A review of glucagon-like peptide 1 receptor agonist and sodium-glucose cotransporter 2 inhibitor cardiovascular trials: Implications for practice.

BACKGROUND: Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality for people with type 2 diabetes mellitus (T2DM). Previous pharmacological management recommendations focused primarily on glucose lowering. However, new data demonstrate that select glucagon-like peptide 1 receptor agonists (GLP1 RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) not only provide glucose lowering but also can reduce the risk of cardiovascular (CV) disease. OBJECTIVES: The purpose of this study was to evaluate the current data regarding CV benefits of GLP1 RA and SGLT2i in select patients with T2DM and the impact on clinical guidelines so that nurse practitioners may optimize pharmacologic management of patients with T2DM. DATA SOURCES: A literature review was conducted using the PubMed and CINAHL complete databases to identify studies with CV benefits of GLP1 RA and SGLT2i. Pivotal clinical trials were selected for review. CONCLUSIONS: Select GLP1 RA and SGLT2i can reduce the risk of major adverse CV events, death from CV cases, or hospitalization due to heart failure (HF) in patients with a history of, or at high risk for, CV disease. IMPLICATIONS FOR PRACTICE: Based on data from major CV outcomes trials, clinical guidelines recommend GLP1a or SGLT2i in select patients for glucose lowering and CV risk reduction. In addition, even in patients who have achieved glycemic goals, these agents can provide additional benefit by reducing the incidence of major CV adverse events or hospitalization for HF. Understanding the data will help nurse practitioners select the most appropriate agent for a given individual based on comorbidities.

Traditional lecture versus jigsaw learning method for teaching Medication Therapy Management (MTM) core elements.

BACKGROUND AND PURPOSE: To determine if traditional didactic lecture or the jigsaw learning method is more effective to teach the medication therapy management (MTM) core elements in a first year pharmacy course. EDUCATIONAL ACTIVITY AND SETTING: Traditional didactic lecture and a pre-class reading assignment were used in the fall semester cohort, and the jigsaw method was used in the spring semester cohort. Jigsaw is a cooperative learning strategy requiring students to assume responsibility for learning, and subsequently teaching peers. The students were responsible for reading specific sections of the pre-class reading, and then teaching other students in small groups about their specific reading assignments. To assess potential differences, identical pre- and post-tests were administered before and after the MTM section. Additionally, grade performance on an in-class project and final exam questions were compared, and students were surveyed on perceptions of teaching method used. FINDINGS: A total of 45 and 43 students completed both the pre- and post-test in the fall and spring (96% and 93% response rate), respectively. Improvement in post-test scores favored the traditional method (p = 0.001). No statistical differences were noted between groups with grade performance on the in-class project and final exam questions. However, students favored the jigsaw method over traditional lecture and perceived improvements in problem solving skills, listening/communication skills and encouragement of cooperative learning (p = 0.018, 0.025 and 0.031). SUMMARY: Although students favored the jigsaw learning method, traditional didactic lecture was more effective for the pre- and post-knowledge test performance. This may indicate that traditional didactic lecture is more effective for more foundational content.

Reflections on a year-long student and pharmacist paired mentorship program.

BACKGROUND AND PURPOSE: Mentorship programs can play a significant role in the professional development of a variety of individuals, including student pharmacists and practitioners. Many mentorship programs have been described in the literature, but the literature pertaining to mentorship programs for student pharmacists specifically is varied. EDUCATIONAL ACTIVITY AND SETTING: A leadership society at one school of pharmacy established a formal mentorship program to aid the professional development of student pharmacists. This year-long program matched third-year student pharmacists with practicing pharmacists. This paper describes the development of the program, along with perceived benefits and challenges associated with implementation. FINDINGS: The mentor (n=8) and mentee (n=17) respondents provided positive feedback (100% and 94%, respectively) regarding the mentorship program. Most mentors and mentees noted they enjoyed having the opportunity to network and gained different perspectives on issues related to pharmacy. The challenges most noted by both the mentors and mentees were time limitations and scheduling conflicts. More consistent communication between mentors and mentees was noted as an area of improvement for future programs. DISCUSSION: The described program may create avenues to achieve professional development elements of the 2016 Accreditation Council for Pharmacy Education (ACPE) Standards and 2013 Center for Advancement of Pharmacy Education (CAPE) Outcomes. Continued, regular evaluation is important to help with process improvement, address challenges, and ensure the program is meeting desired objectives. Adjustments may be needed based on participant feedback, available resources, and student interest. SUMMARY: Overall, the program was successful, helping participants grow personally and professionally. With modifications, other institutions may utilize this data to develop similar programs.

A 10-year Study of the Academic Progress of Students Identified as Low Performers after Their First Semester of Pharmacy School.

Objective. To examine whether pharmacy students characterized as low performers at the conclusion of their first semester remained low performers throughout their academic career. Methods. Bottom quartile performance on first semester grade point average (GPA) was compared to licensing examination success, cumulative grade point average at the end of the didactic education and whether the student graduated on time, using cross tabulation analysis. Relative risk ratios and confidence intervals were calculated. Results. Students in the bottom quartile for GPA at the end of their first semester in pharmacy school were approximately six times more likely not to graduate on time, not to pass the North American Pharmacist Licensure Exam on their first attempt and to remain in the bottom quartile for GPA at the end of their didactic education. Conclusion. This study suggests that pharmacy students who score in the bottom quartile for GPA at the end of their first semester are more likely to underperform academically unless they take corrective action.

Effectiveness of Electronic Cigarettes as a Tool for Smoking Cessation or Reduction.

Objective: To examine the evidence concerning effectiveness of electronic cigarettes (e-cigarettes) in smoking cessation or reduction and reduction in desire to smoke and withdrawal symptoms. Data Sources: A PubMed literature search through May 2014 was performed using search terms electronic cigarettes or e-cigarettes; smoking or tobacco; and efficacy or effectiveness limited to clinical trials in humans. Cochrane Library and International Pharmaceutical Abstracts were searched using the term electronic cigarettes. Relevant citations from identified articles were reviewed. Study Selection and Data Extraction: All English-language clinical trials assessing cessation, reduction in cigarette use, desire to smoke, and/or reduction in withdrawal symptoms with e-cigarettes were included. Data Synthesis: Of 7 trials, one showed similar 6-month abstinence rates between e-cigarettes and nicotine patches. Another trial reported 12.5% of participants achieving abstinence at 24 months with e-cigarettes. Three studies demonstrated significant percentages of patients maintaining ≥50% reduction in cigarettes/day from baseline to 24 or 52 weeks. Another trial showed significant reductions in cigarette use from baseline through 52 weeks with e-cigarettes; no difference in abstinence rates beyond 12 weeks was found between nicotine and placebo e-cigarettes. Only 2 trials assessed reduction in desire to smoke or withdrawal symptoms, and results varied. Conclusions: The limited evidence available supports that e-cigarettes may be effective as monotherapy for smoking cessation and reduction. However, superiority to nicotine replacement therapy was not proven. Limited conclusions can be drawn regarding reduction in desire to smoke and withdrawal symptoms. The unknown long-term safety risk should also be considered.