Financial investment of United States pharmacy schools on international activities.

INTRODUCTION: The primary objective of this study was to determine the financial resources that United States (US) pharmacy schools spend and receive for international activities, as well as the future direction of expenditures and revenue. METHODS: An online survey was sent in April 2019 to the chief financial or administrative officer at each accredited pharmacy school (N = 141) to ask about average annual budget for international activities and areas of expenditure (student travel, partnership development, faculty salary, staff salary, training programs) and revenue (dean's office, university, student tuition and fees, alumni, grants and contracts, other) associated with their budget. Participants were asked whether they anticipated spending or receiving more, the same, or less on the aforementioned expenditure and revenue areas. RESULTS: Sixty-three programs (45%) responded, with 61 (43%) complete responses used for data analysis. Thirty-eight schools (62%) had an annual budget for international activities with an average of $77,327, a median of $18,750, and a range from $2000 to $615,000. Public schools averaged $102,129 compared to $43,225 for private schools. The largest expenditure source was split evenly between student travel and faculty salaries while the largest revenue source was student tuition and fees. The most common response for future trends was to spend or receive the same amount of support. CONCLUSIONS: There is wide variance regarding the amount each US pharmacy school spends on international activities, with most programs anticipating spending or receiving the same amount in the future.

Tissue-directed placement of dental implants in the esthetic zone for long-term biologic synergy: a clinical report.

Implant dentistry steadily evolves as more is learned about the unique biologic interrelationship of the dental implant restoration and the surrounding hard and soft tissues. Important factors include the impact of the surface microtopography on biochemically-mediated cell differentiation, the unavoidable bacterial colonization of the implant-abutment (or crown) microgap, the vertical and horizontal dimensions of biologic width, and the histology of surrounding structures. The recipient site, implant design, surgical technique, and location of the restorative platform significantly influence the optimal esthetics and biologic stability of implant restorations. There are differing opinions among clinicians regarding the appropriate positioning of the implant restorative platform in the vertical and sagittal planes relative to the alveolar crest. An apical and palatal orientation of the coronal platform relative to the alveolar crest in the esthetic zone is generally advocated for favorable facial and proximal emergence profiles of the definitive crown. Tissue-directed implant placement primarily considers the long-term consequences of the implant restoration upon the surrounding hard and soft tissues. The goal is to develop optimal gingival contours and a definitive restoration in the esthetic zone that coexist in stable biologic synergy. The rationale and the specific prosthodontic and surgical protocols inherent in the tissue-directed concept are discussed in this report.

Cardiovascular implications of thiazolidinedione therapy.

The incidence of obesity and type 2 diabetes mellitus (DM2) in the United States has been increasing dramatically over the past 15 years, and is now at epidemic proportions. DM2 is the clinical manifestation of a long-term metabolic process that is initiated by cells' decreased sensitivity to the actions of insulin. Many outcome studies have identified DM2 as a strong and independent risk factor for the development of cardiovascular complications such as hypertension, arteriosclerosis, and heart failure. The goals of therapy in treating DM2 are to improve the long-term outlook for these patients. However, in selecting a therapeutic regimen for patients, clinicians should be aware that potentially severe adverse events may occur at a rate not previously identified in phase 3 studies. Certain therapies used to treat DM2, by effectively increasing the sensitivity of insulin, have also been reported to cause adverse effects, which can precipitate symptomatic heart failure. The purpose of this column is to discuss the therapeutic options available for treating patients with DM2, the potential pathophysiology of the adverse events of symptomatic heart failure, encouragement of use of the US Food and Drug Administration MedWatch program for reporting adverse events associated with medication therapy, and review of newer treatment guidelines for use of insulin-sensitizing agents in patients with chronic heart failure.

Left ventricular diastolic dysfunction: risks, identification, and treatment.

Risk factors of cardiovascular disease, such as hypertension, diabetes, and myocardial infarction, if left untreated, will increase the risk of the development of chronic heart failure. Much is known about the pathophysiology and effective treatments of chronic heart failure from left ventricular systolic dysfunction; however, little clinical trial evidence exists concerning benefits of treating patients with chronic heart failure and preserved systolic function, also known as left ventricular diastolic dysfunction. Rather, an understanding of the pathophysiology and patient signs and symptoms has usually dictated choice of treatments. With the results of ongoing trials, as well as the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM)-Preserved and the Digitalis Investigation Group (DIG) trials, clinical evidence is accumulating to support effective treatments in patients with left ventricular diastolic dysfunction. The focus of this review is to discuss the risks of, identification of, and rationale for therapeutic choices being employed for treating left ventricular diastolic dysfunction and implications from studies that may support these choices.

Aldosterone receptor antagonists: focus on eplerenone.

Despite the development of hypertension treatment guidelines, blood pressure control in the general population remains inadequate, indicating the need for ongoing re-evaluation of treatment strategies to further improve blood pressure control. Hypertension results from alterations in cardiac output and/or peripheral resistance. The renin-angiotensin-aldosterone system may be responsible, at least in part, for these alterations. Despite pharmacologic intervention with angiotensin-converting enzyme inhibitors and angiotensin type-1 receptor antagonists, aldosterone continues to be produced. Therapeutic modalities for treating hypertension directed toward antagonizing aldosterone might more effectively control blood pressure. Eplerenone, a new selective aldosterone receptor antagonist, recently received approval from the US Food and Drug Administration for the treatment of hypertension, either alone or in combination with other antihypertensive agents. The objective of this review is to summarize the renin-angiotensin-aldosterone system, emphasizing the role for aldosterone antagonism in the management of hypertension, with a focus on eplerenone.

Controlling hypertension to reduce the risk of stroke.

Long-term hypertension has been implicated as one of the greatest risk factors for the cause of stroke, but yet it is a very controllable one. The risks of stroke increase with age and, as the population of the United States grows older, the number of people who will experience a stroke will greatly increase. In the past, various antihypertensive therapies have proved to lower blood pressure with a resulting decrease in stroke. Stroke can be devastating in terms of quality of life and cost of care; therefore, prevention of stroke should become a priority for all health care professionals. As newer antihypertensive classes of drugs are being studied in high-risk cardiovascular populations, health care professionals need to educate themselves and their patients regarding new treatment options, where these options belong within treatment guidelines for hypertension, and their relevance in preventing the incidence of stroke. This review briefly summarizes the significance of controlling hypertension to reduce the risk of stroke by reviewing some of the clinical trials that support pharmacologic intervention.

Development of gingival esthetics in the edentulous patient prior to dental implant placement using a flangeless removable prosthesis: a case report.

Development of gingival contours found in healthy natural dentitions enhances the esthetic results achieved with implant-supported fixed prostheses. However, this endeavor is frequently difficult to achieve, especially in the completely edentulous patient. Edentulous patients with optimal hard and soft tissue can be treated with a specially designed removable prosthesis that will develop gingival contours prior to implant placement. By means of a transitional complete removable prosthesis with ovate pontics and no labial flange, a natural-looking soft tissue profile can be developed prior to dental implant placement. A minimally invasive tissue punch surgical technique is used to place the implants, which are immediately restored with a 1-piece, cross-arch, provisional fixed prosthesis. This article presents the prosthodontic and surgical protocols utilized to improve the appearance of the definitive implant rehabilitation.