"Brown bag" simulations to teach drug utilization review.

OBJECTIVE: To teach drug utilization review (DUR) skills to pharmacy students and assess their abilities and confidence before and after training. DESIGN: Profile reviews and online and live drug-utilization-review activities of increasing difficulty were incorporated into the first (P1), second (P2), and third (P3) years of the Pharmacy Skills Training Laboratory sequence in a doctor of pharmacy (PharmD) curriculum. ASSESSMENT: An online survey instrument was administered to gauge how comfortable students were with specific DUR skills before and after the activities. Students' confidence in performing specific DUR skills improved after completing the activities. CONCLUSION: Profile reviews, as well as online and live medication reviews, gave students numerous opportunities to practice drug utilization review skills throughout the first 3 years of the pharmacy curriculum. Students' confidence in performing specific drug utilization review skills improved after the activities. Students' ability to perform the skills also improved as measured with the developed checklist in section V and VI of the Pharmacy Skills Laboratory sequence.

The physician's role in managing acute stress disorder.

Acute stress disorder is a psychiatric diagnosis that may occur in patients within four weeks of a traumatic event. Features include anxiety, intense fear or helplessness, dissociative symptoms, reexperiencing the event, and avoidance behaviors. Persons with this disorder are at increased risk of developing posttraumatic stress disorder. Other risk factors for posttraumatic stress disorder include current or family history of anxiety or mood disorders, a history of sexual or physical abuse, lower cognitive ability, engaging in excessive safety behaviors, and greater symptom severity one to two weeks after the trauma. Common reactions to trauma include physical, mental, and emotional symptoms. Persistent psychological distress that is severe enough to interfere with psychological or social functioning may warrant further evaluation and intervention. Patients experiencing acute stress disorder may benefit from psychological first aid, which includes ensuring the patient's safety; providing information about the event, stress reactions, and how to cope; offering practical assistance; and helping the patient to connect with social support and other services. Cognitive behavior therapy is effective in reducing symptoms and decreasing the future incidence of posttraumatic stress disorder. Critical Incident Stress Debriefing aims to mitigate emotional distress through sharing emotions about the traumatic event, providing education and tips on coping, and attempting to normalize reactions to trauma. However, this method may actually impede natural recovery by overwhelming victims. There is insufficient evidence to recommend the routine use of drugs in the treatment of acute stress disorder. Short-term pharmacologic intervention may be beneficial in relieving specific associated symptoms, such as pain, insomnia, and depression.

A survey of pharmacy students' experiences with gambling.

OBJECTIVES: To assess gambling among pharmacy students using the South Oaks Gambling Screen (SOGS). METHODS: Six hundred fifty-eight pharmacy students enrolled at Creighton University were surveyed to determine the extent and characteristics of their gambling. RESULTS: Four hundred eighty-eight students (74.2%) participated (mean age was 26.6 years and 63.4% were female). Almost two-thirds (63.1%) gambled at least once during the past 12 months. Slightly more than 16% (80) of students were identified as "at-risk" (SOGS scores of 1 to 2). Another 5% (24) were likely to be problem gamblers (SOGS scores of 3 to 4), while 1% of students were identified as probable pathological gamblers (SOGS scores > or = 5). Students who gambled were significantly more likely than non-gamblers to be single males. Gamblers with a score > or = 1were significantly more likely to report gambling had affected their relationships with others, compared to casual gamblers. CONCLUSIONS: Gambling is a common activity among pharmacy students. While the incidence of problem gambling is relatively small, the percentage of our students who may be at-risk for gambling-related problems is noteworthy.

Dental student experiences with gambling: a survey of attitudes, exposure, and impact.

The aim of this study is to assess the extent and characteristics of gambling among dental students. Three hundred sixteen dental students enrolled at a private midwestern dental school accessed the twenty-six-item modified South Oaks Gambling Screen (SOGS) as an online survey. Students were advised of the anonymity and confidentiality of the survey results. Student characteristics are presented as descriptive data. One hundred eighty-six students (58.9 percent) responded. Nearly two-thirds (61.3 percent) of the respondents reported having gambled at least once during the past twelve months. Using the SOGS score, six students can be considered problem gamblers with a value of 3 but <5, and three students can be considered as pathological gamblers with a score of >or=5. Gambling is a common activity among dental students and should be considered a possible factor for students who develop academic or social difficulties. Students do not appear to have a realistic perception of what constitutes problem or pathological gambling and may benefit from programs that address this issue.

Generalized anxiety disorder: practical assessment and management.

Generalized anxiety disorder is common among patients in primary care. Affected patients experience excessive chronic anxiety and worry about events and activities, such as their health, family, work, and finances. The anxiety and worry are difficult to control and often lead to physiologic symptoms, including fatigue, muscle tension, restlessness, and other somatic complaints. Other psychiatric problems (e.g., depression) and nonpsychiatric factors (e.g., endocrine disorders, medication adverse effects, withdrawal) must be considered in patients with possible generalized anxiety disorder. Cognitive behavior therapy and the first-line pharmacologic agents, selective serotonin reuptake inhibitors, are effective treatments. However, evidence suggests that the effects of cognitive behavior therapy may be more durable. Although complementary and alternative medicine therapies have been used, their effectiveness has not been proven in generalized anxiety disorder. Selection of the most appropriate treatment should be based on patient preference, treatment success history, and other factors that could affect adherence and subsequent effectiveness.

Use of a multidisciplinary tool to achieve target outcomes in Native American patients with diabetes: Treat-to-target.

PURPOSE: Our purpose was to test a communication tool used in a multidisciplinary setting to more effectively achieve the recommended goals for glucose, blood pressure, lipids, and prophylactic aspirin use in a Native American population with type 2 diabetes. METHODS: One hundred randomly selected patients were included in this observational, pre-intervention, post-intervention study design. The team began with a chart audit documenting hemoglobin A(1c) (Hgb A(1c)), blood pressure, cholesterol levels, and aspirin use. The intervention included the development of a one page form used to prompt providers to intensify therapy when the patient was not meeting evidence-based goals. The audit was repeated one year later. RESULTS: Analysis of 74 patients completing the study showed a decrease in Hgb A1C from 8.812% pre-intervention to a mean 8.214% post-intervention (p < 0.007). At the time of pre-intervention audit, patients were already at target for blood pressure and no significant further decrease was found. Measures of total cholesterol, triglycerides, and aspirin use showed improvement, but statistical significance was not met. CONCLUSION: The one-page multidisciplinary tool used to intensify therapy significantly improved glucose control. More consistent interaction of the multidisciplinary team is necessary to reach other desired goals.

Depression and congestive heart failure.

The prevalence rates of depression in congestive heart failure patients range from 24%-42%. Depression is a graded, independent risk factor for readmission to the hospital, functional decline, and mortality in patients with congestive heart failure. Physicians can assess depression by using the SIG E CAPS + mood mnemonic, or any of a number of easily administered and scored self-report inventories. Cognitive-behavior therapy is the preferred psychological treatment. Cognitive-behavior therapy emphasizes the reciprocal interactions among physiology, environmental events, thoughts, and behaviors, and how these may be altered to produce changes in mood and behavior. Pharmacologically, the selective serotonin reuptake inhibitors are recommended, whereas the tricyclic antidepressants are not recommended for depression in congestive heart failure patients. The combination of a selective serotonin reuptake inhibitor with cognitive-behavior therapy is often the most effective treatment.