Effect of Live Attendance and Video Capture Viewing on Student Examination Performance.

Objective. To compare pharmacy students' performance in a therapeutics course after attending live lectures and/or viewing video-recorded lectures. Methods. Attendance was taken during seven lectures spaced equally throughout the therapeutics course. Data on students' viewing of the video-recorded lectures was extracted. Students were grouped based on class attendance and video-viewing behavior; these data were correlated to student performance on examination lecture specific material. The data were also evaluated based on students' final course grade. Results. From each lecture for which data were collected, between 346 and 349 students were included in the analysis, resulting in 2,430 data points. Students who were attended lecture and did not access the video-recorded lecture were associated with better performance on the respective examination than students who were absent and accessed the video-recorded lecture only once (grade=71.0 vs 62.3). Students who attended lecture, regardless of whether they subsequently viewed the video online, were associated with better performance on the examination than students who were absent (70.4 vs 64.0). Among all students who attended lecture, those that also used the video-recorded lecture were associated with similar performance on the examination as those who did not access the video (grade=69.1 vs 71.0). Conclusion. Results from this pilot study demonstrated that live class attendance was associated with higher examination performance than viewing recorded lectures for a therapeutics class. The results of this pilot study can be used to guide future research in understanding how teaching methods affect student performance.

Comparison of long-term knowledge retention in lecture-based versus flipped team-based learning course delivery.

OBJECTIVES: To determine whether team based learning (TBL) is superior to traditional lecture -based learning in confidence and knowledge retention one year later. DESIGN: A survey was administered 17 months after a completion of a required over-the-counter /self-care (OTC) course to two different cohorts of students. The survey assessed confidence and knowledge related to OTC topics. The lecture group had a traditional lecture based classroom experience; the intervention group experienced a TBL format throughout the entire course. ASSESSMENT: One hundred forty-seven students of 283 enrolled (51.9%) in the lecture group and 222 of 305 (72.8%) students in the TBL group participated in the knowledge assessment and survey. Demographic data including student grade point averages (GPA) and confidence were similar in both groups. Mean assessment scores (±SD) on OTC knowledge was significantly higher in the traditional lecture based group versus the TBL group; 62.9±19.3 vs. 54.9±15.7 (p=0.001). CONCLUSION: Although TBL is thought to improve student engagement and mastery of material, after an initial implementation of TBL, knowledge retention in the long term appears to be lower than lecture based learning.

Students' Attitudes, Academic Performance and Preferences for Content Delivery in a Very Large Self-Care Course Redesign.

Objective. To evaluate students' performance/attitudes toward a flipped team-based learning (TBL) format in a "very large" self-care course based on student content delivery preference. Design. Third-year students enrolled in the course were surveyed regarding elements of redesign and homework completion. Additionally, their performance and incoming grade point average were evaluated. Assessment. A survey was completed by 286 of 305 students. Nineteen percent of respondents preferred traditional content delivery, whereas 30% preferred flipped TBL, 48% preferred a mixed format, and 3% had no preference. The grades achieved in the course were: A (49%), B (48%), C (3%) and D (0%). The majority completed "all" or "most" of the homework, appreciated attributes of course redesign, felt home preparation and in-class activities engaged them, and reported improved communication/evaluation skills. Content delivery preference significantly affected attitudes. Conclusion. Students positively received a flipped team-based learning classroom format, especially those who preferred flipped TBL or mixed content delivery. A minority with preference for traditional teaching style did not enjoy the new format; however, their academic performance did not differ significantly from those who did.

Angiotensin II type 1 receptor blocker-induced immune thrombocytopenia: a case report.

INTRODUCTION: The development of thrombocytopenia after a dose increase in losartan and subsequently after switching the patient to valsartan is reported. CASE PRESENTATION: A 61-year-old Caucasian man presented with epistaxis and gingival bleeding of three weeks duration. Laboratory evaluation revealed a hemoglobin level of 144g/L, a leukocyte count of 16.2×109 cells/L (72.51% neutrophils, 20.1% lymphocytes, 6.8% monocytes, 0.4% eosinophils, 0.2% bands), and a platelet count of 15.0×109 cells/L. Flow cytometry of his peripheral blood showed normal CD4:CD8 ratio and no evidence of any lymphoproliferative disorder. A peripheral smear showed decreased platelets with a few areas of clumping. Four weeks before presentation to the emergency room, his losartan dose was increased to 100mg once daily due to continuously elevated blood pressure readings. He had been maintained on losartan 50mg once daily for five years and previous routine laboratory measurements revealed a baseline platelet count of 248.0×109 cells/L.The patient began receiving an oral prednisone taper and his platelet count returned to a stable value of >200×109 cells/L. Because there was no other probable cause, he was thought to have developed immune thrombocytopenia from the increased losartan dose. Losartan was discontinued and one week later he was switched to valsartan 160mg once daily.Forty-seven days after starting valsartan, the patient presented once again to the emergency room with intermittent epistaxis and gingival bleeding while brushing his teeth of two weeks duration. Laboratory measurement revealed a platelet count of 37×109 cells/L. Valsartan was held and another prednisone taper was initiated. The patient's platelet count recovered upon valsartan discontinuation and in four weeks, his platelet count improved to 214×109 cells/L. CONCLUSIONS: A 61-year-old Caucasian man developed immune thrombocytopenia after an increase in losartan dose and developed immune thrombocytopenia again after he was switched to valsartan.

Insulin degludec: a novel basal insulin analogue.

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical trial data, adverse effects, and potential role in therapy of insulin degludec. DATA SOURCES: Articles were identified using the MEDLINE database (January 1996-December 2012). Abstracts and posters were identified from respective congressional websites and published supplements of the American Diabetes Association, the European Association for the Study of Diabetes, and the American Association of Clinical Endocrinologists (January 2008-December 2012). Clinicaltrials.gov was used to identify any ongoing clinical trials or completed trials whose results had not been presented or published. STUDY SELECTION AND DATA EXTRACTION: All available studies were reviewed for inclusion; pharmacokinetic studies were limited to those reporting human data. DATA SYNTHESIS: Insulin degludec is a novel, ultra-long-acting basal insulin analogue that has a similar safety and efficacy profile when compared with insulin glargine in patients with type 1 or type 2 diabetes. Clinical trials have indicated that there is less hypoglycemia, particularly nocturnal hypoglycemia, associated with this agent. CONCLUSIONS: If insulin degludec is approved, it may offer an alternative basal insulin for patients needing more flexible dosing, having a history of nocturnal hypoglycemia, or those with severe insulin resistance needing a higher concentration of basal insulin.

An evaluation of low-dose simvastatin in achieving LDL goal: a retrospective chart review.

Treatment for hyperciholesterolemia targets low-density lipoprotein (LDL) cholesterol. In July 2004, an update to the existingcholesterol guidelines was published that recommended more intense lowering of LDL levels. This study, a retrospective chart review conducted at a multispecialty medical group practice, aimed to determine iflow-dose simvastatin (5 or 10 mg) was effective at achieving LDL goal, in light of these more aggressive guidelines. Demographic data, including risk factors and LDL levels, were collected on 173 patients identified as taking low-dose simvastatin. The review indicated that 66% of patients with low-to-rnoderate cardiovascular risk treated with low-dose simvastatin achieved their risk-appropriate LDL goalMore than 50% of patients who achieved this LDL goal on low-dose simvastatin fell into lower-risk cattegories. Therefore, low-dose simvastatin may be a beneficial treatment option for patients in lower cardiovascular-risk categories.

Adenoid basal carcinoma of the cervix in a 20-year-old female: a case report.

BACKGROUND: Adenoid basal carcinoma of the cervix is a rare condition mostly occurring among postmenopausal women. Although it can be confused with adenoid cystic carcinoma of the cervix, adenoid basal carcinoma has several clinicopathologic features that will allow distinction from adenoid cystic carcinoma. CASE PRESENTATION: This is the case of a twenty-year old African-American female who initially presented with a high-grade squamous intraepithelial lesion on Pap smear, with a subsequent cervical LEEP specimen revealing adenoid basal carcinoma. The lesion showed the characteristic histologic features of adenoid basal carcinoma and was positive for the immunohistochemical marker EMA and negative for collagen IV, further defining the tumor while helping to rule out the possibility of adenoid cystic carcinoma. As far as the authors are aware, this is the youngest reported case of adenoid basal carcinoma to date. CONCLUSION: This case shows that adenoid basal carcinoma can deviate markedly from its typical postmenopausal demographics to affect women as young as 20 years of age. In addition, adenoid basal carcinoma has several identifiable features that will differentiate it from adenoid cystic carcinoma including histologic and cellular morphologies, as well as immunohistochemistry. Treatment for most patients involves hysterectomy, LEEP, or a conization procedure which provides a favorable prognosis because of this lesion's low potential for recurrence and metastasis.

An update on the pharmacological treatment of obesity.

OBJECTIVE: To review the commonly utilized pharmacological options for the treatment of overweight and obese patients in the United States. METHODS: A MEDLINE and EMBASE search, in English, between January 1995 and November 2005 was conducted using the terms, "anti-obesity agents", "orlistat", "sibutramine", and "phentermine". References cited in relevant studies and reviews were also examined for additional clinical trials to be included in the review. RESULTS: There are several pharmacological options currently available for the treatment of overweight and obese individuals in the United States, including phentermine, sibutramine, and orlistat, with only sibutramine and orlistat being indicated for use in the long term (> 6 months). However, none of these medications have proven to be more effective than another for the indication of weight loss, each with a very similar maximum weight loss potential. Therefore choosing a weight loss medication should be patient specific and based on its pharmacological profile, including mechanism of action and potential adverse effects. Most importantly, it is imperative to realize that these agents are only indicated for use when combined with lifestyle modifications. Most studies have indicated that maximum benefits from any of these medications are only shown when taken in addition to a hypocaloric diet. CONCLUSION: It has been shown that the combination of lifestyle changes and pharmacological treatment leads to a greater decrease in total body weight loss. Treatment with anti-obesity agents is associated with side effects and an increased cost in health care. These factors must be weighed prior to initiating anti-obesity treatment.