Qualitative Analysis of Student Perceptions Comparing Team-based Learning and Traditional Lecture in a Pharmacotherapeutics Course.

Objective. To qualitatively compare students' attitudes and perceptions regarding team-based learning (TBL) and lecture. Design. Students were exposed to TBL and lecture in an elective pharmacotherapeutics course in a randomized, prospective, cross-over design. After completing the course, students provided their attitudes and perceptions through a written self-reflection and narrative questions on the end-of-course evaluation. Student responses were reviewed using a grounded theory coding method. Assessment. Students' responses yielded five major themes: impact of TBL on learning, perceptions about TBL learning methods, changes in approaches to learning, building skills for professional practice, and enduring challenges. Overall, students report TBL enhances their learning of course content (knowledge and application), teamwork skills, and lifelong learning skills. Conclusion. Students' attitudes and perceptions support TBL as a viable pedagogy for teaching pharmacotherapeutics.

A Randomized Crossover Comparison of Team-based Learning and Lecture Format on Learning Outcomes.

Objective. To compare learning outcomes and student confidence between team-based learning (TBL) and lecture. Methods. A crossover study was conducted with 30 students divided into two sections. Each section was taught six therapeutic topics (three TBL and three lecture). There were two assessments of 24 questions each. A survey (Likert scale) assessing student confidence and attitudes was administered at the end. Results. A significantly higher overall examination score was observed for TBL as compared to lecture. Students were more confident in providing therapeutic recommendations following TBL. Higher survey scores favoring TBL were also seen related to critical-thinking skills and therapeutic knowledge. Conclusion. Learning outcomes and student confidence in performing higher-order tasks were significantly higher with TBL. The findings of this novel crossover type design showed that TBL is an effective pedagogy.

Masters Swimmers Use More Dietary Supplements Than a Large National Comparison Population in the United States.

The use of dietary supplements was compared between a cohort of committed exercisers, U.S. Masters Swimming (USMS) members (n = 1,042), and the general U.S. population, exemplified by respondents to the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2010 (n = 6,209). USMS swimmers were significantly more likely to take dietary supplements (62%) than the general U.S. adult population, as represented by the NHANES population (37%). Those taking dietary supplements were older, more likely to be female and Caucasian, and more highly educated and affluent than those not taking supplements (p < .001 for all). When adjusted for age, race, gender, annual income, and education, masters swimmers were still more likely (p < .001) to use dietary supplements than the NHANES cohort. In addition, masters swimmers were significantly more likely (p < .001) to use either creatine or dehydroepiandrosterone or testosterone than those in the NHANES cohort.

Alternate Routes of Administration of Antidepressant and Antipsychotic Medications.

OBJECTIVE: To review the administration of antidepressant and antipsychotic medications via inhaled, intranasal, buccal, sublingual, transdermal, and rectal routes. DATA SOURCES: A PubMed search was conducted for all data through March 31, 2015 to identify pertinent literature. Search terms included the generic name of each antidepressant and antipsychotic medication in combination with the following terms: alternate routes of administration, inhaled, intranasal, buccal, sublingual, transdermal, and rectal. STUDY SELECTION AND DATA EXTRACTION: English-language case reports, studies, and reviews describing medication administration in human subjects were included. DATA SYNTHESIS: Commercially available products that use an alternative route of administration include loxapine for inhalation, asenapine for sublingual administration, and selegiline for transdermal administration. Case reports and studies describe intranasal, sublingual, and transdermal routes of administration of antipsychotic medications as well as buccal, sublingual, transdermal, and rectal administration of antidepressant medications. The concordance between the physicochemical properties possessed by some antipsychotic and antidepressant agents and the physicochemical properties required for nontraditional routes of administration suggest that administration via alternative routes may be feasible for some of these drugs. Further exploration of drug absorption via alternative routes in addition to consideration of patient and formulation factors may yield improvements in medication therapy for patients with psychiatric illnesses. CONCLUSIONS: For patients unable to tolerate oral or injectable therapy, administration of psychotropic medications via nontraditional routes may be feasible. The development of alternative routes of drug delivery could prevent discontinuation of needed medication therapy.

Regional brain [(11)C]carfentanil binding following tobacco smoking.

OBJECTIVE: To determine if overnight tobacco abstinent carriers of the AG or GG (*G) vs. the AA variant of the human mu opioid receptor (OPRM1) A118G polymorphism (rs1799971) differ in [(11)C]carfentanil binding after tobacco smoking. METHODS: Twenty healthy American male smokers who abstained from tobacco overnight were genotyped and completed positron emission tomography (PET) scans with the mu opioid receptor agonist, [(11)C]carfentanil. They smoked deniconized (denic) and average nicotine (avnic) cigarettes during the PET scans. RESULTS: Smoking avnic cigarette decreased the binding potential (BPND) of [(11)C]carfentanil in the right medial prefrontal cortex (mPfc; 6, 56, 18), left anterior medial prefrontal cortex (amPfc; -2, 46, 44), right ventral striatum (vStr; 16, 3, -10), left insula (Ins; -42, 10, -12), right hippocampus (Hippo; 18, -6, -14) and left cerebellum (Cbl; -10, -88, -34), and increased the BPND in left amygdala (Amy; -20, 0, -22), left putamen (Put; -22, 10, -6) and left nucleus accumbens (NAcc; -10, 12, -8). In the AA allele carriers, avnic cigarette smoking significantly changed the BPND compared to after denic smoking in most brain areas listed above. However in the *G carriers the significant BPND changes were confirmed in only amPfc and vStr. Free mu opioid receptor availability was significantly less in the *G than the AA carriers in the Amy and NAcc. CONCLUSION: The present study demonstrates that BPND changes induced by avnic smoking in OPRM1 *G carriers were blunted compared to the AA carriers. Also *G smokers had less free mu opioid receptor availability in Amy and NAcc.

Statin use and self-reported swimming performance in US masters swimmers.

Exercise and treating hyperlipidaemia with statins are two integral components of the American Heart Association guidelines to reduce cardiovascular risk in adults. Since statins can cause myalgias and myopathies, they could affect the duration or intensity of an exercise regimen. To determine the impact of statin use in adult masters swimmers, a survey was distributed to examine the association between swimming performance and statin usage in adult swimmers (≥35 years). After excluding those with chronic diseases or taking drugs that reduce physical capacity, 749 swimmers (118 taking statins, 73 not taking statins to control elevated cholesterol and 558 controls) were included in a regression model to determine the factors significantly affecting the duration and intensity of swimming workouts. Age and gender were significantly (P ≤ 0.001) associated with the distance swam per 60 min. Younger, male swimmers completed more yards per 60-min workout. Use of statins was not significantly associated with yards swam per 60-min workout. Nor did statin usage affect the number of swim sessions per month or the length of swim session. Evidently, statins do not cause enough fatigue or pain in masters swimmers to require a decrease in the duration or intensity of workouts.

Team-based learning to improve learning outcomes in a therapeutics course sequence.

OBJECTIVE: To compare the effectiveness of team-based learning (TBL) to that of traditional lectures on learning outcomes in a therapeutics course sequence. DESIGN: A revised TBL curriculum was implemented in a therapeutic course sequence. Multiple choice and essay questions identical to those used to test third-year students (P3) taught using a traditional lecture format were administered to the second-year pharmacy students (P2) taught using the new TBL format. ASSESSMENT: One hundred thirty-one multiple-choice questions were evaluated; 79 tested recall of knowledge and 52 tested higher level, application of knowledge. For the recall questions, students taught through traditional lectures scored significantly higher compared to the TBL students (88%±12% vs. 82%±16%, p=0.01). For the questions assessing application of knowledge, no differences were seen between teaching pedagogies (81%±16% vs. 77%±20%, p=0.24). Scores on essay questions and the number of students who achieved 100% were also similar between groups. CONCLUSION: Transition to a TBL format from a traditional lecture-based pedagogy allowed P2 students to perform at a similar level as students with an additional year of pharmacy education on application of knowledge type questions. However, P3 students outperformed P2 students regarding recall type questions and overall. Further assessment of long-term learning outcomes is needed to determine if TBL produces more persistent learning and improved application in clinical settings.

Increased distractor vulnerability but preserved vigilance in patients with schizophrenia: evidence from a translational Sustained Attention Task.

OBJECTIVE: Attentional deficits represent a core cognitive impairment in schizophrenia. The distractor condition Sustained Attention Task (dSAT) has been identified by the Cognitive Neuroscience Treatment to Improve Cognition in Schizophrenia (CNTRICS) initiative as a promising translational task for assessing schizophrenia-related deficits in attentional selection-control, identifying neuroimaging biomarkers of such deficits, and for preclinical animal research on potential pro-cognitive treatments. Here, we examined whether patients would show specific difficulties in selection-control and in avoiding distraction in the dSAT. METHOD: Selection-control deficits are measured by comparing attentional performance in the Sustained Attention Task (SAT) without distraction to performance on the task when distraction is present (dSAT). The baseline SAT condition can also be used to assess time-on-task or vigilance effects. Patients with schizophrenia, age- and gender-matched healthy controls and, as an additional control, school-aged children were tested on both the SAT and dSAT. RESULTS: Compared to healthy controls, patients had reduced performance overall and were differentially vulnerable to distraction. In contrast, patients but not children had preserved vigilance over time. CONCLUSION: These results demonstrate specific input-selection control impairments in schizophrenia and suggest that patients' distraction-related impairments can be distinguished from general performance impairments and from deficits in other attentional processes (e.g., sustaining attention) evident in other groups.

Comparison of the prevalence and treatment of hypertension in two populations in the United States: masters swimmers versus the NHANES population.

This research compares the prevalence of hypertension in a group of adult masters swimmers with an age and sex matched cohort from the 2008 NHANES (National Health and Nutrition Examination Survey), used to represent the general population in the United States. Masters swimmer data were obtained from a one-time survey of all United States Masters Swimming (USMS) members. Both datasets included demographics, drug therapy, diseases and health status. Characteristics of swimming sessions as well as perceptions of impact of medications on exercise were also collected from the USMS respondents. Of 1346 completed surveys from USMS respondents, 15.8% self-identified as having hypertension while 36.2% participants in the NHANES survey suffered from hypertension (P < 0.001). The two groups were well matched for age and gender but the USMS group was primarily Caucasian, higher income, higher education, and reported higher health status. In the USMS group, not only was hypertension less prevalent but those who suffered from hypertension took fewer medications (P = 0.04) to manage their hypertension than in the NHANES group. Additionally, The USMS group suffering from hypertension considered themselves healthier (P < 0.001) than the NHANES group.

Denicotinized versus average nicotine tobacco cigarette smoking differentially releases striatal dopamine.

INTRODUCTION: Nicotine has long been recognized as a necessary but insufficient component of tobacco cigarettes to maintain a psychophysiological need to smoke. This study examined venous plasma concentrations effects of nicotine in cigarette smoking after overnight abstinence to release striatal dopamine (DA). METHODS: Twenty-two male smokers smoked either denicotinized (denic) or average nicotine (nic) cigarettes under single blind conditions. Each was given [(11)C]raclopride and scanned in a positron emission tomography (PET) facility. RESULTS: Smoking either denic or nic cigarettes released striatal DA. Denic cigarette smoking released DA primarily in the right striatum, whereas nic cigarette smoking released DA in both striata, but especially in the left. Increases in venous plasma nicotine concentrations correlated positively with increased DA release in the left caudate nucleus. Smoking denic cigarettes reduced craving as much as smoking nic cigarettes. Craving reduction after nic tobacco smoking correlated with increases in plasma nicotine. CONCLUSIONS: Nonnicotine factors in tobacco smoking produce important right brain effects. Nicotine is a pharmacological factor during tobacco smoking that releases bilateral striatal DA, but more in the left brain.

Tobacco smoking produces greater striatal dopamine release in G-allele carriers with mu opioid receptor A118G polymorphism.

OBJECTIVE: To determine if carriers of the allelic expression of the G variant of the human mu opioid receptor (OPRM1) A118G polymorphism have greater increases in striatal dopamine (DA) release after tobacco smoking. METHODS: Nineteen of 20 genotyped male tobacco smokers, after overnight abstinence, smoked denicotinized (denic) and average nicotine (nic) containing tobacco cigarettes in a PET brain imaging study using [(11)C]raclopride. RESULTS: The right striatum had more free D(2) receptors than the left striatum pre- and post-tobacco smoking. After smoking the nic cigarettes, mean decreased DA binding was observed in the left dorsal caudate (-14 6 11; t=3.77), left and right ventral putamen (-26 3-8; t=4.27; 28 2 1; t=4.25, respectively), and right caudate (17 18 1; t=3.92). The effects of A118G genotype on the binding potentials for these four regions were then analyzed. Carriers of the G allele had larger magnitudes of DA release in response to nic smoking than those homozygous for the more prevalent AA allele in the right caudate and right ventral pallidum (t=3.03; p=0.008 and t=3.91; p=0.001). A voxel by voxel whole brain SPM analysis using an independent samples t test did not reveal any other differences between genotype groups. In addition, the venous plasma cortisol levels of the volunteers from 8:30 a.m. to 12:40 p.m. were lower in the AG/GG allele carriers. Nic smoking increased plasma cortisol in both groups, but they were higher in the AA group. CONCLUSION: This preliminary study indicates a difference in both brain striatal DA release and plasma cortisol in A118G polymorphic male tobacco smokers.

Venous plasma nicotine correlates of hormonal effects of tobacco smoking.

The present study resolves some of the discrepancies in the literature by correlating the effects of tobacco smoking on hormone release with venous plasma nicotine levels. Cortisol, prolactin, and beta-endorphin concentrations were measured. Habitual male tobacco users smoked denicotinized (very low nicotine) and average nicotine cigarettes in the morning after overnight tobacco abstinence. Several venous blood samples were withdrawn before and during the smoking sessions for subsequent analyses. The increases in plasma nicotine correlated well with plasma cortisol and prolactin levels (correlation coefficients r=0.66 and 0.53, respectively, p<0.05). This study quantifies the well known increase in plasma cortisol and prolactin after nicotine postsmoking for about 1h with peak plasma levels up to 35 ng/ml. Contrary to most abused drugs which release dopamine and decrease prolactin, nicotine concentration correlated with increased prolactin release. Increases in maximal plasma beta-endorphin levels following tobacco smoking were barely statistically significant with insufficient data to obtain a correlation coefficient.

Severity of anxiety and work-related outcomes of patients with anxiety disorders.

BACKGROUND: This study examined associations between anxiety and work-related outcomes in an anxiety disorders clinic population, examining both pretreatment links and the impact of anxiety change over 12 weeks of treatment on work outcomes. Four validated instruments were used to also allow examination of their psychometric properties, with the goal of improving measurement of work-related quality of life in this population. METHODS: Newly enrolled adult patients seeking treatment in a university-based anxiety clinic were administered four work performance measures: Work Limitations Questionnaire (WLQ), Work Productivity and Activity Impairment Questionnaire (WPAI), Endicott Work Productivity Scale (EWPS), and Functional Status Questionnaire Work Performance Scale (WPS). Anxiety severity was determined using the Beck Anxiety Inventory (BAI). The Clinical Global Impressions, Global Improvement Scale (CGI-I) was completed by patients to evaluate symptom change at a 12-week follow-up. Two severity groups (minimal/mild vs. moderate/severe, based on baseline BAI score) were compared to each other on work measures. RESULTS: Eighty-one patients provided complete baseline data. Anxiety severity groups did not differ in job type, time on job, job satisfaction, or job choice. Patients with greater anxiety generally showed lower work performance on all instruments. Job advancement was impaired for the moderate/severe group. The multi-item performance scales demonstrated better validity and internal consistency. The WLQ and the WPAI detected change with symptom improvement. CONCLUSION: Level of work performance was generally associated with severity of anxiety. Of the instruments tested, the WLQ and the WPAI questionnaire demonstrated acceptable validity and internal reliability.

Antipsychotic-induced hyperprolactinemia.

Use of antipsychotic agents has been associated with hyperprolactinemia, or elevated prolactin levels; this hormonal abnormality can interfere with the functioning of reproductive, endocrine, and metabolic systems. As antipsychotic agents are increasingly used for both United States Food and Drug Administration-approved and nonapproved indications, many individuals are at risk for developing antipsychotic-induced hyperprolactinemia. First-generation antipsychotics pose the greatest risk of causing this adverse effect; however, second-generation antipsychotics, particularly risperidone and paliperidone, also often increase prolactin secretion. Hyperprolactinemia has short- and long-term consequences that can seriously affect quality of life: menstrual disturbances, galactorrhea, sexual dysfunction, gynecomastia, infertility, decreased bone mineral density, and breast cancer. Although many of these are definitively connected to elevated prolactin levels, some, such as breast cancer, require further study. Both clinicians and patients should be aware of hyperprolactinemia-associated effects. To prevent or alleviate the condition, tailoring an antipsychotic drug regimen to each individual patient is essential. In addition, the risk of hyperprolactinemia can be minimized by using the lowest effective dose of the antipsychotic agent. If the effects of prolactin are evident, the drug can be changed to another agent that is less likely to affect prolactin levels; alternatively, a dopamine agonist may be added, although this may compromise antipsychotic efficacy. Additional research is needed to clarify the appropriate level of monitoring, the long-term effects, and the optimal treatment of antipsychotic-induced hyperprolactinemia.

Smoking modulation of mu-opioid and dopamine D2 receptor-mediated neurotransmission in humans.

This is a pilot examination of the hypothesis that some of the effects of smoking cigarettes in humans are mediated through nicotine activation of opioid and dopamine (DA) neurotransmission. Neuroimaging was performed using positron emission tomography and the radiotracers [11C]carfentanil and [11C]raclopride, labeling mu-opioid and DA D2 receptors, respectively. Six healthy male smokers were abstinent overnight. After radiotracer administration, subjects smoked two denicotinized cigarettes, followed 45 min later by two average nicotine cigarettes. Dynamic data were acquired over 90 min, and transformed into parametric maps of receptor availability in vivo (binding potential, BP), corresponding to low and high nicotine smoking periods and analyzed on a voxel-by-voxel basis using SPM'99 and correction for multiple comparisons. Significant activation of mu-opioid receptor-mediated neurotransmission from denicotinized to average nicotine conditions was observed in the right anterior cingulate cortex. DA D2 neurotransmission was activated in the ventral basal ganglia, correlating with Fagerström scale nicotine dependence scores. Lower mu-opioid receptor BP was also detected during the denicotinized smoking condition in the smoker group, compared to baseline scans in non-smokers, in the cingulate cortex, thalamus, ventral basal ganglia, and amygdala. These reductions were reversed during the average nicotine condition in the thalamus, ventral basal ganglia and amygdala. These data point to both the feasibility of simultaneously examining opioid and DA neurotransmission responses to smoking in humans, as well as to the need to examine non-nicotine aspects of smoking to more fully understand the behavioral effects of this drug.

Risperidone treatment of bipolar mania.

OBJECTIVE: To review clinical trial evidence regarding the efficacy and safety of risperidone for the treatment of bipolar mania. DATA SOURCES: Articles were identified through searches of PubMed (1950-August 2005), EMBASE (1988-August 2005 week 37), and International Pharmaceutical Abstracts (1970-August 2005) databases using the key words risperidone, atypical antipsychotics, and bipolar mania. Additional references were found through review of bibliographies of identified articles. PubMed searches for efficacy and safety were limited to clinical trials. STUDY SELECTION AND DATA EXTRACTION: Six randomized trials and 6 observational studies of risperidone monotherapy or combination therapy for bipolar mania in adults were selected. DATA SYNTHESIS: Randomized, placebo-controlled and observational trials reported that risperidone monotherapy decreases manic symptoms in patients with a moderate severity of mania, as determined by change in Young Mania Rating Scale (YMRS) scores. Adverse effects observed in monotherapy trials included somnolence, extrapyramidal symptoms (EPS), and weight gain. Clinical trials of risperidone in combination with other mood stabilizers (ie, lithium, valproate, carbamazepine, topiramate) also reported decreases in YMRS scores in patients with moderate and severe manic symptoms. CONCLUSIONS: Risperidone monotherapy or adjunctive therapy with other first-line mood stabilizers may be effective for the treatment of acute bipolar mania in adults with moderate severity of mania. The use of risperidone as monotherapy in severe mania or in maintenance treatment remains to be elucidated.

Prevalence and motives for illicit use of prescription stimulants in an undergraduate student sample.

To assess the prevalence and motives for illicit use of prescription stimulants and alcohol and other drugs (AODs), associated with these motives, the authors distributed a self-administered Web survey TO a random sample of 9,161 undergraduate college students. Of the study participants, 8.1% reported lifetime and 5.4% reported past-year illicit use of prescription stimulants. The most prevalent motives given for illicit use of prescription stimulants were to (1) help with concentration, (2) increase alertness, and (3) provide a high. Although men were more likely than women were to report illicit use of prescription stimulants, the authors found no gender differences in motives. Regardless of motive, illicit use of prescription stimulants was associated with elevated rates of AOD use, and number of motives endorsed and AOD use were positively related. Students appear to be using these prescription drugs non-medically, mainly to enhance performance or get high.

Regional cerebral blood flow responses to smoking in tobacco smokers after overnight abstinence.

OBJECTIVE: The purpose of the study was to determine the effects of cigarette smoking on brain regional function in a group of chronic smokers by using cerebral blood flow (CBF) measures and positron emission tomography (PET). METHOD: Nineteen tobacco smokers were studied after about 12 hours of smoking abstinence. Regional CBF (rCBF) measures were obtained with PET and [15O]H2O in six consecutive scans. Two average-nicotine-yield (1.0 mg) and one denicotinized (0.08 mg) research cigarettes with similar tar yields (9.5 mg and 9.1 mg, respectively) were smoked in a double-blind design, preceded and followed by baseline scans. The rCBF effects of smoking were compared to baseline measures and between cigarettes, as well as to subjective ratings of craving for cigarettes. RESULTS: Smoking the first cigarette of the day resulted in increases in rCBF in the visual cortex and the cerebellum and reductions in the anterior cingulate, the right hippocampus, and the ventral striatum, including the nucleus accumbens. Cigarette craving scores correlated with rCBF changes in the dorsal anterior cingulate and right hippocampus. Less pronounced effects were observed with the second cigarette and the denicotinized cigarette. CONCLUSIONS: Smoking affects rCBF not only in areas of the brain rich in nicotinic cholinergic receptors but also in areas implicated in the rewarding effects of drugs of abuse. Furthermore, craving for a cigarette in chronic smokers was correlated with rCBF in the right hippocampus, an area involved in associating environmental cues with drugs, and in the left dorsal anterior cingulate, an area implicated in drug craving and relapse to drug-seeking behavior.

Relative rectal bioavailability of fluoxetine in normal volunteers.

This study was conducted to determine the relative rectal bioavailability of fluoxetine capsules as well as the acceptability of the rectal route of fluoxetine capsule administration. Using a 2-period, crossover design with a 30-day washout between study sessions, 20 mg fluoxetine capsules were administered to 7 healthy, drug-free, nonsmoking volunteers by the oral and rectal routes. Blood samples were collected at baseline, and 1, 2, 4, 6, 8, 10, 12, 24 hours, as well as 2, 3, 4, 5, 7, 14, 21, 28 days following drug administration. Plasma concentrations of fluoxetine and norfluoxetine were determined using high performance liquid chromatography with ultraviolet detection. The area under the plasma concentration versus time curve could not be determined for fluoxetine following rectal administration due to very low fluoxetine plasma levels. The relative rectal bioavailability was determined for norfluoxetine and total (fluoxetine + norfluoxetine) in each individual. Six subjects completed both phases of the study. The relative bioavailability of rectally administered fluoxetine was approximately 15% [norfluoxetine, 95% CI 9-21%, and total (fluoxetine + norfluoxetine), 95% CI 8-22%]. The rectal route of administration was rated as reasonably tolerable by all subjects. Although rectal bioavailability of fluoxetine capsules is considerably less than oral, the rectal route of administration might be an option in patients who cannot take oral medications.

Prevalence and correlates of illicit methylphenidate use among 8th, 10th, and 12th grade students in the United States, 2001.

The prevalence and correlates of illicit methylphenidate use were examined within a nationally representative U.S. sample of 8th, 10th, and 12th graders. The annual prevalence of illicit methylphenidate use was 4%. Race, grade level, geographical region, grade point average, and substance use were all significantly associated with illicit methylphenidate use.