Amy L. Pittenger

DHEA and DHEA‐S: A Review

Dehydroepiandrosterone (DHEA) and its sulfated metabolite DHEA‐S are endogenous hormones secreted by the adrenal cortex in response to adrenocorticotrophin (ACTH). Much has been published regarding potential effects on various systems. Despite the identification of DHEA and DHEA‐S more than 50 years ago, there is still considerable controversy as to their biological significance. This article reviews the metabolism and physiology of DHEA and DHEA‐S, the influence of age and gender on concentrations, and changes in endogenous concentrations associated with disease states and other factors, including diet and exercise. This article is unique in that it also summarizes the influence of drugs on DHEA and DHEA‐S concentrations, as well as concentrations of DHEA and DHEA‐S observed after the administration of DHEA by various routes. Sections of the article specifically address DHEA and DHEA‐S concentrations as they relate to stress, central nervous system function and psychiatric disorders, insulin sensitivity, immunological function, and cardiovascular disorders.

Pharmacokinetics and pharmacodynamics of triazolam after two intermittent doses in obese and normal-weight men

This study was designed to determine whether differences in alpha-1 acid glycoprotein and free drug concentrations result in an altered response to triazolam. Twelve normal-weight and 12 obese adult male subjects received intravenous doses of triazolam, 0.5 mg, on two occasions separated by 1 week. There was a small difference in the alpha-1 acid glycoprotein concentrations between groups but no difference in free fraction of triazolam. There was a longer terminal half-life (t1/2 beta) in the obese subjects (3.16 +/- 0.87 vs. 3.83 +/- 1.24, p = 0.0098). Overall, week 1 data revealed no difference in effect between normal and obese subjects. However, response data reveal a pattern of increased sensitivity with the second exposure to triazolam. For example, area under the effect curve (AUEC) on all tests was significantly greater in week 2 for both groups of subjects. For a memory test and sedation from 0 to 12 hours, AUEC/free AUC ratios were significantly greater in week 2 for all subjects. The obese had a higher ratio on week 2 than on week 1 for all psychomotor tests and sedation (0 to 4.5 hours; p < 0.05). The results of modeling psychomotor impairment-concentration data pooled by group for each week continue the pattern: week 1 data are similar between the obese and normal-weight subjects. Although EC50 values are up to 15% lower in week 2 for the normal-weight subjects, EC50 values are as much as 66% lower in week 2 for the obese, where a lower EC50 indicates greater sensitivity. Logistic regression of the recognition data is consistent with these results.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of Motivational Design on Completion Rates in Online Self-Study Pharmacy-Content Courses

Student retention rates are a constant concern in higher education, but this concern has become especially challenging as online courses become more common and there are widespread reports of low completion rates for online, self‐study courses. We evaluated four self‐study online pharmacy courses with a history of very high completion rates for motivational design features, as an explanation for the difference in completion rates between these classes and those reported in the literature. The validated Instructional Materials Motivation Survey [IMMS] (Keller, 1987) and an open‐ended survey based on Keller’s (1987) ARCS components were used to assess the design and instructional materials of these courses for motivational influence. Specifically, the ARCS components of attention, relevance, confidence, and satisfaction were measured and then compared. Findings suggest that the extent and type of educational scaffolding does impact the motivational effectiveness of self‐study, in online pharmacy‐content courses.

Recognition of Teaching Excellence

The 2008–2009 Task Force for the Recognition of Teaching Excellence was charged by the AACP Council of Faculties Leadership to examine teaching excellence by collecting best practices from colleges and schools of pharmacy, evaluating the literature to identify evidence-based criteria for excellent teaching, and recommending appropriate means to acknowledge and reward teaching excellence. This report defines teaching excellence and discusses a variety of ways to assess it, including student, alumni, peer, and self-assessment. The task force identifies important considerations that colleges and schools must address when establishing teaching recognition programs including the purpose, criteria, number and mix of awards, frequency, type of award, and method of nominating and determining awardees. The report concludes with recommendations for the academy to consider when establishing and revising teaching award programs.

An interprofessional diabetes experience to improve pharmacy and nursing students' competency in collaborative practice.

Objective. To improve pharmacy and nursing students’ competency in collaborative practice by having them participate in an interprofessional diabetes experience involving social networking. Design. An existing elective course on diabetes management was modified to include interprofessional content based on Interprofessional Education Collaborative (IPEC) competency domains. Web-based collaborative tools (social networking and video chat) were used to allow nursing and pharmacy students located on 2 different campuses to apply diabetes management content as an interprofessional team. Assessment. Mixed-method analyses demonstrated an increase in students’ knowledge of the roles and responsibilities of the other profession and developed an understanding of interprofessional communication strategies and their central role in effective teamwork. Conclusion. Interprofessional content and activities can be effectively integrated into an existing course and offered successfully to students from other professional programs and on remote campuses.

Dehydroepiandrosterone, dehydroepiandrosterone-sulfate, and cortisol concentrations in intensive care unit patients.

Study Objective This purpose of this study was to determine whether severity of illness, as defined by the intensive care unit (ICU) admission APACHE II (updated Acute Physiology and Chronic Health Evaluation) score, is correlated with early morning cortisol, dehydroepiandrosterone (DHEA), and/or dehydroepiandrosterone-sulfate (DHEA-S) concentrations. DesignEarly morning concentrations of DHEA, DHEA-S, and cortisol were determined within 24 hrs of admission and compared with admission APACHE II scores. SettingMedical (MICU), neurologic (NICU), and surgical (SICU) intensive care units of the University of Pittsburgh Medical Center. PatientsA total of 191 men and women ranging in age from 16 to 93 yrs. All had been admitted to an ICU. Measurements and Main Results Statistically significant correlations between APACHE II scores and cortisol were observed for women in the MICU and SICU (r = .68, p = .0001;r = .35 p = .017, respectively) and for men in the NICU (r = .55, p = .003) and the SICU (r = .29, p = .036). The correlations between APACHE II scores and DHEA concentration data were statistically significant for women in the MICU (r = .37, p = .047) and SICU (r = .43, p = .002), as was the correlation between APACHE II and DHEA-S concentrations among women in the SICU (r = .38, p = .008). Although not statistically significant, a similar relationship was observed in the smaller group of NICU women (r = .40, p = .099). Each correlation was essentially unchanged when adjusted for age. ConclusionThese data show a positive correlation between APACHE II and cortisol concentrations in all groups except the MICU men. Also evident is the positive correlation between APACHE II scores and DHEA and DHEA-S concentrations in women, but not in men.

Entrustable Professional Activities for Pharmacy Practice

The profession of pharmacy is facing a shifting health system context that holds both opportunity and risk. If the profession of pharmacy is to advance, pharmacists must be recognized as a consistent member of the health care team in all clinical settings, contributing at the fullest extent of licensure and education. One part of achieving this broad goal is to implement a new way of defining and assessing pharmacy practice skills, such as entrustable professional activities (EPA). Assessment of professional tasks and practice activities with EPAs has been successfully implemented in medical education for assessing trainee preparation for practice. This EPA model is being applied to pharmacy education to develop an assessment framework across the advanced pharmacy practice experience (APPE) curriculum. The APPE course directors, practice faculty members, and the Office of Experiential Education collaboratively defined a set of universal EPAs critical for pharmacists in any practice setting and would be assessed in all practice experience types.

Report of the 2016-17 Academic Affairs Standing Committee: Entrustable Professional Activities Implementation Roadmap

EXECUTIVE SUMMARY The purpose of this report is to: 1) Identify linkages across the EPA statements, Center for the Advancement of Pharmacy Education 2013 Educational Outcomes (CAPE 2013) and the Joint Commission of Pharmacy Practitioners’ Pharmacist Patient Care Process (PPCP); 2) Provide ways EPA statements can be used to communicate core skills that are part of the entry-level pharmacist identity; 3) Suggest a potential roadmap for AACP members on how to implement EPA statements.

The Use of Social Networking to Improve the Quality of Interprofessional Education

Objective. To evaluate the feasibility and effectiveness of using an online social networking platform for interprofessional education. Design. Three groups of 6 students were formed with 1 student in each group from medicine, nursing, dentistry, pharmacy, veterinary medicine, and public health. Each group followed a different collaborative educational model with a unique pedagogical structure. Students in all groups interacted via an online social networking platform for a minimum of 15 weeks and met in person once at the end of the 15-week experience for a focus group session. The students were tasked with developing a collaborative recommendation for using social networking in interprofessional education programs. Assessment. Most of the students who reported in a post-experience survey that their expectations were not met were in the minimally structured group. Almost all students in the facilitated and highly structured groups indicated that this experience positively impacted their knowledge of other health professions. Most students stated that interacting within a social networking space for 15 weeks with other members of the university’s health professions programs was a positive and effective interprofessional education experience. Conclusion. Social networking is feasible and can be used effectively within an overall strategy for interprofessional education, but design and placement within a core content course is critical to success.

Peer-led team learning in an online course on controversial medication issues and the US healthcare system.

Objective. To implement peer-led team learning in an online course on controversial issues surrounding medications and the US healthcare system. Design. The course was delivered completely online using a learning management system. Students participated in weekly small-group discussions in online forums, completed 3 reflective writing assignments, and collaborated on a peer-reviewed grant proposal project. Assessment. In a post-course survey, students reported that the course was challenging but meaningful. Final projects and peer-reviewed assignments demonstrated that primary learning goals for the course were achieved and students were empowered to engage in the healthcare debate. Conclusions. A peer-led team-learning is an effective strategy for an online course offered to a wide variety of student learners. By shifting some of the learning and grading responsibility to students, the instructor workload for the course was rendered more manageable.