Kristi W. Kelley

An active-learning strategies primer for achieving ability-based educational outcomes

Active learning is an important component of pharmacy education. By engaging students in the learning process, they are better able to apply the knowledge they gain. This paper describes evidence supporting the use of active-learning strategies in pharmacy education and also offers strategies for implementing active learning in pharmacy curricula in the classroom and during pharmacy practice experiences.

A quality improvement course review of advanced pharmacy practice experiences.

Objectives. To determine strengths of and quality improvements needed in advanced pharmacy practice experiences (APPE) through a systematic course review process. Design. Following the “developing a curriculum” (DACUM) format, course materials and assessments were reviewed by the curricular subcommittee responsible for experiential education and by key stakeholders. Course sequence overview and data were presented and discussed. A course review worksheet was completed, outlining strengths and areas for improvement. Assessment. Student feedback was positive. Strengths and areas for improvement were identified. The committee found reviewing the sequence of 8 APPE courses to be challenging. Conclusions. Course reviews are a necessary process in curricular quality improvement but can be difficult to accomplish. We found overall feedback about APPEs was positive and student performance was high. Areas identified as needing improvement will be the focus of continuous quality improvement of the APPE sequence.

Use of Gabapentin for the Management of Natural or Surgical Menopausal Hot Flashes

Objective: To review the literature examining the use of gabapentin for treatment of hot flashes during natural or surgically Induced menopause. Data Sources: A literature search was conducted via PubMed, MEDLINE, and International Pharmaceutical Abstracts (1948-November 2010) using the search terms gabapentin, hot flashes, and menopause. Literature was limited to English-language, human studies. Additional material was identified by reviewing reference citations of the articles retrieved. Study Selection and Data Extraction: Studies with data describing gabapentin for hot flash management during natural or surgically induced menopause were included. Any studies including women with a history of breast cancer were excluded. Four studies met the inclusion criteria. Data Synthesis: Gabapentin significantly decreased hot flash frequency and hot flash composite scores by 45-71% from baseline in the 4 trials included in this review. In 2 of the trials, gabapentin was comparable to hormone replacement therapy (71 % vs 72%, respectively, p = 0.63) in decreasing hot flash composite scores at the end of 12 weeks and in decreasing hot flash frequency at the end of 8 weeks (58.9% vs 70.1 %, p > 0.05). In all trials, the most common adverse effects with gabapentin were somnolence/drowsiness, unsteadiness, and dizziness. These adverse effects were most pronounced during the first 1-2 weeks of therapy, but resolved and were similar to those reported with placebo by week 4. These trials were short (<12 weeks) and had small sample sizes; however, their results appear to show that gabapentin is safe and effective for short-term treatment of hot flashes in women who have entered menopause either naturally or surgically. Conclusions: Gabapentin 600-2400 mg/day in divided doses may be a viable option for treating hot flashes in menopausal women who do not want to use hormone replacement therapy.

A review of current treatment strategies for gestational diabetes mellitus.

Approximately 90% of diabetes cases in pregnant women are considered gestational diabetes mellitus (GDM). It is well known that uncontrolled glucose results in poor pregnancy outcomes in both the mother and fetus. Worldwide there are many guidelines with recommendations for appropriate management strategies for GDM once lifestyle modifications have been instituted and failed to achieve control. The efficacy and particularly the safety of other treatment modalities for GDM has been the source of much debate in recent years. Studies that have demonstrated the safety and efficacy of both glyburide and metformin in the management of patients with GDM will be reviewed. There is a lack of evidence with other oral and injectable non-insulin agents to control blood glucose in GDM. The role of insulin will be discussed, with emphasis on insulin analogs. Ideal patient characteristics for each treatment modality will be reviewed. In addition, recommendations for postpartum screening of patients will be described as well as recommendations for use of agents to manage subsequent type 2 diabetes in patients who are breastfeeding.

Overcoming barriers to scholarly activity in a clinical practice setting.

Scholarly activity is an essential component of any clinician’s professional advancement and is especially important to full-time clinical faculty members seeking promotions and career advancement.[1][1] Among other benefits, scholarly activity facilitates quality improvement, the sharing of

Review of metformin and glyburide in the management of gestational diabetes

Background: Worldwide, gestational diabetes affects 15% of pregnancies. It is recommended in patients with gestational diabetes to initiate diet therapy and if this is not adequate, insulin is the next treatment modality. While insulin is the preferred drug therapy to manage gestational diabetes in the majority of women, it may not always be the best option for all women. Objective: The purpose of this review is to assess the efficacy and safety of oral agents for treatment of gestational diabetes. Methods: A literature search of the MEDLINE, Ovid databases and Google Scholar was performed using the search term “gestational diabetes” combined with each “metformin” and “glyburide”. The time frame for the search was inception through August 2014. Randomized controlled trials and cohort (both prospective and retrospective) trials, published in English, with human participants were included. Studies included only pregnant women diagnosed with gestational diabetes. Results: There were no significant differences in preterm deliveries, delivery modes, macrosomia, and birth weights and large for gestational age when utilizing glyburide vs insulin for gestational diabetes management. There were significantly higher neonatal intensive care unit admissions as well as longer lengths of stay for hypoglycemia and respiratory distress in babies whose mothers were treated with glyburide versus insulin. For the studies comparing metformin to insulin, there are no significant differences reported for birth weight, gestational age, delivery mode, prematurity and perinatal deaths. Women taking metformin may require supplemental insulin more frequently than those taking glyburide. Conclusion: Glyburide and metformin appear to be safe and effective to manage blood glucose in patients with gestational diabetes who prefer to not utilize insulin or who cannot afford insulin therapy. All other oral therapies to manage blood glucose levels during gestational diabetes should be reserved until additional evidence is available regarding safety and efficacy to both mother and fetus.

Overcoming practice site challenges in clinical faculty positions.

New practitioners who become faculty members at colleges of pharmacy commonly describe their positions as both challenging and rewarding on many levels. For faculty members with experiential teaching responsibilities, practice site challenges can be among the more difficult challenges to conquer.

Serving as a student preceptor: Focus on emerging challenges

As the practice of pharmacy continues to evolve and embrace students of different generations and backgrounds, preceptors may find themselves facing challenges unlike those encountered just a decade or two ago. The purpose of this article is to describe some of the emerging challenges a preceptor

In women with gestational diabetes requiring drug treatment, glibenclamide may be inferior to insulin and metformin: metformin (plus insulin when required) performs better than insulin

Commentary on : Balsells M, Garia-Patterson A, Sola I, et al. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ 2015;350:h102.[OpenUrl][1][Abstract/FREE Full Text][2] Insulin therapy is recommended as a first-line approach after failure of diet therapy to manage gestational diabetes (GDM).1 ,2 Not all women are suitable candidates or decline to use insulin to manage their blood glucose levels and alternative options are needed. Metformin and glibenclamide are mentioned as alternatives to insulin for management of gestational diabetes mellitus (GDM) in several guidelines,1 ,2 while National Institute for Health and Care Excellence guidelines recommend metformin as a first-line.3 This systematic review and meta-analysis examines the short-term maternal and neonatal outcomes in women with GDM receiving glibenclamide, metformin or insulin in randomised controlled trials (RCTs). … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.h102%26rft_id%253Dinfo%253Apmid%252F25609400%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=350/jan21_14/h102&atom=%2Febmed%2F20%2F4%2F127.atom

Serving as a preceptor to pharmacy students: Tips on maintaining the desire to inspire

As pharmacists, we all have been influenced by people with whom we have worked and by our educational paths. Each of us has also been influenced by practical training experiences. Often our experiences prompt us to serve as preceptors, thereby gaining an opportunity to give back to the profession