Oral micronized progesterone for perimenopausal night sweats and hot flushes a Phase III Canada-wide randomized placebo-controlled 4 month trial.

This study tested progesterone for perimenopausal hot flush ± night sweat (vasomotor symptom, VMS) treatment. It was a double-blind, randomized trial of 300 mg oral micronized progesterone@bedtime versus placebo for 3-months (m) after a 1-m untreated baseline during 2012/1-2017/4. We randomized untreated, non-depressed, screen- and baseline-eligible by VMS, perimenopausal women (with flow within 1-year), ages 35-58 (n = 189). Participants aged 50 (± SD = 4.6) were mostly White, educated, minimally overweight with 63% in late perimenopause; 93% participated remotely. The 1° outcome was 3rd-m VMS Score difference. Participants recorded VMS number and intensity (0-4 scale)/24 h on a VMS Calendar. Randomization required VMS (intensity 2-4/4) of sufficient frequency and/or ≥ 2/week night sweat awakenings. Baseline total VMS Score (SD) was 12.2 (11.3) without assignment difference. Third-m VMS Score did not differ by therapy (Rate Difference - 1.51). However, the 95% CI [- 3.97, 0.95] P = 0.222, did not exclude 3, a minimal clinically important difference. Women perceived progesterone caused decreased night sweats (P = 0.023) and improved sleep quality (P = 0.005); it decreased perimenopause-related life interference (P = 0.017) without increased depression. No serious adverse events occurred. Perimenopausal night sweats ± hot flushes are variable; this RCT was underpowered but could not exclude a minimal clinically important VMS benefit. Perceived night sweats and sleep quality significantly improved.

Multiple mini-interview predictive validity for performance on a pharmacy licensing examination.

CONTEXT: Predictive validity studies on the use of the multiple mini-interview (MMI) have been primarily in medicine. OBJECTIVES: This study sought to determine the predictive validity of the MMI for performance within a pharmacy programme and on the Pharmacy Examining Board of Canada (PEBC) Qualifying Examination for licensure, and to compare the predictive validity of the MMI with that of pre-pharmacy grade point average (GPA) and Pharmacy College Admission Test (PCAT) score. METHODS: Admissions data for 223 graduates of the pharmacy programme at the University of Toronto were matched to programme and licensure outcome measures. Multiple linear regression assessed the predictive ability of the MMI, pre-pharmacy GPA, PCAT and covariates for performance in final-year experiential rotations, cumulative GPA (cGPA) and PEBC-MCQ (multiple-choice question examination) and PEBC-OSCE (objective structured clinical examination) overall and subcomponent scores. RESULTS: The PCAT, pre-pharmacy GPA and age significantly predicted the PEBC-MCQ overall score. The MMI was the only significant predictor of overall score on the PEBC-OSCE (ß = 0.17, p = 0.02); it also predicted communication and performance subscores. Scores on the PCAT and female gender predicted the communication subscore. Pre-pharmacy GPA, age and female gender significantly predicted cGPA. The MMI was the only significant predictor of institutional/ambulatory rotation score (ß = 0.26, p = 0.00). CONCLUSIONS: The MMI, designed to measure non-academic attributes including communication, motivation and problem-solving skills, was the only admissions tool with significant predictive validity for performance on the PEBC-OSCE national pharmacy certification examination and in an institutional/ambulatory rotation. These findings, from a single cohort of undergraduates, provide the first report of the predictive validity of the MMI for performance on pharmacy licensure examinations and thereby strengthen the evidence for its use in health professions selection. Prior university academic performance significantly predicted cGPA and performance on the PEBC-MCQ. Performance on the PCAT also predicted PEBC-MCQ results.

A study of caloric restriction versus standard diet in overweight men with newly diagnosed prostate cancer: a randomized controlled trial.

INTRODUCTION: Obese men have an increased risk of prostate cancer (PCa)-specific mortality. Potential mechanisms include insulin and related proteins. We investigate whether a short-term caloric restriction diet in overweight/obese men with newly diagnosed PCa can lead to measurable changes in patient anthropometrics and insulin-related proteins. METHODS: Overweight and obese PCa patients choosing active surveillance or radical prostatectomy were randomized to a 6-week, caloric-restricted diet or to continue their current diet. Changes from baseline to end of study in anthropometrics, dietary constituents and serum proteins (insulin, c-peptide, IGF-1, adiponectin, IGF-BP3) were compared between the intervention and control groups using a Generalized Estimating Equation model. RESULTS: Nineteen patients were randomized to the intervention (N = 10) or control (N = 9) group. Men in the intervention group had a 1.7% (3.7 lbs) mean decline in weight versus 1.0% (2.0 lbs) in controls (P < 0.05), and a reduced intake of calories, total and saturated fat, protein and starch (all P < 0.1 compared to controls). There was a significant difference (P = 0.002) in mean serum IGFBP-3 between the intervention (+2.8%) and control group (-6.9%). Other biomarkers changed with the diet intervention to a degree similar to previous weight loss studies but were not statistically significant compared with controls. CONCLUSION: In this small pilot study, a 6-week caloric restricted diet in men with newly diagnosed PCa produced changes in weight, diet and serum proteins possibly related to prognosis. These results support larger-scale trials testing longer-term weight loss effects on potential PCa progression biomarkers.

Development and pilot testing of a multiple mini-interview for admission to a pharmacy degree program.

OBJECTIVES: To develop and pilot test a multiple mini-interview (MMI) to select students for admission to a pharmacy degree program. METHODS: A nominal group process was used to identify 8 important nonacademic attributes of pharmacists, with relative importance determined by means of a paired-comparison survey of pharmacy stakeholders (ie, university-affiliated individuals with a vested interest in the quality of student admitted to the pharmacy program, such as faculty members, students, admissions staff members, and practitioners). A 10-station MMI based on the weighted-attribute blueprint was pilot tested with 30 incoming pharmacy students. MMI score reliability (intraclass correlation coefficient [ICC]) and correlation with other admissions tool scores were determined. RESULTS: Station scores provided by student interviewers were slightly higher than those of faculty member or practitioner interviewers. While most interviewers judged a 6-minute interview as "just right" and an 8-minute interview "a bit long," candidates had the opposite opinion. Station scenarios had face validity for candidates and interviewers. The ICC for the MMI was 0.77 and correlations with prepharmacy average (PPA) and Pharmacy College Admission Test (PCAT) composite were negligible. CONCLUSIONS: MMI feasibility was confirmed, based on the finding that interview scores were reliable and that this admissions tool measures different attributes than do the PCAT and PPA.

An introduction to teamwork: findings from an evaluation of an interprofessional education experience for 1000 first-year health science students.

Effective interprofessional collaboration is an important factor in addressing health care needs and priorities. Educators and health care practitioners have argued that interprofessional education (IPE) is necessary to equip students with the knowledge, skills, attitudes, and behaviors to work collaboratively and ultimately deliver enhanced patient/client care. The University of Toronto has implemented an introductory IPE session for approximately 1000 health science students that focuses on teamwork. This session provides students with an opportunity to be sensitized to the client's perspective and become familiar with roles and perspectives of different professions. A mixed method pre/post research design was developed to examine changes in students' perceptions and attitudes regarding IPE following their participation in this session. This study also endeavored to explore the pedagogic effectiveness of this large-scale IPE session. Students completed pre and post surveys based on the Interprofessional Attitudes Questionnaire and the Interdisciplinary Education Perception Scale. A total of 399 surveys were matched for pre/post analysis, and 25 students participated in follow-up focus group interviews. Findings from this study reveal that a significant shift in many indicators occurred after this single intervention. Despite the large numbers of students, which meant a complex range of logistical factors to negotiate, our findings indicated that it is feasible to deliver a successful IPE session to a large cohort of first-year students. We suggest that the findings presented in this report can be of value to other interprofessional groups of course developers.

An interprofessional education session for first-year health science students.

OBJECTIVE: To implement and evaluate the effectiveness and short-term impact of an interprofessional education (IPE) session in the first year for health sciences students representing 9 health professions. DESIGN: An interprofessional faculty committee created a 2(1/2) hour introductory interprofessional education session focusing on a single patient case and 2 possible discharge scenarios. A mixed method pretest/posttest research design was used to examine changes in students' perceptions of and attitudes toward IPE. Six follow-up focus groups also were held with students from the participating professions. ASSESSMENT: Of 1197 health professions students enrolled, 914 students (76%) attended the IPE session. Two hundred thirty-two of 240 pharmacy students (97%) attended. Forty-three (18.5%) pharmacy students responded to the open-ended questions on the survey instrument. The most frequently reported gains from attending the session were recognition of teamwork importance to benefit the patient (30%) and understanding of other professionals' roles (29%). Shortfalls reported by students related to the content/style of presentation (26%) and technical/organizational (23%) aspects of the session. Pharmacy students who participated in one of the focus groups stated the session demonstrated the benefits as well as facilitators and barriers to collaborative care. CONCLUSION: The session served as an effective introduction to IPE; debriefing and integration with uniprofessional curricula should occur. Students need additional small group interaction with other health professional students, and can contribute as members of the planning committee.

An interfaculty pain curriculum: lessons learned from six years experience.

Minimal pain content has been documented in pre-licensure curricula and students lack important pain knowledge at graduation. To address this problem, we have implemented and evaluated a mandatory Interfaculty Pain Curriculum (IPC) yearly since 2002 for students (N=817 in 2007) from six Health Science Faculties/Departments. The 20-h pain curriculum continues to involve students from Dentistry, Medicine, Nursing, Pharmacy, Physical Therapy, and Occupational Therapy as part of their 2nd or 3rd year program. Evaluation methods based on Kirkpatrick's model now include evaluation of a Comprehensive Pain Management Plan along with the previously used Pain Knowledge and Beliefs Questionnaire (PKPQ) and Daily Content and Process Questionnaires (DCPQ). Important lessons have been learned and subsequent changes made in this iterative curriculum design based on extensive evaluation over the 6-year period. Modifications have included case development more relevant to the diverse student groups, learning contexts that are uni-, inter-, and multi-professional, and facilitator development in working with interprofessional student groups. PKBQ scores have improved in all years with a statistically significant average change on correct responses from 14% to 17%. The DCPQ responses have also indicated consistently that most students (85-95%) rated highly the patient panel, expert-lead clinically focused sessions, and small interprofessional groups. Relevancy and organization of the information presented have been generally rated highly from 80.3% to 91.2%. This curriculum continues to be a unique and valuable learning opportunity as we utilize lessons learned from extensive evaluation to move the pain agenda forward with pre-licensure health science students.