Elizabeth Pogge

Vitamin D and Alzheimer's disease: is there a link?

OBJECTIVE To review the research on a possible link between Alzheimers disease (AD) and vitamin D deficiency. DATA SOURCE MEDLINE/PUBMED (January 1950-January 2010) and ISI Web of Science searches (January 1900-January 2010) were conducted using the key words vitamin D, Alzheimer disease, and dementia to identify pertinent studies. The Cochrane Library was searched to identify review articles along with clinicaltrials.gov to identify unpublished research. STUDY SELECTION AND DATA EXTRACTION Vitamin D and (Alzheimer* disease or dementia) was entered into each database. Manual review of the search results identified trials that discussed an association between AD or dementia and vitamin D. Manual bibliography searches were performed to identify other pertinent articles. DATA SYNTHESIS Vitamin D deficiency is a widespread problem among the elderly and has been associated with multiple disease states. Vitamin D deficiency has recently been linked to dementia, particularly AD, through several mechanisms. Current clinical trials discuss a possible link between low vitamin D levels and low cognitive test scores in AD patients. CONCLUSION The current observational studies seem to identify a link between vitamin D and dementia, particularly AD. Before this evidence can be used to make a recommendation for routine supplementation in elderly patients to prevent AD, more prospective trials with a longer follow-up period are needed to show a causality relationship.

A Team-Based Learning Course on Nutrition and Lifestyle Modification

Objective. To create, implement, and evaluate an elective team-based learning (TBL) course on nutrition and lifestyle modification for pharmacy students. Design. An elective course with 15 contact hours was developed for second-year pharmacy students based on the principles of TBL. Student knowledge gained and satisfaction with the course were measured. Assessment. Sixty-two students completed the course. Knowledge about nutrition and lifestyle modification was significantly improved by completing the course (59% and 91%, respectively, p=<0.001). The satisfaction survey instrument had a response rate of 97%, and the majority of students (>85%) responded favorably to the TBL components. Conclusion. An elective course using TBL effectively delivered course content while teaching students communication and teamwork skills. The course was well received by students.

Elevated International Normalized Ratio Associated with Use of Dronedarone and Warfarin

Objective: To describe a case of elevated International normalized ratio (INR) after addition of dronedarone to warfarin therapy. Case Summary: A 72-year-old white female with a history of tinnitus, gastroesophageal reflux disease, and permanent pacemaker implantation was taking warfarin (target INR 2-3) and Sotalol for chronic atrial fibrillation; atorvastatin for hyperlipidemia; and risedronate for osteopenia. Her warfarin therapy had been managed by a nurse-run anticoagulation clinic for several years. During the prior year, her INR had been stable with a weekly dose of warfarin 25 mg. After persistent episodes of atrial fibrillation, the antiarrhythmic agent was changed from Sotalol to dronedarone 400 mg twice daily. Approximately 10 days after starting dronedarone, the INR was 4.6; she stated that there was no bleeding. The warfarin dose was decreased to 20 mg/wk, and the INR remained stable with that dosage for the next 11 months. Discussion: Postmarketing surveillance has revealed cases of increased INR values with or without bleeding in patients taking warfarin who were started on dronedarone. In this case, the Horn Drug Interaction Probability Scale suggested a probable causality for an interaction between dronedarone and warfarin. Based on current knowledge, this interaction may involve an indirect gastrointestinal mechanism and/or a direct pharmacokinetic mechanism. Conclusions: Clinicians should monitor patients who are taking warfarin and dronedarone for INR changes and bleeding episodes about 1 week after initiation of dronedarone. If a significant interaction Is noted, the warfarin dosage should be decreased and the patient should be monitored within 2 weeks to assess the need for further adjustments.

Effect of a 12-Week Nutrition and Wellness Program in Independent Living Seniors

Almost one third of total United States health care dollars are spent on older adults, which will continue to rise as the number of older Americans increases. Several large-scale health and wellness programs have been able to demonstrate positive health and financial outcomes for people older than 65 years. The Academy of Nutrition and Dietetics, along with the American Society for Nutrition and the Society for Nutrition Education and Behavior, has issued a position statement that all older adults should have access to food and nutrition programs. The common framework for developing nutrition education programs includes messages that are simple, targeted, practical, limited in number, and reinforced; incentives; regular contact with health care professionals; active involvement in determining goals of intervention; hands-on activity; and a focus on behavior modification based on theoretical models.

Evaluation of a Pharmacist and Nurse Practitioner Smoking Cessation Program

Purpose: To evaluate the efficacy of a smoking cessation program led by a pharmacist and a nurse practitioner. Methods: During a 6-month period, patients attended 7 one-on-one face-to-face smoking cessation counseling sessions with a pharmacist and 1 to 2 one-on-one face-to-face smoking cessation counseling sessions with a nurse practitioner. The primary outcome was smoking cessation point prevalence rates at months 1, 3, and 5 post-quit date. Secondary outcomes included medication adherence rates at months 1, 3, and 5 post-quit date, nicotine dependence at baseline versus program end, and patient satisfaction. Results: Nine (47%) of 19 total participants completed the program. Seven of the 9 patients who completed the program were smoke-free upon study completion. Point prevalence rates at months 1, 3, and 5 post-quit date were 66%, 77%, and 77%, respectively, based on patients who completed the program. Medication adherence rates were 88.6%, 54.6%, and 75% at months 1, 3, and 5 post-quit date, respectively. Based on the Fagerstrom test, nicotine dependence decreased from baseline to the end of the study, 4.89 to 0.33 (P < .001). Overall, participants rated the program highly. Conclusion: A joint pharmacist and nurse practitioner smoking cessation program can assist patients in becoming smoke-free.

A Pilot Study on an Interprofessional Course Involving Pharmacy and Dental Students in a Dental Clinic

Objective. To assess the effect of a dental clinical rotation program involving pharmacy students and dental students. Methods. An interprofessional education (IPE) course was offered as an elective to second-year pharmacy students and required for third-year dental students. The course included two in-class sessions, one online lecture, and five clinic sessions. Program evaluation analyses included a comparison of participating versus nonparticipating students on a knowledge survey of pharmacotherapy and IPE, and a descriptive analysis of IPE course evaluation results. Results. Among pharmacy students, mean scores were significantly higher for participants than nonparticipants on the 31-item pharmacy knowledge component of the survey. On the eight-item IPE component of the survey, scores were significantly higher for participants than for nonparticipants, both among pharmacy students and among dental students. Awareness and attitudes about IPE were generally high among course participants. Conclusion. An IPE course that integrates second-year pharmacy students with third-year dental students in the dental clinic to provide medication history, education, and identification of potential drug-related problems improved pharmacy students’ knowledge of pharmacotherapy related to or associated with dental conditions and improved pharmacy and dental students’ knowledge and attitudes about IPE.

Evaluation of an interprofessional team-based learning nutrition and lifestyle modification course

ABSTRACT An interprofessional, team-based learning elective was developed, implemented, and evaluated to determine the knowledge gained, attitude changes towards interprofessional education, and overall satisfaction with the course. Thirty participants, 14 osteopathic medicine students and 16 pharmacy students, completed the course. The majority of students (88–96%) responded favourably to the team-based learning aspects of the course. Knowledge about nutrition and lifestyle modification was significantly improved by taking the course. Overall, students’ readiness for and perception of interprofessional learning improved by taking the course, although not all improvements were statistically significant. In conclusion, the benefits of team-based learning, such as enhancing communication and teamwork skills, can enhance interprofessional education.

Vitamin D for the Prevention of Alzheimer’s Disease

Abstract Alzheimer’s disease is an incurable degenerative dementia that affects individuals’ quality of life. Because Alzheimer’s disease is incurable, current studies are aimed at prevention as well as delaying the progression of the disease. Vitamin D is a hormone that has been proven to be important in skeletal health and has been implicated in the development of many non-skeletal-related diseases. Expert committees have recommended that individuals at risk for vitamin D insufficiency have a 25(OH)D3 level drawn, and treatment should be given to reach sufficient levels. Several theories have linked vitamin D insufficiency to decreased cognition. For this reason, observational studies have explored the link between vitamin D and dementia, with most results pointing to the fact that low vitamin D levels are associated with poorer cognition. Before vitamin D supplementation is recommended for the prevention of Alzheimer’s disease, large, randomized, controlled trials are needed.