly that CHD and high blood cholesterol levels, respectively, are significant health problems facing Americans, and 60% believed that not enough is currently being done to reduce this risk. Pharmacists indicated that they very regularly advised patients about prescription and nonprescription treatments (75%) and encouraged adherence to them (78%); a smaller but substantial proportion regularly monitored patient response to prescription (33%) and nonprescription therapies (15%) and provided point-of-care cholesterol testing (7%). The survey also revealed that the majority of pharmacists (68%) would support consumers interested in purchasing a nonprescription statin product and 82% believed such a product would be more effective than currently available cholesterol-lowering dietary supplements. Pharmacists were concerned that patients pursuing nonprescription statins might discontinue their prescription cholesterol-lowering medications (79%), experience adverse effects (79%), and not be able to self-manage their use of a nonprescription statin product (78%). CONCLUSION: Community pharmacist members of APhA believe that CHD and cholesterol are important problems facing many people, routinely provide services that support patients who wish to self-administer nonprescription therapies, and would be interested in supporting consumers who wish to carry out therapy with a nonprescription statin.

Peripheral arterial disease: pathophysiology, risk factors, and role of antithrombotic therapy.

OBJECTIVE: To provide an overview of the impact of peripheral arterial disease (PAD) and the steps that can be taken to reduce its burden through greater awareness of the disease, improved diagnosis, and better treatment, with emphasis on the use of antiplatelet agents. DATA SOURCES: Recent (1990-2003) published scientific literature, as identified by the author through Medline searches, using the terms peripheral arterial disease, atherothrombosis, pathophysiology, risk factors, treatment, clinical trials, and reviews on treatment. STUDY SELECTION: Recent systematic English-language review articles and reports of controlled randomized clinical trials were screened for inclusion. DATA SYNTHESIS: PAD is a distinct atherothrombotic syndrome marked by stenosis and occlusion of peripheral arterial beds, typically those in the lower extremities. Symptoms range from intermittent claudication (IC) during exercise to peripheral limb ischemia requiring limb amputation. IC, the most common symptom, is experienced by 2% to 3% of men and 1% to 2% of women aged 60 years and older. Despite its recognition as a major atherothrombotic risk factor, PAD is not widely appreciated by clinicians, and most cases remain undiagnosed. Asymptomatic PAD, as indicated by a reduced ankle brachial systolic pressure index, should alert the health care provider to the presence of diffuse atherothrombotic disease and need for treatment. Risk factors for development and progression of PAD include smoking, hypertension, diabetes, hyperlipidemia, and physical inactivity. The aim of pharmacotherapy is to improve the symptoms of PAD (especially IC), defer onset of limb-threatening ischemia, and improve long-term survival. Successful treatment strategies include risk factor modification, particularly smoking cessation; initiation of regular exercise; control of hypertension, diabetes, and hyperlipidemia; and use of antiplatelet agents to reduce the risk of atherothrombotic events. Available data suggest that aspirin reduces morbidity and mortality in PAD, while clopidogrel reduces the risk of atherothrombotic events such as myocardial infarction and stroke in these patients. CONCLUSION: Increased awareness among members of the health care community about the prevalence of PAD and benefits associated with risk-factor reduction and antiplatelet therapy could produce substantial decreases in the burden of this disease.

New perspectives on the pharmacotherapy of ischemic stroke.

OBJECTIVE: To provide an overview of the impact of ischemic stroke and the steps that can be taken to reduce its burden through greater awareness of the disease, improved diagnosis and better treatment, with emphasis on the use of antiplatelet agents. DATA SOURCES: Recent (1995-2003) published scientific literature, as identified by the authors through Medline searches, using the terms stroke, transient ischemic attack, cerebrovascular disease, atherothrombosis, risk factors, pharmacotherapy, prevention, and reviews on treatment. STUDY SELECTION: Recent systematic English-language review articles and reports of controlled randomized clinical trials were screened for inclusion. DATA SYNTHESIS: Ischemic stroke is generally the result of an atherothrombotic process leading to vessel obstruction or narrowing. Of the two types of ischemic stroke, thrombotic stroke is caused by a thrombus that develops within the cerebral vasculature, while embolic stroke arises from a distant embolus that lodges in a cerebral artery. The neurologic manifestations of stroke depend on the location of injury in the brain and the degree of ischemia or infarction. Symptoms may be reversible or irreversible and range from sensory deficits to hemiplegia. Risk factors for development of ischemic stroke include hypertension, diabetes, dyslipidemia, smoking, atrial fibrillation, prior stroke, and transient ischemic attack. Tissue plasminogen activator is currently the only available drug treatment for acute ischemic stroke. Stroke recurrence rates are high (about 40% over 5 years), and all ischemic stroke patients should receive antithrombotic therapy (unless contraindicated) for secondary prevention. Of the oral antiplatelet therapies, aspirin, clopidogrel (Plavix--Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership), and the extended-release dipyridamole plus aspirin combination are acceptable first-line agents, while anticoagulants (warfarin) are preferred in patients with atrial fibrillation. CONCLUSION: Lifestyle changes and drug therapy are important components of primary and secondary prevention strategies in ischemic stroke. Risk factors such as elevated blood pressure and high cholesterol should be aggressively treated. Antiplatelet agents, antihypertensive agents, and cholesterol-lowering agents are therapeutic cornerstones for secondary prevention.

Pharmacist compensation for cognitive services: focus on the physician office and community pharmacy.

We provide a stepwise approach for the clinical pharmacy practitioner in the physician clinic or community pharmacy setting to secure compensation for cognitive services. How to establish compensation for pharmacist services is explored, including evaluating the payer mix, developing a relationship with the first- or third-party payer, becoming credentialed with a third-party payer, and creating a fee structure. We detail the physical process of billing, which involves completing appropriate billing forms, appropriately using billing codes, documenting cognitive services in the patient record, and obtaining the proper waivers and/or approvals to provide specific services such as laboratory services and immunizations. This comprehensive review of compensation for cognitive services available in the community pharmacy and physician office environment is designed to be a template for pharmacists to further develop specific strategies, implement fee structures, and obtain compensation in their pharmacy environment and payer mix. Exploration into these innovative markets will enable pharmacists to increase revenue as they enhance and expand their cognitive services for patients.