Beyond peer observation of teaching

OBJECTIVE To summarize the evidence on effectiveness of translational diabetes prevention programs, based on promoting lifestyle change to prevent type 2 diabetes in real-world settings and to examine whether adherence to international guideline recommendations is associated with effectiveness. RESEARCH DESIGN AND METHODS Bibliographic databases were searched up to July 2012. Included studies had a follow-up of ≥12 months and outcomes comparing change in body composition, glycemic control, or progression to diabetes. Lifestyle interventions aimed to translate evidence from previous efficacy trials of diabetes prevention into real-world intervention programs. Data were combined using random-effects meta-analysis and meta-regression considering the relationship between intervention effectiveness and adherence to guidelines. RESULTS Twenty-five studies met the inclusion criteria. The primary meta-analysis included 22 studies (24 study groups) with outcome data for weight loss at 12 months. The pooled result of the direct pairwise meta-analysis shows that lifestyle interventions resulted in a mean weight loss of 2.12 kg (95% CI -2.61 to -1.63; I(2) = 91.4%). Adherence to guidelines was significantly associated with a greater weight loss (an increase of 0.3 kg per point increase on a 12-point guideline-adherence scale). CONCLUSIONS Evidence suggests that pragmatic diabetes prevention programs are effective. Effectiveness varies substantially between programs but can be improved by maximizing guideline adherence. However, more research is needed to establish optimal strategies for maximizing both cost-effectiveness and longer-term maintenance of weight loss and diabetes prevention effects

Tegument Assembly and Secondary Envelopment of Alphaherpesviruses.

Alphaherpesviruses like herpes simplex virus are large DNA viruses characterized by their ability to establish lifelong latent infection in neurons. As for all herpesviruses, alphaherpesvirus virions contain a protein-rich layer called "tegument" that links the DNA-containing capsid to the glycoprotein-studded membrane envelope. Tegument proteins mediate a diverse range of functions during the virus lifecycle, including modulation of the host-cell environment immediately after entry, transport of virus capsids to the nucleus during infection, and wrapping of cytoplasmic capsids with membranes (secondary envelopment) during virion assembly. Eleven tegument proteins that are conserved across alphaherpesviruses have been implicated in the formation of the tegument layer or in secondary envelopment. Tegument is assembled via a dense network of interactions between tegument proteins, with the redundancy of these interactions making it challenging to determine the precise function of any specific tegument protein. However, recent studies have made great headway in defining the interactions between tegument proteins, conserved across alphaherpesviruses, which facilitate tegument assembly and secondary envelopment. We summarize these recent advances and review what remains to be learned about the molecular interactions required to assemble mature alphaherpesvirus virions following the release of capsids from infected cell nuclei.HSV-1 research in the laboratory of CMC is supported by the Leverhulme Trust (Grant RPG-2012-793) and the Biotechnology and Biological Sciences Research Council (Grant BB/M021424/1). SCG is a Sir Henry Dale Fellow jointly funded by the Wellcome Trust and the Royal Society (Grant Number 098406/Z/12/Z)This is the final version of the article. It first appeared from MDPI via http://dx.doi.org/10.3390/v709286

Exploring the Adverse Effects of CAR-T Therapy: A Cases Report of Potential MINOCA in CAR-T

A 48-year-old man with a history of Stage IV Diffuse Large B-Cell Lymphoma refractory to R-CHOP alternating with high-dose methotrexate and cytarbine, craniospinal irradiation, and haploidentical stem cell transplant, underwent CD 19-directed CAR-T

Assessing Patient Adherence and Satisfaction: Clinical Services Beyond the Pharmacy Counter

Medication adherence is a bigger problem than many of us are willing to admit. If patients do not take their medications as prescribed, they will not get the full therapeutic benefits and will put themselves at risk if serious harm. An estimated 125,000 deaths occur in the United States annually due to non-adherence. The objective of this study is to establish a pharmacy intervention model that best provides patient satisfaction and improved medication adherence through the use of home visits and follow-up calls by pharmacists and pharmacy interns at Clark’s Pharmacy. In order to do this, patients receiving home visits from pharmacists or pharmacy interns will receive phone calls 90 days after every visit. These will be patients that have recently been discharged from skilled nursing facilities and other health care centers. In the calls, survey questions will be asked in order to measure their adherence and satisfaction with the pharmacy. Satisfaction will be measured in addition to adherence because studies show that there is a positive correlation between it and adherence. The questions will be formulated in consultation with a pharmacist who has used a similar survey over the phone before. We will need to use convenience sampling, since only patients of Clark’s Pharmacy already being visited at home will qualify to participate. This will be a cross-sectional study. Once data has been collected, SPSS will be used to run descriptive statistics, as well as a Chi-squared test. Data collection will take place from the spring of 2015 until the fall of 2016

Patients’ Perceptions of Pharmacist Intervention Through Pre-Screened Medication Therapy Management Service

Background: The continued challenge of time commitment in a community pharmacy setting is reported by pharmacists as the single largest setback in providing quality patient care. Additionally, when efforts are made by pharmacists to intervene on a patient’s therapy through medication therapy management (MTM), patient “no shows” further challenge an already busy community pharmacy world. Many studies show the value of a pharmacist-patient relationship. However, continued barriers prevent the value of this relationship to take full effect. While numerous methods of comprehensive medication review take place, the issue of establishing a model that best suits the needs of community pharmacy patients still exists. Statement of the Problem: To assess patients’ perceptions of pharmacist intervention through a pre-screened medication therapy management service at prescription pick-up. Description of Methodology: This study utilized a nonprobability convenience sampling of MTM participants at a local community pharmacy pickup for research. A questionnaire was designed to assess patients’ perceptions prior to and after the pharmacist intervention. All adult patients willing to participate in MTM services were included. After the MTM intervention, participants were encouraged to complete the questionnaire at home and mail it back to the pharmacy. The questionnaires were then collected from the pharmacy for review and data was analyzed with SPSS software. Results: Reported increased patient satisfaction and knowledge by survey following the MTM intervention. Unfortunately, the results were insignificant and the study did not achieve ideal power. Conclusions: The descriptive statistical results enumerated in this study do not reveal any applicable trends relating to the use of MTM services at-large. Despite these findings, however, all patients who commented on the intervention provided positive feedback. Further research is encouraged to appropriately assess the value of pharmacist-delivered MTM at prescription pick-up

Risk factors for heart failure in patients with type 2 diabetes mellitus and stage 4 chronic kidney disease treated with bardoxolone methyl

Background: A phase 3 randomized clinical trial was designed to test whether bardoxolone methyl, a nuclear factor erythroid-2–related factor 2 (Nrf2) activator, slows progression to end-stage renal disease in patients with stage 4 chronic kidney disease and type 2 diabetes mellitus. The trial was terminated because of an increase in heart failure in the bardoxolone methyl group; many of the events were clinically associated with fluid retention.<p></p> Methods and Results: We randomized 2,185 patients with type 2 diabetes mellitus (T2DM) and stage 4 chronic kidney disease (CKD) (estimated glomerular filtration rate 15 to <30 mL min−1 1.73 m−2) to once-daily bardoxolone methyl (20 mg) or placebo. We used classification and regression tree analysis to identify baseline factors predictive of heart failure or fluid overload events. Elevated baseline B-type natriuretic peptide and previous hospitalization for heart failure were identified as predictors of heart failure events; bardoxolone methyl increased the risk of heart failure by 60% in patients with these risk factors. For patients without these baseline characteristics, the risk for heart failure events among bardoxolone methyl– and placebo-treated patients was similar (2%). The same risk factors were also identified as predictors of fluid overload and appeared to be related to other serious adverse events.<p></p> Conclusions: Bardoxolone methyl contributed to events related to heart failure and/or fluid overload in a subpopulation of susceptible patients with an increased risk for heart failure at baseline. Careful selection of participants and vigilant monitoring of the study drug will be required in any future trials of bardoxolone methyl to mitigate the risk of heart failure and other serious adverse events.<p></p&gt

Impact of Social Contact on Predator-Induced Fear Responses in Young Male Chicks

Post-Traumatic Stress Disorder (PTSD) is thought to involve unusually strong associative memories between the intense fear felt during a traumatic experience and other environmental cues present at the time of the trauma. Our study uses an animal model to investigate social contact, one of the factors that can impact fear responses, to learn more about possible risk factors or interventions that may be relevant to humans who may experience PTSD. Freezing, or the cessation of movement, is a common fear response observed in laboratory animals in the presence of a perceived threat. We tested whether or not the degree of fear expressed by a social companion impacted the level of fear demonstrated by young male chicks. We initially predicted that the presence of a companion would reduce the fear demonstrated by a chick in response to an audiovisual predator stimulus, known as social buffering of fear. Previous results in our lab actually demonstrated the opposite effect. Chicks that experienced predator stimuli in the presence of another chick remained immobile longer than those who experienced the predator alone. It seemed as though chicks were mirroring the fear expressed by their companion. The current study was aimed at investigating whether social transmission of fear is, in fact, occurring between chicks. In order to more carefully control the fear response of companion chicks, we created two different videos to serve as the “companion” stimuli in this experiment. In one, a control chick walked around naturally, and in another, the chick demonstrated fear that was timed to the onset of the predator stimulus. After three daily habituation sessions to the testing apparatus and video screen, 48 Cornish Cross chicks were exposed to one of four conditions: no predator stimulus and a non-fearful video companion, no predator stimulus and a fearful companion, predator stimulus and a non-fearful companion, or predator stimulus and a fearful companion. One chick from each home cage was randomly assigned to each condition. Half of the chicks were exposed to the predator stimuli and half were not. In each group, half were paired with a fearful companion video and half were paired with a non-fearful companion video. Activity of each chick was recorded and quantified by behavioral analysis software (Smart 3.0, Panlab). Statistical analysis revealed a significant main effect of the predator stimulus, F(1, 89) = 28.11,