Use of a CPD Plan Template with SMART Goals as Part of a Diabetes Pharmacotherapy Module.

OBJECTIVE: To evaluate the effectiveness of a Continuing Professional Development (CPD) plan template used in Fall of 2017 on quality of SMART goal development and student quiz scores. INNOVATION: The gap in time from when pharmacology is taught and when it is applied has contributed to poor student retention and performance in the diabetes pharmacotherapy course. To address this gap, the diabetes pharmacotherapy learning sequence was redesigned and included a self-assessment (pre-test), and the completion of a "CPD plan template", which involved writing 1-3 SMART goals for each question missed on the pre-test. Following sequence completion, students took an identical post-quiz. Pre- and post-quiz scores were compared. Quality of CPD plan SMART goals was evaluated. KEY FINDINGS: The CPD plan template was completed by 98% of students. The majority, 62.5% of students, wrote SMART goals at the intermediate or good level, while 37.5% were evaluated as needs improvement. The average pre-quiz score was 7.4 points and average post-quiz score was 17.1 points with an average improvement of 9.8 points (p<0.0001). There was a statistically significant improvement for top 25% post-quiz scoring students who wrote "good" SMART goals compared to those who wrote goals needing improvement (p= 0.002). For students scoring in the lowest 25%, students with goals needing improvement scored higher than those with intermediate quality goals (p< 0.04). NEXT STEPS: It may be beneficial to introduce CPD to students sooner, as well as teach students more intentionally how to create and use SMART goals to improve learning. Finally, instructor follow up with students regarding use of their plan during a learning sequence may have additional benefit.

The pharmacist role in the development and implementation of a naloxone prescription program in Alabama.

OBJECTIVE: The purpose of this report is to describe the development and implementation of a pharmacist-led naloxone-training and prescription service at a county health department. SETTING: Jefferson County Department of Health, Birmingham, Alabama. PRACTICE DESCRIPTION: This service was developed in response to the overwhelming heroin and opioid epidemic that is currently affecting the entire nation and which is highly prevalent in the state of Alabama. Because of this epidemic, new state laws have been established regarding prescriptive authority, liability, and possession of naloxone. PRACTICE INNOVATION: Through a collaborative protocol, pharmacists at the Jefferson County Department of Health were responsible for prescribing and educating the public about naloxone. EVALUATION: Between 2014 and 2015 the Jefferson County Coroner reported a 131% increase in opioid prescription-related deaths indicating the continued need for the naloxone prescription program. RESULTS: In total, 83 clients were trained and 150 naloxone kits were distributed among heroin and opioid users, concerned family members or friends, and those who work closely with users. CONCLUSION: This service and its extending arms were developed in response to the need for naloxone education among heroin and opioid users, their family members, civil servants who work with users, and family practice physicians who prescribe opioids.

Red muscle proportions and enzyme activities in deep-sea demersal fishes.

Owing to the paucity of data on the red muscle of deep-sea fishes, the goal of this study was to determine the proportions of red muscle in demersal fishes and its enzymatic activities to characterize how routine swimming abilities change with depths of occurrence. Cross sectional analysis of the trunk musculature was used to evaluate the proportion of red muscle in 38 species of Californian demersal fishes living at depths between 100 and 3000 m. The activity of metabolic enzymes was also assayed in a sub-set of 18 species. Benthic fishes had lower proportions of red muscle and lower metabolic enzyme activities than benthopelagic species. Mean proportion of red muscle declined significantly with depth with the greatest range of values in shallow waters and species with low proportions found at all depths. This suggested that while sedentary species occur at all depths, the most active species occur in shallow waters. Citrate synthase activity declined significantly with depth across all species, indicating that the mass-specific metabolic capacity of red muscle is lower in deep-sea species. These patterns may be explained by coupling of red and white muscle physiologies, a decrease in physical energy of the environment with depth or by the prevalence of anguilliform body forms and swimming modes in deep-living species.

Milnacipran for treatment of fibromyalgia.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of milnacipran and evaluate relevant clinical trial data. DATA SOURCES: MEDLINE, International Pharmaceutical Abstracts, and Google Scholar searches (1966-June 2010) were conducted using the key words fibromyalgia, milnacipran, and serotonin-norepinephrine reuptake inhibitor. Searches were limited to articles published in English. STUDY SELECTION AND DATA EXTRACTION: All available English-language articles of human studies were evaluated. One pharmacokinetic study reviewed included animal data. References cited in identified articles were used for additional evaluation. DATA SYNTHESIS: Milnacipran is a serotonin-norepinephrine reuptake inhibitor with a 3-fold increased selectivity for norepinephrine compared to serotonin. It is well absorbed with 85-90% bioavailability. Maximum concentrations are achieved 2-4 hours after administration. Milnacipran does not undergo cytochrome P450 metabolism and has a half-life of 6-8 hours. Fifty-five percent of each dose is excreted unchanged in the urine. Dose adjustment is needed in patients with an estimated creatinine clearance of <30 mL/min. Clinical trials indicated that twice-daily dosing at 100 mg/day or 200 mg/day was superior to single-daily dosing. Studies further established the effectiveness of both doses in the treatment of fibromyalgia pain utilizing patient self-reported pain scores, as well as on a visual analog scale, Patient Global Impression of Change scale, and the Short-Form 36 Physical Component Summary. A 6-month extension trial, which evaluated patients continued on milnacipran for up to 1 year, demonstrated continued pain relief. The most common adverse drug reaction associated with milnacipran was nausea, which was reduced with slow-dose titration and administration with food. CONCLUSIONS: Milnacipran is an effective treatment option for patients with fibromyalgia. More head-to-head clinical trials are necessary to assess its ultimate place in therapy.

Enhancing community pharmacy through advanced pharmacy practice experiences.

The pressures driving the need for an expanded practice scope in community pharmacy have been building for the past 2 decades. Many pharmacists have chosen to embrace the pharmaceutical care model in their practice sites to meet patient and healthcare system needs. The potential for medication therapy management (MTM) services provide an additional career opportunity for pharmacy graduates. Colleges of pharmacy offer advanced pharmacy practice experiences (APPEs) in the community setting that are designed to prepare students for these opportunities. These sites provide students with the opportunity to observe the integration of pharmaceutical care activities into community practice. Although developing an APPE site is challenging, serving as a preceptor benefits the students, the site, and the patients served. Therefore, colleges of pharmacy and community pharmacists are collaborating to increase the number of APPE sites to prepare pharmacy students for practice today and tomorrow.

Load carriage energy expenditure with and without hiking poles during inclined walking.

The purpose of this study was to compare load carriage energy expenditure with and without using hiking poles. Twenty male volunteers aged 20-48yr (Mean=29.8yr) completed two randomly ordered submaximal treadmill trials with poles (E) and without poles (C). Poles and load (15 kg backpack) were fitted for each subject according to the manufacturers' suggestions. Heart rates (HR), minute ventilation (V(E)), oxygen consumption (O2), caloric expenditure (Kcal), and rating of perceived exertion (RPE) were recorded at the end of each minute. Two trials separated by one week consisted of a constant treadmill speed of 1.5 mph and 1 min at 10% grade, 2 min at 15% grade, 2 min at 20% grade, and 10 min. at 25% grade. Mean HR (E = 144.8 +/- 24.4 b x min(-1); C = 144.0 +/- 25.7 b x min(-1)) and mean V(E) (E=51.4 +/- 15.8L x min(-1); C=50.8 +/- 17.0L x min(-1)), VO2 (E = 26.9 +/- 6.1 ml x kg(-1) x min(-1); C = 27.4 +/- 6.6 ml x kg(-1) x min(-1)), and Kcal (E = 10.6 +/- 2.9 Kcal x min(-1); C = 10.8 +/- 3.1 Kcal x min(-1)) were not significantly different between the two conditions. RPE (E = 13.28 +/- 1.2; C = 14.56 +/- 1.2) was significantly lower (P < 0.05) with hiking poles. Analysis of paired time points yielded no significant differences in HR, VO2, V(E), and Kcal, however, RPE means were significantly lower for 5 of the last 7 trial minutes with the use of poles. These results suggest that during load carriage on moderate grade, the weight and use of hiking poles does not increase energy expenditure but may provide reduced perceptions of physical exertion.

Overpressure and fluid flow in the new jersey continental slope: implications for slope failure and cold seeps

Miocene through Pleistocene sediments on the New Jersey continental slope (Ocean Drilling Program Site 1073) are undercompacted (porosity between 40 and 65%) to 640 meters below the sea floor, and this is interpreted to record fluid pressures that reach 95% of the lithostatic stress. A two-dimensional model, where rapid Pleistocene sedimentation loads permeable sandy silt of Miocene age, successfully predicts the observed pressures. The model describes how lateral pressure equilibration in permeable beds produces fluid pressures that approach the lithostatic stress where overburden is thin. This transfer of pressure may cause slope failure and drive cold seeps on passive margins around the world.

Outcomes of universal antenatal screening for haemoglobinopathies.

OBJECTIVE: To evaluate universal antenatal screening for haemoglobinopathies. SETTING: District general hospital serving a London borough with 45% ethnic minorities. METHODS: Retrospective cohort study of 1444 women referred in 1688 pregnancies and 95 tertiary referrals during 101 pregnancies. RESULTS: Unselected women at risk for sickle cell disease booked 2.7 weeks (95% confidence interval (CI) 0.14 to 5.1) later in gestation than those at risk for beta thalassaemia were less likely to attend counselling (83% v 93%, relative risk (RR) 0.89; 95% CI 0.85 to 0.94), their partners were less likely to be tested (77% v 95%, RR 0.81; 0.77 to 0.83), and they were less likely to accept prenatal diagnosis (22% v 90%, RR 0.37; 0.24 to 0.57). Over 99% of tertiary referrals attended counselling and had their partners tested. There were no significant differences in acceptance of prenatal diagnosis between those at risk of sickle cell disease and beta thalassaemia (55% v 67%). Unselected women at risk of sickle cell disease were significantly less likely to have their partner tested or to accept prenatal diagnosis than tertiary referrals, but not those at risk of beta thalassaemia. 80% of beta thalassaemia and 16% of SS births were prevented. CONCLUSIONS: Uptake of prenatal diagnosis among unselected women at risk of beta thalassaemia is similar to that reported by tertiary centres. It is considerably lower for sickle cell disease but could increase considerably if screening occurred earlier in gestation. Acceptance of counselling is universally high, suggesting that informed choices are made, and indicating a need to measure these outcomes for cost effectiveness studies.

Temperature-dependent index-of-refraction changes in BaTiO(3).

We investigate thermally induced changes in the index of refraction of BaTiO(3) that are caused by optical absorption. We show that the absorption of a 900-mW optical beam will change the surface temperature of a BaTiO(3) crystal by more than 40 degrees C and cause the extraordinary index of refraction to change by more than 10(-2). For a 900-mW beam incident upon a BaTiO(3) crystal that is not mounted on a heat sink, the surface temperature and the extraordinary index of refraction are still changing after more than 10 min. We also demonstrate that the thermally induced time-dependent index change is partially responsible for the frequency-shifted return from a two-internal-reflection or Cat self-pumped phase-conjugate mirror that has not reached thermal equilibrium.

Effect of low saturated fat diet in early and late cases of multiple sclerosis.

144 multiple sclerosis patients took a low-fat diet for 34 years. For each of three categories of neurological disability (minimum, moderate, severe) patients who adhered to the prescribed diet (less than or equal to 20 g fat/day) showed significantly less deterioration and much lower death rates than did those who consumed more fat than prescribed (greater than 20 g fat/day). The greatest benefit was seen in those with minimum disability at the start of the trial; in this group, when those who died from non-MS diseases were excluded from the analysis, 95% survived and remained physically active.