James W. Fetterman

Therapeutic potential of n-3 polyunsaturated fatty acids in disease

PURPOSE The potential therapeutic benefits of supplementation with n-3 polyunsaturated fatty acids (PUFAs) in various diseases are reviewed, and the antiinflammatory actions, activity, and potential drug interactions and adverse effects of n-3 PUFAs are discussed. SUMMARY Fish oils are an excellent source of long-chain n-3 PUFAs, such as eicosapentaenoic acid and docosahexaenoic acid. After consumption, n-3 PUFAs can be incorporated into cell membranes and reduce the amount of arachidonic acid available for the synthesis of proinflammatory eicosanoids (e.g., prostaglandins, leukotrienes). Likewise, n-3 PUFAs can also reduce the production of inflammatory cytokines, such as tumor necrosis factor alpha, interleukin-1, and interleukin-6. Considerable research has been conducted to evaluate the potential therapeutic effects of fish oils in numerous conditions, including arthritis, coronary artery disease, inflammatory bowel disease, asthma, and sepsis, all of which have inflammation as a key component of their pathology. Additional investigations into the use of supplementation with fish oils in patients with neural injury, cancer, ocular diseases, and critical illness have recently been conducted. The most commonly reported adverse effects of fish oil supplements are a fishy aftertaste and gastrointestinal upset. When recommending an n-3 PUFA, clinicians should be aware of any possible adverse effect or drug interaction that, although not necessarily clinically significant, may occur, especially for patients who may be susceptible to increased bleeding (e.g., patients taking warfarin). CONCLUSION The n-3 PUFAs have been shown to be efficacious in treating and preventing various diseases. The wide variation in dosages and formulations used in studies makes it difficult to recommend dosages for specific treatment goals.

Consortium-based approach to an online preceptor development program.

Objective. To describe the implementation process of a consortium-based preceptor development program and to review completion and assessment data over the first 27 months. Design. Five 1-hour, Web-based preceptor development modules were developed using streaming media technologies. Modules were released using a password-protected Internet site and were free to consortium-affiliated preceptors. Preceptors institutional affiliation, module completion dates, module assessments, and continuing education credits were recorded and made available to each institution. Assessment. Three hundred eighty-two preceptors completed 1489 modules. Fifty-six percent of preceptors were affiliated with more than 1 consortium institution. The number of participating preceptors per institution varied from 72 to 204. Sixty-five percent of preceptors completed all 5 modules. Preceptor satisfaction was high, with 93% agreeing with each course evaluation statement. Program cost per institution ranged from

Impact of Advanced Pharmacy Practice Experience Placement Changes in Colleges and Schools of Pharmacy

12 to

Enteral Nutrition in the Chronic Obstructive Pulmonary Disease (COPD) Patient

35 per preceptor. Conclusions. A consortium-based approach to preceptor development is a convenient and effective means of providing required training.

Enteral and Parenteral Nutrition for the Diabetic Patient: A Case-Based Approach

Objective. To document the annual number of advanced pharmacy practice experience (APPE) placement changes for students across 5 colleges and schools of pharmacy, identify and compare initiating reasons, and estimate the associated administrative workload. Methods. Data collection occurred from finalization of the 2008-2009 APPE assignments throughout the last date of the APPE schedule. Internet-based customized tracking forms were used to categorize the initiating reason for the placement change and the administrative time required per change (0 to 120 minutes). Results. APPE placement changes per institution varied from 14% to 53% of total assignments. Reasons for changes were: administrator initiated (20%), student initiated (23%), and site/preceptor initiated (57%) Total administrative time required per change varied across institutions from 3,130 to 22,750 minutes, while the average time per reassignment was 42.5 minutes. Conclusion. APPE placements are subject to high instability. Significant differences exist between public and private colleges and schools of pharmacy as to the number and type of APPE reassignments made and associated workload estimates.

Barriers to Expanding Advanced Pharmacy Practice Experience Site Availability in an Experiential Education Consortium

Chronic obstructive pulmonary disease (COPD) is a progressive, chronic disease, in which malnutrition can have an undesirable effect. Therefore, the patient’s nutritional status is critical for optimizing outcomes in COPD. The initial nutrition assessment is focused on identifying calorically compromised COPD patients in order to provide them with appropriate nutrition. Nutritional intervention consists of oral supplementation and enteral nutrition to prevent weight loss and muscle mass depletion. Evaluation of nutritional status should include past medical history (medications, lung function, and exercise tolerance) and dietary history (patient’s dietary habits, food choices, meal patterns, food allergy information, and malabsorption issues), in addition to physiological stress, visceral proteins, weight, fat-free mass, and body mass index. The current medical literature conflicts regarding the appropriate type of formulation to select for nutritional intervention, especially regarding the amount of calories from fat to provide COPD patients. This review article focuses on the enteral product formulations currently available, and how they are most appropriately utilized in patients with COPD.

Pharmacogenomics in advanced pharmacy practice experiences

Patients’ nutritional status is essential to ensure beneficial outcomes. However for the diabetic, the caloric energy required is not only sustaining but problematic if not managed appropriately. Uncontrolled hyperglycemia places these patients at risk of complications such as infections, neuropathy, and retinopathy. Health care providers can assist in tailoring nutritional support for diabetic patients. Possible interventions include adjusting caloric requirements to minimize carbohydrates and maximize fat as a main calorie substitute and to suggest appropriate macronutrient sources. Other disease state complications such as diabetic-associated nephropathy and gastroparesis affect nutritional support and present opportunity for further interventions. Diligence regarding blood glucose monitoring is imperative. Additional anti-diabetic therapies can be used to maintain tight glucose control; however, close monitoring must occur to minimize hypoglycemic episodes, which can be life-threatening.