The clinical utility of professional continuous glucose monitoring by pharmacists for patients with type 2 diabetes.

Background: There are limited data regarding the use of diabetes technologies, such as professional continuous glucose monitoring (CGM), as part of a pharmacist-managed diabetes service.

Objective: To assess how professional CGM affected treatment decisions and glucose control as part of a pharmacist-managed service for patients with type 2 diabetes.

Practice Description: Clinical Pharmacy Specialists (CPS's) within an outpatient diabetes management service provide comprehensive diabetes care under a scope of practice that includes prescriptive privileges.

Alternative schedules of levothyroxine administration.

Purpose: Published evidence on bedtime versus prebreakfast administration of levothyroxine is reviewed.

Summary: Because levothyroxine absorption has been shown to increase when the drug is administered to patients in a fasted state, the standard recommendation is that levothyroxine be taken one half to one hour prior to breakfast and at least four hours before or after potentially interacting drugs. However, compliance with this recommendation may be problematic for patients with unpredictable or variable schedules.

Combining insulins for optimal blood glucose control in type I and 2 diabetes: focus on insulin glulisine.

Normalization of blood glucose is essential for the prevention of diabetes mellitus (DM)-related microvascular and macrovascular complications. Despite substantial literature to support the benefits of glucose lowering and clear treatment targets, glycemic control remains suboptimal for most people with DM in the United States. Pharmacokinetic limitations of conventional insulins have been a barrier to achieving treatment targets secondary to adverse effects such as hypoglycemia and weight gain.

A strategy to develop advanced pharmacy practice experiences.

Objective: To establish statewide medication, disease management, and other clinical programs to serve as advanced pharmacy practice experience (APPE) training sites for the University of Colorado at Denver and Health Sciences Center School of Pharmacy, and to guarantee year-round support for the programs by providing pharmacy students with the necessary competencies to carry a significant proportion of each program's workload.

Methods: Partnerships with pharmacies willing to use students to expand their scope of clinical practice or support existing programs were established. Partners were asked to choose the clinical program(s) they wished implemented or supported and were guaranteed that APPE students would contribute to carrying each program's clinical service workload for 48 week/year under the supervision of the partners' pharmacists.

An introductory pharmacy practice experience emphasizing student-administered vaccinations.

Objective: To introduce a requirement for second-professional year (P2) and third-professional year (P3) students to administer vaccinations to adults in community pharmacy-based immunization clinics.

Design: Second-professional year students were trained to administer influenza, pneumococcal, and other vaccinations to adults following the American Pharmacists Association's standards. All P2 students in fall 2004 and all P2 and P3 students in fall 2005 were assigned to 2 community pharmacy-based immunization clinics in the metropolitan Denver area under the supervision of immunization-certified staff pharmacists.

A comparison of pharmacy students' confidence and test performance.

Objectives: The objectives of this study were to estimate student retention of knowledge regarding the management of patients with hypertension and dyslipidemia, measure student clinical confidence, and identify the relationship between clinical confidence and actual performance on a knowledge assessment test.

Methods: This was a sequential cross-sectional study to evaluate knowledge retention and clinical confidence of second-year pharmacy students. To measure student clinical confidence, a 12-item clinical confidence questionnaire was administered.

An assessment system for mapping CAPE outcomes in an advanced pharmacy practice experience program.

Objective: To implement and evaluate an assessment system based on the 1998 Center for the Advancement of Pharmaceutical Education's (CAPE) Outcomes for students in advanced pharmacy practice experiences (APPEs).

Description: The system requires each preceptor to create a summative assessment tool by choosing the most important 20-30 CAPE competencies and sub-elements necessary for his/her pharmacy practice with each to be scored by him/her on a 4-point scale from "exceeds expectations" to "below expectations." Students' grades are determined by an examination committee based on the preceptors' assessments.

The cost effectiveness of anticoagulation management services for patients with atrial fibrillation and at high risk of stroke in the US.

Background: Anticoagulation therapy with warfarin is widely considered the standard of care for stoke prophylaxis in patients with atrial fibrillation who are at high risk of stroke. Community-based studies in the US have reported that the effectiveness of anticoagulation varies by management approach and that patients receiving warfarin have international normalised ratio (INR) values within the target therapeutic range less than half the time.

Objective: To estimate the lifetime societal costs and health benefits of warfarin therapy to prevent strokes, specifically in elderly patients (mean age 70 years) with atrial fibrillation who are at high risk of stroke, when anticoagulation is managed through usual care versus anticoagulation management services, where dedicated anticoagulation professionals (e.

Similar medication compliance and control of dyslipidemia with simvastatin or atorvastatin in a staff-model HMO medical clinic.

Objective: The primary objective of this study was to determine medication compliance rates and dyslipidemia control in a patient population receiving simvastatin or atorvastatin (statins) in a unique staff-model health maintenance organization (HMO). The secondary objective of this study was to measure the effect of gender and statin regimen on the success rate of dylipidemia control and medication compliance.

Methods: This was a retrospective chart review conducted for patients with a diagnosis of dyslipidemia who received monotherapy with a statin for cholesterol reduction.

Insulin glulisine: a new rapid-acting insulin analogue for the treatment of diabetes.

Insulin glulisine (Apidra, Sanofi-Aventis), a new and recently approved rapid-acting insulin analogue, mimics the pharmacokinetic and pharmacodynamic profiles of physiological human insulin, but has a rapid onset, peak effect at 1h, and a shorter duration of action (approximately 4 h). Its rapid-action properties are maintained across subject types. Formal clinical evaluations show that insulin glulisine can be administered safely and effectively pre- and postmeal.