Notes

Coming from Sculpting the Input to Healing for doing things.
The effectiveness of the course was assessed through a mixed methods approach involving pre- and post-course surveys and a focus group. Evaluation Of 166 students, 152 (91.6%) completed both pre- and post-course surveys, and nine students participated in the focus group. Students reported significant improvements in 21 out of 22 course objectives. Qualitative analysis revealed three key themes learning environment, faculty engagement and collegiality. The main challenge to executing the course was procuring adequate faculty, material and facility resources. Reflection This simulation-based, resource-heavy transition course achieved its educational objectives and provided a safe, supportive learning environment for practicing and refining clinical skills.Mentorship may offer protégés numerous benefits including improved self-esteem, increased interest in research, and/or enhanced productivity. Without proper planning, reflection, and evaluation, however, mentorship programs may result in undesirable consequences. In this paper we describe a mentorship program designed to improve psychosocial support and professional development for residents, that while initially successful, was terminated due to perceptions of inequity that led to strife among residents and ultimately created a toxic learning climate. Leader-member exchange theory provides a lens through which to view our program's failure and to offer some potential solutions to mitigate such challenges for other programs. Leader-member exchange theory focuses on the importance of relationships, communication, and awareness of biases to optimize interactions between dyads such as a mentor and a protégé. We highlight opportunities during the stranger, acquaintance, and mature partnership phases that could have helped to save a residency mentorship program.Background One of the main roles of the medical information (MI) department within a pharmaceutical company is to develop scientific/standard response documents (SRDs) to provide comprehensive medical information to healthcare providers (HCPs). This study seeks to gain HCP feedback on the various elements in the format of an SRD. Methods This study surveyed 400 healthcare providers (200 physicians, 100 pharmacists, and 100 nurse practitioners/advanced practice nurses and physician assistants) regarding their opinions and preferences on the structure, content, layout, and delivery options of SRDs. The survey also included questions assessing where HCPs access their medical information, their trust in the medical information they receive from MI Departments, and alternative methods for receiving medical information. Results HCPs often self-search for medical information via an electronic device, which allows for SRDs to serve as a key resource. HCPs, who had prior contact with a pharmaceutical company's MI department, have a high degree of trust in the SRDs that they had received. However, perception of bias can have an impact on their level of trust. HCPs prefer all relevant data such as real-world evidence, adverse drug reactions, and clinical trial data, while abstracts and data on file may not be needed, but the overall length should only be three to five pages. HCPs find value in various SRD formatting characteristics, such as charts, tables, and infographics. Conclusions Overall, HCPs seek medical information resources, such as SRDs, to aid in the delivery of personalized patient care. HCPs prefer SRDs to be concise, but include comprehensive, unbiased medical information. Through HCP feedback, MI Departments of pharmaceutical companies can continue to develop and update their SRDs to increase uptake and potentially impact clinical practice.Background Vericiguat is a stimulator of soluble guanylate cyclase currently under investigation as a first-in-class therapy for worsening chronic heart failure (NCT02861534). https://www.selleckchem.com/products/nms-873.html Patients with heart failure often require polypharmacy because of comorbidities. Hence, understanding the clearance mechanisms, elimination, and potential for pharmacokinetic drug-drug interactions of vericiguat is important for dose recommendations in this patient population. Methods Biotransformation and perpetrator properties of vericiguat were characterized in vitro using human hepatocytes, liver microsomes, and recombinant enzymes. This was complemented by a human mass balance study and ten drug-drug interaction studies in healthy volunteers wherein vericiguat was co-administered orally with omeprazole, magnesium/aluminum hydroxide, ketoconazole, rifampicin, mefenamic acid, midazolam, warfarin, digoxin, sacubitril/valsartan, aspirin, or sildenafil. Results In the human mass balance study, mean total radioactivity recovered was 98.3% of the dose administered (53.1% and 45.2% excreted via urine and feces, respectively). The main metabolic pathway of vericiguat is glucuronidation via uridine diphosphate-glucuronosyltransferase 1A9 and 1A1. In vitro studies revealed a low risk of vericiguat acting as a perpetrator by inhibiting cytochrome P450s, uridine diphosphate-glucuronosyltransferase isoforms, or major transport proteins, or by inducing cytochrome P450s. These observations were supported by phase I drug-drug interaction studies. Phase I studies that assessed the propensity of vericiguat as a victim drug showed changes in the range that did not warrant recommendations for dose adjustment in phase III. Conclusions A low pharmacokinetic interaction potential of vericiguat was estimated from in vitro data and confirmed in vivo. Thus, vericiguat is suitable for a patient population with multiple comorbidities requiring polypharmacy.Purpose We sought to determine the prevalence of low arousal threshold (LAT) in veterans with post-traumatic stress disorder (PTSD) and whether or not LAT is associated with decreased use of continuous positive airway pressure (CPAP). Methods We conducted a retrospective study of all veterans with documented PTSD who had an apnea hypopnea index > 5/h over a 27-month period. Demographic, clinical characteristics, and CPAP usage were extracted from the medical records. A multivariate analysis was conducted to assess predictors of CPAP use at 3 months in patients with LAT after adjusting for severity of PTSD. Results LAT was identified in 55% of 119 patients with PTSD and newly diagnosed OSA. LAT was associated with younger age (odds ratio [OR] 0.91; 95% confidence interval [CI] 0.86-0.95), lower BMI (OR 0.82; 95% CI 0.73-0.91), presence of insomnia (OR 1.34; 95% CI 1.19-1.81), and use of antidepressant (OR 1.14; 95% CI 1.09-2.01). PTSD severity, REM rebound, and the presence of baseline comorbid insomnia were each associated with CPAP use at 3 months.
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