In the midst of curricular revision, remember the importance of over-the-counter and self-care education.

INTRODUCTION: Over-the-counter (OTC) and self-care products are frequently utilized by adult patients as initial treatment for common health issues. This availability of OTC/self-care products, coupled with the accessibility of community-based pharmacists, uniquely positions pharmacists to serve as stewards of appropriate OTC/self-care treatment. As a result, community-based pharmacists must be competent in the practice of providing individualized, patient-specific, OTC recommendations and self-care education to assist patients in achieving optimal self-managed health outcomes. COMMENTARY: Schools and colleges of pharmacy often undergo curricular revision/integration. As a result, it is often necessary to reallocate credit hours dedicated to OTC/self-care content. Curriculum committees should therefore be aware of several best-practice resources that may assist them with this task. IMPLICATIONS: The impact on OTC/self-care content during curricular revision/integration directly effects the preparation of graduate ready student pharmacists and ultimately patient's self-managed health outcomes. Considerations include appointing an OTC/self-care champion to oversee the integration of OTC/self-care content as well as post-revision monitoring to ensure core topic areas are being adequately covered in the didactic curriculum and in accordance with best practices.

Lessons Learned from Evaluating a Process for Systematic Curriculum Review.

Objective. To describe an evaluation of and improvements made to a process of systematic curriculum review. Methods. The systematic curriculum review process was developed with the goal of continuous curriculum assessment and improvement. Information on impact and feedback on the processes were collected from curriculum committee experience and an anonymous web-based survey sent to instructors of courses offered by the pharmacy school, and current and past curriculum committee members. Results. Thirty (88%) participants completed the survey with 72% reporting course changes due to systematic curriculum review, such as changes to programmatic outcomes covered (77%), assessment strategies/grading (46%), course outcomes (38%), and content (38%). Based on feedback received, revisions were made to the process: changing the frequency of course review (from every 3 years to 4 years), including experiential and elective courses (supported by 63% of faculty), and streamlining the logistics of course review and presentation to the curriculum committee. Conclusion. The development of the systematic curriculum review process resulted in course improvements and a system to keep curricular mapping current. It was valuable in the most recent preparation of the self-study and could be readily transferred to other institutions.

Professional and pre-professional pharmacy students' perceptions of team based learning (TBL) at a private research-intensive university.

BACKGROUND AND PURPOSE: Pharmacy students need to develop critical thinking and problem-solving skills as well as be a valuable team member. The use of team based learning (TBL) fosters effective team collaboration, enables continuous active and self-directed learning, and requires both individual and team accountability. The purpose was to evaluate pharmacy students' perceptions and experiences related to TBL in different years of the pharmacy curriculum. EDUCATIONAL ACTIVITY AND SETTING: Two classes, Introduction to the Profession of Pharmacy (intro), a required course, and Self-Care/Non-Prescription Medications (self-care), an elective course, utilize the TBL approach. Students enrolled in both courses were recruited to complete a validated questionnaire during the last class. FINDINGS: There was 100% participation; the majority of students, regardless of course, expressed positive attitudes towards TBL. Variations, relevance of TBL activities and the use of TBL as a learning strategy, between the required intro class and the elective self-care class were observed using a Mann-Whitney U test (p<0.05). DISCUSSION: Both cohorts of pharmacy students positively rated the TBL sessions in terms of learning effectiveness. It's important to consider the differences in professional development in these students and how this may impact their perceptions of TBL. TBL imparts more responsibility and accountability on the individual student allowing for the development of self-directed learners. SUMMARY: Students, regardless of their year, found TBL to be an effective learning strategy. Third professional year (P3) pharmacy students further along in the curriculum are more accepting of TBL and are better able to appreciate the benefits of active and self-directed learning as well as working within a team.

SLC44A2 single nucleotide polymorphisms, isoforms, and expression: Association with severity of Meniere's disease?

SLC44A2 was discovered as the target of an antibody that causes hearing loss. Knockout mice develop age related hearing loss, loss of sensory cells and spiral ganglion neurons. SLC44A2 has polymorphic sites implicated in human disease. Transfusion related acute lung injury (TRALI) is linked to rs2288904 and genome wide association studies link rs2288904 and rs9797861 to venous thromboembolism (VTE), coronary artery disease and stroke. Here we report linkage disequilibrium of rs2288904 with rs3087969 and the association of these SLC44A2 SNPs with Meniere's disease severity. Tissue-specific isoform expression differences suggest that the N-terminal domain is linked to different functions in different cell types. Heterozygosity at rs2288904 CGA/CAA and rs3087969 GAT/GAC showed a trend for association with intractable Meniere's disease compared to less severe disease and to controls. The association of SLC44A2 SNPs with VTE suggests that thrombi affecting cochlear vessels could be a factor in Meniere's disease.

Pharmacist Pain E-Consults That Result in a Therapy Change.

Pain specialty pharmacists can provide support to prescribing primary care providers and enable changes in therapy.

Imiquimod enhances IFN-gamma production and effector function of T cells infiltrating human squamous cell carcinomas of the skin.

Squamous cell carcinomas (SCCs) are sun-induced skin cancers that are particularly numerous and aggressive in patients taking T-cell immunosuppressant medications. Imiquimod is a topical immune response modifier and Toll-like receptor 7 (TLR7) agonist that induces the immunological destruction of SCC and other skin cancers. TLR7 activation by imiquimod has pleiotropic effects on innate immune cells, but its effects on T cells remain largely uncharacterized. Because tumor destruction and formation of immunological memory are ultimately T-cell-mediated effects, we studied the effects of imiquimod therapy on effector T cells infiltrating human SCC. SCC treated with imiquimod before excision contained dense T-cell infiltrates associated with tumor cell apoptosis and histological evidence of tumor regression. Effector T cells from treated SCC produced more IFN-gamma, granzyme, and perforin and less IL-10 and transforming growth factor-beta (TGF-beta) than T cells from untreated tumors. Treatment of normal human skin with imiquimod induced activation of resident T cells and reduced IL-10 production but had no effect on IFN-gamma, perforin, or granzyme, suggesting that these latter effects arise from the recruitment of distinct populations of T cells into tumors. Thus, imiquimod stimulates tumor destruction by recruiting cutaneous effector T cells from blood and by inhibiting tonic anti-inflammatory signals within the tumor.

Acquired cutis laxa following urticarial vasculitis associated with IgA myeloma.

Cutis laxa (CL) is an inherited or acquired connective tissue disorder characterized clinically by loosely hanging skin folds. There is often preceding cutaneous inflammatory eruption (ie, urticaria, eczema, erythema multiforme), and there is frequently internal organ involvement of the gastrointestinal, urogenital, pulmonary, and cardiovascular systems. Histologically, there are degenerative changes in the dermal elastic fibers. Of the few reports on this rare disorder, authors have speculated about an immune-mediated destruction of elastic fibers, and monoclonal gammopathies, such as multiple myeloma or heavy chain deposition disease, have a recognized association with CL. We report an unusual case of rapidly progressing acquired CL associated with leukocytoclastic vasculitis, IgA myeloma, and an immune complex-mediated glomerulonephritis. Light microscopy of the lax skin revealed complete absence of elastic fibers in areas of vasculitis.

Skin spicules: A newly described paraneoplastic phenomenon associated with a marginal zone B-cell lymphoma.

Paraneoplastic signs are an important clue to diagnosing an associated malignancy. We report an unusual variant of the sign of Leser-Trélat in a patient with a low-grade B-cell lymphoproliferative disorder and intertriginous skin spicules with histologic morphology of minute seborrheic keratoses.

Human squamous cell carcinomas evade the immune response by down-regulation of vascular E-selectin and recruitment of regulatory T cells.

Squamous cell carcinomas (SCCs) of the skin are sun-induced skin cancers that are particularly numerous in patients on T cell immunosuppression. We found that blood vessels in SCCs did not express E-selectin, and tumors contained few cutaneous lymphocyte antigen (CLA)(+) T cells, the cell type thought to provide cutaneous immunosurveillance. Tumors treated with the Toll-like receptor (TLR)7 agonist imiquimod before excision showed induction of E-selectin on tumor vessels, recruitment of CLA(+) CD8(+) T cells, and histological evidence of tumor regression. SCCs treated in vitro with imiquimod also expressed vascular E-selectin. Approximately 50% of the T cells infiltrating untreated SCCs were FOXP3(+) regulatory T (T reg) cells. Imiquimod-treated tumors contained a decreased percentage of T reg cells, and these cells produced less FOXP3, interleukin (IL)-10, and transforming growth factor (TGF)-beta. Treatment of T reg cells in vitro with imiquimod inhibited their suppressive activity and reduced FOXP3, CD39, CD73, IL-10, and TGF-beta by indirect mechanisms. In vivo and in vitro treatment with imiquimod also induced IL-6 production by effector T cells. In summary, we find that SCCs evade the immune response at least in part by down-regulating vascular E-selectin and recruiting T reg cells. TLR7 agonists neutralized both of these strategies, supporting their use in SCCs and other tumors with similar immune defects.

Intravascular cytotoxic T-cell lymphoma: A case report and review of the literature.

Intravascular lymphoma (IVL) is a rare subtype of extranodal diffuse large B-cell lymphoma in the World Health Organization classification. Although the majority of cases are of B-cell lineage, cases of IVL with a T-cell phenotype and, rarely, histiocytic and natural killer (NK)-cell phenotypes have been reported. We report a case of T-cell IVL with a cytotoxic phenotype. A 62-year-old male presented with erythematous patches and plaques on the lower extremities, and a biopsy revealed IVL with an activated cytotoxic phenotype (CD56(+), perforin+, granzyme B+, TIA-1+, CD3epsilon(+), CD20(-), CD4(-), CD8(-), CD5(-), and T-cell receptor [TCR] betaF1(-)), consistent with either NK-cell or T-cell origin. TCR gene analysis showed a monoclonal T-cell population, supporting the diagnosis of a T-cell IVL. Although the patient's skin lesions were refractory to combination chemotherapy and salvage chemotherapy regimens, there has been no evidence of disease progression in 24 months of follow-up.

Neurocutaneous melanosis in association with encephalocraniocutaneous lipomatosis.

We describe a white female infant with neurocutaneous melanosis (NCM) and encephalocraniocutaneous lipomatosis (ECCL). Multiple, giant and small congenital melanocytic nevi (CMN) were observed on the head, neck and trunk and involved 70% of body surface area. Histologic examination of several CMN revealed atypical nodular proliferations of dermal nevomelanocytes. In a small (<1 cm) truncal CMN, single and dyscohesive intraepidermal nests of atypical nevomelanocytes simulating a superficial spreading melanoma, were observed. The placenta was grossly normal and histologically demonstrated multiple banal appearing nevomelanocytes within the stroma of its villi. At the 17-month follow-up no evidence of primary or metastatic melanoma was present. This previously undescribed association of NCM, ECCL and placental nevomelanocytes provides strong support for the hypothesized causal role of anomalous neural crest morphogenesis and migration in the development of all three disorders. The genetic mechanism underlying these complex birth defects has been hypothesized to result from the action of lethal autosomal dominant genes surviving by mosaicism.