An evaluation of the use of oral bisphosphonates and risk of esophageal cancer.

OBJECTIVE: To evaluate the use of oral bisphosphonates and risk of esophageal cancer. DATA SOURCES: MEDLINE (1948-October 2011) was searched using the terms esophageal cancer, esophageal carcinoma, bisphosphonate, bisphosphonates, etidronate, pamidronate, alendronate, tiludronate, risedronate, zoledronic acid, and ibandronate. Citations from relevant publications were reviewed for additional information. STUDY SELECTION AND DATA EXTRACTION: A comprehensive review of the available literature was performed. DATA SYNTHESIS: Two summaries of case reports and 3 observational studies were retrieved and reviewed. Oral bisphosphonates can cause esophageal irritation; therefore, it is biologically plausible that they may increase the risk of esophageal cancer. Although many cases were reported, causality was difficult to determine due to their weak methodology, and subsequent evaluations from national registers did not support an increased risk. Of the 3 observational studies (1 in patients with Barrett's esophagus and 2 using the same patient database), only 1 found an increased risk with use of daily or weekly regimens, and significant limitations were noted in each. CONCLUSIONS: Evidence on the use of bisphosphonates and risk of esophageal cancer is weak and conflicting. Additional studies are needed to further evaluate this issue and formulate stronger conclusions. In the meantime, health care professionals should ensure that patients take oral bisphosphonates properly to minimize esophageal irritation, are prescribed regimens that minimize exposure if adherence is difficult, and are evaluated for discontinuation of the drugs if appropriate. For patients at increased risk of esophageal cancer for other health reasons, nonoral bisphosphonates may be considered.

Preparing pharmacy graduates for traditional and emerging career opportunities.

Educational programs in pharmacy must focus on educating pharmacists of the future who are prepared to serve as competent and confident health care "providers" whose "practice" can occur in any number of current and future settings; and whose expertise is essential to an interprofessional health care team. Graduates must be able to incorporate a scholarly approach to their practice in identifying patient care problems; practicing in an evidence-based manner; and ensuring safe, effective, and appropriate use of medications. It is time for colleges and schools of pharmacy to implement contemporary teaching and assessment strategies that facilitate effective and efficient student learning that is focused at the graduate professional level, to evolve the content around which the curriculum is organized, and clearly articulate the abilities graduates must have to function effectively in the myriad professional roles in which they may find themselves.

Assessment of teaching experiences completed during accredited pharmacy residency programs.

OBJECTIVES: To examine teaching experiences in residency programs accredited by the American Society of Health-System Pharmacists (ASHP) and how they relate to career choices of residents. METHODS: An online survey instrument was developed that asked former residents about the type of teaching experiences they completed during their residency and the effect of these experiences on the decision to pursue an academic career. Our target population was pharmacists completing accredited residencies from 2003-2006. RESULTS: Four hundred fifty-five (11% of the target population) pharmacists who had completed a residency responded. Former residents who completed 2 years of postgraduate training were significantly more likely to participate in all teaching experiences identified by this survey (p < 0.008). Former residents in college- or school-affiliated programs were significantly more likely to participate in all of the teaching experiences identified (p < 0.003). Former residents who went on to take a faculty position were more likely to have given lectures, participated in problem-based learning (PBL) or small group seminars (SGS), and served as a primary preceptor (p < 0.008) during their residency. CONCLUSIONS: Residents who eventually became faculty members were more likely to have acquired training and experience in teaching during their residency programs.

Management of age-related osteoporosis and prevention of associated fractures.

Osteoporosis and related fractures are a significant concern for the global community. As the population continues to age, morbidity and mortality from fractures due to low bone mineral density (BMD) will likely continue to increase. Efforts should be made to screen those at risk for osteoporosis, identify and address various risk factors for falls and associated fractures, ensure adequate calcium and vitamin D intake, and institute pharmacological therapy to increase BMD when indicated. Agents which increase BMD and have been shown to decrease fractures, particularly at the hip, should be considered preferentially over those for which only BMD data are available. Drugs which have been shown to decrease the risk of age-related osteoporotic fractures include oral bisphosphonates (alendronate, ibandronate, and risedronate), intranasal calcitonin, estrogen receptor stimulators (eg, estrogen, selective estrogen receptor modulators [raloxifene]), parathyroid hormone (teriparatide), sodium fluoride, and strontium ranelate. Data are beginning to emerge supporting various combination therapies (eg, bisphosphonate plus an estrogen receptor stimulator), though more data are needed to identify combinations which are most effective and confer added fracture protection. In addition, further research is needed to identify ideal regimens in special populations such as nursing home patients and men.