Eric J. Ip

The Anabolic 500 Survey: Characteristics of Male Users versus Nonusers of Anabolic-Androgenic Steroids for Strength Training

Study Objective. To contrast the characteristics of two groups of men who participated in strength‐training exercise—those who reported anabolic‐androgenic steroid (AAS) use versus those who reported no AAS use.

Enhancing diabetes care by adding a pharmacist to the primary care team

PURPOSE The impact of pharmacist interventions on short-term clinical markers and long-term cardiovascular risk in patients with type 2 diabetes is investigated. METHODS Selected health outcomes were retrospectively analyzed in 147 adults with type 2 diabetes whose care was managed by a team of providers including a pharmacist (the enhanced care group) and a matched sample of patients (n = 147) managed by a primary care physician only (the control group). All patients received services through the same health maintenance organization (HMO). The primary study endpoints were (1) the changes from baseline to 12-month follow-up in glycosylated hemoglobin (HbA(1c)), low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) values, (2) rates of attainment of HbA(1c), LDL-C and BP goals, and (3) changes from baseline in predicted 10-year risks of coronary heart disease (CHD) and stroke. RESULTS During the 12-month study period, the mean HbA(1c) value was decreased from 9.5% to 6.9% in the enhanced care group and from 9.3% to 8.4% in the control group (p < 0.001); patients in the enhanced care group were significantly more likely to attain goals for HbA(1c) (odds ratio [OR], 3.9), LDL-C (OR, 2.0), and BP reduction (OR, 2.0) and three times more likely to attain all three goals (OR, 3.2). The estimated 10-year risk of CHD was decreased from 16.4% to 9.3% with enhanced care versus a reduction from 17.4% to 14.8% with usual care (p < 0.001). CONCLUSION The addition of a pharmacist to an HMO primary care team improved short-term surrogate markers as well as long-term cardiovascular risk in adult patients with type 2 diabetes.

Pharmacy students' performance and perceptions in a flipped teaching pilot on cardiac arrhythmias.

Objective. To implement the flipped teaching method in a 3-class pilot on cardiac arrhythmias and to assess the impact of the intervention on academic performance and student perceptions. Design. An intervention group of 101 first-year pharmacy students, who took the class with the flipped teaching method, were supplied with prerecorded lectures prior to their 3 classes (1 class in each of the following subjects: basic sciences, pharmacology, and therapeutics) on cardiac arrhythmias. Class time was focused on active-learning and case-based exercises. Students then took a final examination that included questions on cardiac arrhythmias. The examination scores of the intervention group were compared to scores of the Spring 2011 control group of 105 first-year students who took the class with traditional teaching methods. An online survey was conducted to assess student feedback from the intervention group. Assessment. The mean examination scores of the intervention group were significantly higher than the mean examination scores of the control group for the cardiac arrhythmia classes in pharmacology (with 89.6 ± 2.0% vs 56.8 ± 2.2%, respectively) and therapeutics (89.2 ± 1.4% vs 73.7 ± 2.1%, respectively). The survey indicated higher student satisfaction for flipped classes with highly rated learning objectives, recordings, and in-class activities. Conclusion. Use of the flipped teaching method in a 3-class pilot on cardiac arrhythmias improved examination scores for 2 of the 3 classes (pharmacology and therapeutics). Student satisfaction was influenced by the quality of the learning objectives, prerecorded lectures, and inclass active-learning activities.

Psychological and Physical Impact of Anabolic-Androgenic Steroid Dependence

To contrast the characteristics of two groups of anabolic‐androgenic steroid (AAS) users—those with versus those without AAS dependence.

Women and anabolic steroids: an analysis of a dozen users.

Objective:To provide an in-depth analysis of 12 female self-reported anabolic-androgenic steroid (AAS) users. Design:Web-based survey. Setting:A Web-based survey was posted on 38 discussion boards of various fitness, bodybuilding, weightlifting, and steroid Web sites between February and June 2009. Interventions:Participants completed a survey regarding demographics and use of AAS and other performance-enhancing agents (PEAs). Participants:A cohort of 1519 strength-trained subjects fully completed and submitted a valid survey. Five hundred eighteen subjects were self-reported AAS users consisting of 12 women and 506 men. One thousand one subjects were non-AAS users consisting of 230 women and 771 men. Main Outcome Measures:Demographic data and use of AAS and other PEAs. Results:The female AAS users reported using an average of 8.8 PEAs in their routine. Compared with male AAS users and female non-AAS users, respectively, female AAS users were more likely to have met criteria for substance-dependence disorder (58.3% vs 23.4%; P = 0.01; 58.3% vs 9.1%; P < 0.001), have been diagnosed with a psychiatric illness (50.0% vs 17.4%; P = 0.01; 50.0% vs 22.2%; P = 0.04), and have reported a history of sexual abuse (41.7% vs 6.1%; P < 0.001; 41.7% vs 15.3%; P = 0.03). Conclusions:Female AAS users practice polypharmacy. Female AAS users are more likely to have qualified for substance-dependence disorder, have been diagnosed with a psychiatric illness, and have a history of sexual abuse than both male AAS users and female non-AAS users.

The Touro 12-Step: A Systematic Guide to Optimizing Survey Research with Online Discussion Boards

The Internet, in particular discussion boards, can provide a unique opportunity for recruiting participants in online research surveys. Despite its outreach potential, there are significant barriers which can limit its success. Trust, participation, and visibility issues can all hinder the recruitment process; the Touro 12-Step was developed to address these potential hurdles. By following this step-by-step approach, researchers will be able to minimize these pitfalls and maximize their recruitment potential via online discussion boards.

Low-dose filgrastim in patients with breast cancer treated with docetaxel, doxorubicin, and cyclophosphamide

PURPOSE The objective of this study was to compare low-dose filgrastim (150 microg/day subcutaneously) with standard-dose subcutaneous filgrastim (300 microg/day) or lenograstim (263 microg/day) in preventing febrile neutropenia and hospitalizations in breast cancer patients receiving the docetaxel-doxorubicin-cyclophosphamide regimen. METHODS A single-center retrospective data analysis was performed involving 22 adult women with breast cancer who concurrently received the docetaxel-doxorubicin-cyclophosphamide chemotherapy regimen and low-dose filgrastim from March 2004 to February 2007. Data from this study were compared to previously published data in which patients received standard-dose filgrastim or lenograstim. RESULTS More patients developed febrile neutropenia in the low-dose filgrastim group compared with the standard-dose group (32% versus 7.5%, respectively; p = 0.0014; relative risk [RR] = 4.24; 95% confidence interval [CI], 2.04-7.83). More patients were hospitalized due to febrile neutropenia in the low-dose filgrastim group compared with the standard-dose group (32% versus 6.5%, respectively; p < 0.001; RR = 4.89; 95% CI, 2.32-9.13). More chemotherapy cycles resulted in febrile neutropenia in the low-dose filgrastim group compared with the standard-dose group (6.7% versus 1.2%, respectively; p < 0.001; RR = 5.58; 95% CI, 2.49-12.27). CONCLUSION In patients with breast cancer treated with the docetaxel-doxorubicin-cyclophosphamide regimen, low-dose filgrastim was associated with a higher frequency of febrile neutropenia, hospitalization due to febrile neutropenia, and cycles with febrile neutropenia compared with a historical control group treated with standard-dose filgrastim or lenograstim.

A Randomized Prospective Study on Outcomes of an Empathy Intervention among Second-year Student Pharmacists

Objective. To determine the impact of a single, 3-day intervention on empathy levels as measured by the validated Jefferson Scale of Empathy-Health Profession Students version (JSE-HPS). Methods. Forty second-year student pharmacists were recruited to participate in a non-blinded prospective study. Subjects were randomized to an intervention group (n=20) or control group (n=20) and completed the JSE-HPS at baseline, 7 days postintervention, and 90 days postintervention. The intervention group consisted of a 3-day simulation, each day including a designated activity with loss of dominant hand usage, vision, and speech. Results. The 3-day simulation increased empathy levels in the intervention group compared to the control group 7 days postintervention (p=0.035). However, there were no effects on empathy levels 90 days postintervention (p=0.38). Conclusion. Empathy scores increased but were not sustained in the long-term with a 3-day empathy intervention.

Weightlifting's Risky New Trend: A Case Series of 41 Insulin Users

Use of performance-enhancing drugs (PEDs) is common among strength-trained individuals, and a growing concern is the misuse of insulin. A 99-item Internet-based survey was posted on discussion boards of various fitness, bodybuilding, weightlifting, and anabolic steroid Web sites between February and June 2009. A case series of 41 nondiabetic insulin users is described. The typical insulin user was 30.7 ± 9.2 years old, male (97.6%), and Caucasian/white (86.8%) who classified himself as a “recreational exerciser” (47.5%). The average insulin user also used anabolic steroids (95.1%) and practiced polypharmacy by incorporating 16.2 ± 5.6 PEDs in his or her yearly routine. Hypoglycemia was reported by most of the subjects (56.8%), and one individual reported unconsciousness. Insulin was obtained most commonly from local sources (e.g., friends, training partners, gym member/dealer; 40.5%) and community pharmacies (37.8%), with most (80.6%) finding it “easy” to acquire their insulin. Strategies aimed to prevent insulin misuse are needed.

Characteristics and Behaviors of Older Male Anabolic Steroid Users.

Objective: To compare and contrast the characteristics of 2 groups of men ≥40 years old: reported anabolic–androgenic steroid (AAS) users and nonusers. Design: Cross-sectional survey. Setting: Thirty-eight online fitness, weight lifting, bodybuilding, and steroid Web sites. Participants: A total of 67 male AAS users and 76 male nonusers ≥40 years old. Main Outcomes Measured: Demographics, utilization of AAS and other performance-enhancing agents (PEAs), exercise patterns, history of illicit drugs and alcohol use, and psychiatric traits/diagnoses. Results: The majority of AAS users ≥40 years old were caucasian (92.5%), heterosexual (97.0%), and classified themselves as recreational exercisers (79.1%). AAS users took more PEAs (11.5 ± 5.6 vs 4.6 ± 2.7; P < .001), were more likely to binge drink (47.8% vs 29.0%; P = .025), report heavy alcohol use (21.0% vs 7.9%; P = .031), meet criteria for substance dependence disorder (27.4% vs 4.0%; P < .001), and report an anxiety disorder diagnosis (12.0% vs 2.6%; P = .046) than nonusers. Conclusions: AAS misuse is prevalent among older men and is associated with polypharmacy, more aggressive alcohol use, and a higher incidence of substance dependence and anxiety disorders compared to nonusers. This information may help clinicians and researchers identify and develop appropriate intervention strategies for AAS abuse among older men.