It's been a great weekend in California, so great to enjoy time with the family, great homemade meals & vegan cuisine.
Really quick, 3 applications of OTC work today
#1 Sunblock in the car. Finally really noticed the SPF 30 factor, that also mentioned UVA/UVB factors on the front label. #BlockUVR
#2: Patient left eye swell-up that begin within an hour-and-a-half. Benadryl Allergy relief, or Diphenhydramine, to relieve the swelling, itching and redness #1stGeneration #Sedation
#3 Patient has simple tinea infections on upper back, causes unknown, but possibly complicated by physical activity & athletic clothes. Application of Selsun Blue, that contains Selenium Sulfide, as an active ingredient every day for 30 minutes
#Unknowncauses #Cytostaticisyourfriend
Sunday, December 25, 2011
Tuesday, December 6, 2011
Informatics & Wrong Medicine
Today in Pharmacy Law, we’ve learned about the benefits of Informatics within the Clinical setting. The primary benefits of implementing changes include:
patient safety
cost containment/cost effective therapy
Workflow efficiency
political importance.
In this particular class, we learned about Dennis Quaid and his national campaign to minimize and eliminate errors that prevent hundreds of thousands of deaths each year. On the opposite end of this debate, Baxter, the Heparin manufacturer has been quick to defend the errors are a direct result of product packaging.
In the end, Dennis Quaid’s way of putting it this event is that it is a preventable medical error. Just as American can recall dog food, tires, and other electronics, then it only makes sense to recall Heparin.
Links
To Err is Human Publication
Dennis Quaid USA Today
Dennis Quaid CBS News
patient safety
cost containment/cost effective therapy
Workflow efficiency
political importance.
In this particular class, we learned about Dennis Quaid and his national campaign to minimize and eliminate errors that prevent hundreds of thousands of deaths each year. On the opposite end of this debate, Baxter, the Heparin manufacturer has been quick to defend the errors are a direct result of product packaging.
In the end, Dennis Quaid’s way of putting it this event is that it is a preventable medical error. Just as American can recall dog food, tires, and other electronics, then it only makes sense to recall Heparin.
Links
To Err is Human Publication
Dennis Quaid USA Today
Dennis Quaid CBS News
Thursday, December 1, 2011
Local doctors follow hearts to meet global challenges
Local doctors follow hearts to meet global challenges
An old college classmate, AuCo shared an article today on her dad published in our local paper.
I respect both Dr. Guerrero and Duy for their military services and their humanitarian work, respectively. I remember Auco telling us stories about her dad, who I believed at the time was also a doctor at UCI's medical center when we were in undergrad. I vividly remember stories of Auco sharing her father's experience and her memories of her summer Vietnam trip. What's funny is that I think I remember that her father also collected these interesting artifacts from his world travels and was an avid game hunter. Talk about a unique interest!
Anyhow, congratulations to Auco for fulfilling her dream of pursuing medicine this year at Midwestern (Oh, those pre-med days were ultimately worth it right?)! I'd think it be interesting to check out Vietnam one of these summers as part of their medical mission trips.
Ultimately, I think this is one thing students should really consider as cliche as that sounds. There were moments when I was originally doing both AMCAS and Pharmcas when I debated these type of opportunities.
Is it just coincidental that we had a speaker today in Career Development on a similar service topic: Pharmacist Professional Service?
An old college classmate, AuCo shared an article today on her dad published in our local paper.
I respect both Dr. Guerrero and Duy for their military services and their humanitarian work, respectively. I remember Auco telling us stories about her dad, who I believed at the time was also a doctor at UCI's medical center when we were in undergrad. I vividly remember stories of Auco sharing her father's experience and her memories of her summer Vietnam trip. What's funny is that I think I remember that her father also collected these interesting artifacts from his world travels and was an avid game hunter. Talk about a unique interest!
Anyhow, congratulations to Auco for fulfilling her dream of pursuing medicine this year at Midwestern (Oh, those pre-med days were ultimately worth it right?)! I'd think it be interesting to check out Vietnam one of these summers as part of their medical mission trips.
Ultimately, I think this is one thing students should really consider as cliche as that sounds. There were moments when I was originally doing both AMCAS and Pharmcas when I debated these type of opportunities.
Is it just coincidental that we had a speaker today in Career Development on a similar service topic: Pharmacist Professional Service?
Thursday, November 17, 2011
Monday, November 14, 2011
Thursday, October 27, 2011
The Children’s Museum of Denver - Events - Trick or Treat Street
The Children’s Museum of Denver - Events - Trick or Treat Street
Something to think about this weekend when organizing the UNICEF fund
Something to think about this weekend when organizing the UNICEF fund
Tuesday, October 25, 2011
Pharmacy Law and an FDA officer
As part of the SOUTHWEST REGION, he was a representative of the DEN-DO division
Google search: Chicago Tribune AM2PAT
Google search: Chicago Tribune AM2PAT
Thursday, October 13, 2011
Schedule 2
morphine, codeine, methadone, hydrocodone, meperidine, fentanyl,Amphetamine, methamphetamine, cocaine pentobarbital, amobarbital, methylphenidate, hydomorphone
Misted
Craters
Mangle
Heightened
Medical
Faiths
And
Minuscule
Costs
Activate
Many
Heads
spacefem's mnemonic device generatorCraters
Mangle
Heightened
Medical
Faiths
And
Minuscule
Costs
Activate
Many
Heads
Fiorinal w paregoric; dronabinol THC, Tylenol steroids
Fuzzy
Wrong
Pizzas
Drink
Trying
Trying
Spaceships
spacefem's mnemonic device generatorWrong
Pizzas
Drink
Trying
Trying
Spaceships
Saturday, October 8, 2011
Thursday, October 6, 2011
Propofol, IV's and Pharmacologists
I've never been a court TV fanatic. However, this time around, I find yellow journalism peaking my interest as it relates to what we have been learning so far this semester. I only find it funny that they used a IV infusion setup and description as part of the prosecutor's cross examination of the toxicologist.
The evidence today highlighted
Anderson identified a host of powerful prescription drugs in Michael Jackson’s blood, including the sedative propofol and other anesthetics.
The toxicology report indicates the following six drugs were detected in Jackson’s system:
Propofol (Diprivan)
Lidocaine
Diazepam (Valium)
Lorezepam (Ativan)
Midazolam (Versed)
Ephedrine
Now CNN is looking at bringing the pharmacologist in to testify on the mechanism of action of propofol and its metabolism. Who knows maybe they will use Ttrissel's IV compatibility charts and Micromedex. Imagine that.
More from inside the courthouse
HLN Source
Toxicology
15 Inspirational Steve Jobs Quotes
There is not a day where I don't type on my macbook pro or crank out tunes on my ipod in between classes, bike rides and workouts. With every fingertip to the keyboard, picture to my photobooth and the thousands of mp3s in my iTunes libary, we each carry on Steve Job's vision in how to revolutionize our own spheres within the world.
As part of a business management course, I took a look at Innovation and Sustainability course under Dr. Eppel in 2008. It was during this time I developed an infinite respect for Jobs, Google founders and even Web 2.0 developers and was first exposed TED and the Job's Stanford commencement speech. His innovation along with other revolutionaries became my avenue of play to experience the design of shared knowledge of sustainability business.
Rest In Peace Steve Jobs
15 Inspirational Steve Jobs Quotes
As part of a business management course, I took a look at Innovation and Sustainability course under Dr. Eppel in 2008. It was during this time I developed an infinite respect for Jobs, Google founders and even Web 2.0 developers and was first exposed TED and the Job's Stanford commencement speech. His innovation along with other revolutionaries became my avenue of play to experience the design of shared knowledge of sustainability business.
Rest In Peace Steve Jobs
15 Inspirational Steve Jobs Quotes
Wednesday, October 5, 2011
Tuesday, October 4, 2011
Trick-or-Treat for UNICEF :: Youth Action :: U.S. Fund for UNICEF - UNICEF USA
For our service project with our committee for Phi Delta Chi
Trick-or-Treat for UNICEF :: Youth Action :: U.S. Fund for UNICEF - UNICEF USA
Trick-or-Treat for UNICEF :: Youth Action :: U.S. Fund for UNICEF - UNICEF USA
Monday, October 3, 2011
Michael Jackson Propofol Expert, Dr. Barry Friedberg, to Speak in Veracruz
I'd like to take this time to thank Dr. Friedberg for writing my letter of recommendation for my pharmacy school application. I really wouldn't be where I am today.
The most notable posting by Dr. Friedberg is on the CNN blog where he states,
September 29th, 2011 8:32 am ET
"The fundamental problem with everything Murray did after he entered Jackson's bedroom is that Jackson had already been dead for an irretrievable time.
The window to save the brain's life after oxygen deprivation only extends for 3-5 minutes in adults at normal body temperature.
The critical issue is not the 'lethal' dose of propofol but Murray's failure to repsond to Jackson's drop in oxygen level that would have been indicated by a dropping pulse oximeter tone. No such 'lethal' propofol dose exists when breathing & oxygenation are monitored & appropriate intervention occurs when the tone of the pulse oximeter drops.
The defense contention that Murray had a pulse oximeter without a functioning alarm is ludicrous. The 'alarm' in every pulse oximeter is the drop in tone when the oxygen level drops... long before the body runs out of oxygen.
The critical issue is the failure to monitor Jackson's breathing & intervene before the loss of oxygen caused his hear to stop & his brain to die."
Recently, Dr. Friedberg has been in the spotlight during the Michael Jackson death lawsuit as seen here
1045/1745 GMT: Outside the court, Barry Friedberg, a 62-year-old anesthesiologist, accuses Murray of being "a sociopath" who was not adaquetely monitoring Jackson.
"Leaving Jackson, who desperately wanted to sleep and was desperately asking for propofol, is like leaving a pyromaniac in a room packed with matches," Friedberg says.
Also on comments on ABC's News Website, Dr. Friedberg states
USER COMMENTS
Sadly, Jackson had been dead for some time before Murray even returned to the bedroom. The adult brain @ body temperature, dies after only 3-5 minutes without oxygen.
Propofol is only lethal when breathing is not monitored & appropriate intervention does not occur when the oxygen levels begin to drop… long before cardiac arrest occurs.
By failing to monitor Jackson’s breathing, Murray’s 46 minute phone call allowed for many opportunities for that 3-5 minute interval to occur.
Everything Murray did after his return to the bedroom was calculated to make Murray appear like the conscientious physician he clearly is not.
Read ‘Getting Over Going Under.’ Jackson is only the most famous American to die from anesthesia over-medication.
POSTED BY: BARRY L. FRIEDBERG, M.D. | OCTOBER 3, 2011, 10:04 AM 10:04 A
Michael Jackson Propofol Expert, Dr. Barry Friedberg, to Speak in Veracruz
The most notable posting by Dr. Friedberg is on the CNN blog where he states,
September 29th, 2011 8:32 am ET
"The fundamental problem with everything Murray did after he entered Jackson's bedroom is that Jackson had already been dead for an irretrievable time.
The window to save the brain's life after oxygen deprivation only extends for 3-5 minutes in adults at normal body temperature.
The critical issue is not the 'lethal' dose of propofol but Murray's failure to repsond to Jackson's drop in oxygen level that would have been indicated by a dropping pulse oximeter tone. No such 'lethal' propofol dose exists when breathing & oxygenation are monitored & appropriate intervention occurs when the tone of the pulse oximeter drops.
The defense contention that Murray had a pulse oximeter without a functioning alarm is ludicrous. The 'alarm' in every pulse oximeter is the drop in tone when the oxygen level drops... long before the body runs out of oxygen.
The critical issue is the failure to monitor Jackson's breathing & intervene before the loss of oxygen caused his hear to stop & his brain to die."
Recently, Dr. Friedberg has been in the spotlight during the Michael Jackson death lawsuit as seen here
1045/1745 GMT: Outside the court, Barry Friedberg, a 62-year-old anesthesiologist, accuses Murray of being "a sociopath" who was not adaquetely monitoring Jackson.
"Leaving Jackson, who desperately wanted to sleep and was desperately asking for propofol, is like leaving a pyromaniac in a room packed with matches," Friedberg says.
Also on comments on ABC's News Website, Dr. Friedberg states
USER COMMENTS
Sadly, Jackson had been dead for some time before Murray even returned to the bedroom. The adult brain @ body temperature, dies after only 3-5 minutes without oxygen.
Propofol is only lethal when breathing is not monitored & appropriate intervention does not occur when the oxygen levels begin to drop… long before cardiac arrest occurs.
By failing to monitor Jackson’s breathing, Murray’s 46 minute phone call allowed for many opportunities for that 3-5 minute interval to occur.
Everything Murray did after his return to the bedroom was calculated to make Murray appear like the conscientious physician he clearly is not.
Read ‘Getting Over Going Under.’ Jackson is only the most famous American to die from anesthesia over-medication.
POSTED BY: BARRY L. FRIEDBERG, M.D. | OCTOBER 3, 2011, 10:04 AM 10:04 A
Michael Jackson Propofol Expert, Dr. Barry Friedberg, to Speak in Veracruz
Sunday, October 2, 2011
Thursday, September 29, 2011
Skin Pigs and Cosmeceuticals
Today we started our lecture with our associate dean Dr. Rice. In addition to his class in Career development, Dr. Rice and his bowtie have shared how pigs are used in skin research.
Research example
He even highlights Dr. Perricone products for skin and the debate over a 4 dollar prescription copay and a 400 neuropeptide ointment for your "face lift."
Let's find the medium between the two. Try healthy eating:
Let's look at his Alternatives Here
Research example
He even highlights Dr. Perricone products for skin and the debate over a 4 dollar prescription copay and a 400 neuropeptide ointment for your "face lift."
Let's find the medium between the two. Try healthy eating:
Let's look at his Alternatives Here
Lee Labrada Morning Start
"When achievers fail, they see it only as a momentary event, not a lifelong epidemic. And, it's not personal. Because you encounter a failure, you, yourself are not a failure. Faced with adversity, rejection, and failings, winners continue to persevere despite setbacks, and this is how they become winners, by refusing to think of themselves as failures. There is no famous person, nor anyone that has achieved anything of significance in any field, that has not failed at one time or another. It's how they have dealt with failure that has made them a success"
- Lee Labrada
- Lee Labrada
Wednesday, September 28, 2011
Micromedex and Dr. Drew
So here's a good way of referencing Drug Information resources in the context of current events.
In a CNN blog post, Dr. Drew disputes Murray defense claim, that the defense's opening arguments are false. As the article states, "When he heard the defense make the argument that the combination of lorazepam and propofol created a lethal "perfect storm,” Drew quickly noted that this assertion was “simply false.”
Notice the drug interactions when submitting Lorazepam and propofol into Micromedex's database:
References:
CNN
Micromedex
In a CNN blog post, Dr. Drew disputes Murray defense claim, that the defense's opening arguments are false. As the article states, "When he heard the defense make the argument that the combination of lorazepam and propofol created a lethal "perfect storm,” Drew quickly noted that this assertion was “simply false.”
Notice the drug interactions when submitting Lorazepam and propofol into Micromedex's database:
References:
CNN
Micromedex
Tuesday, September 27, 2011
Wednesday, September 21, 2011
Reward System and Neuroplasticity- Yale Study
Is it irrational to think that one makes your own choices? With these studies, we reframe this question within the context of your physiological responses. These articles force you to question the relationship with body composition (BMI measurements), sugar, your brain's reward system. Alice Park's article in the Times Magazine emphasizes this relationship.
"What happens in lean people, when their blood sugar is not dropping, is that their executive function lights up — the area involved in making decisions," explains Robert Sherwin, professor medicine at Yale and senior author of the paper, published in the Journal of Clinical Investigation. "This executive function controls the reward system, which is much less activated. But in obese people, that executive control is not activated when their blood sugar isn't falling. So they have continued activation of their reward system and that system dominates even if they're not hungry."
Read more: Times Magazine study
Chicago Tribune
"What happens in lean people, when their blood sugar is not dropping, is that their executive function lights up — the area involved in making decisions," explains Robert Sherwin, professor medicine at Yale and senior author of the paper, published in the Journal of Clinical Investigation. "This executive function controls the reward system, which is much less activated. But in obese people, that executive control is not activated when their blood sugar isn't falling. So they have continued activation of their reward system and that system dominates even if they're not hungry."
Read more: Times Magazine study
Chicago Tribune
Can eating plants really change our cells?
Can eating plants really change our cells?
Sushi and cells?
Something discussed during our Science Foundations Class. Maybe we can learn from our Japanese counterparts...
Sushi and cells?
Something discussed during our Science Foundations Class. Maybe we can learn from our Japanese counterparts...
Tuesday, September 13, 2011
To Help Erectile Dysfunction, Treat the Heart
only because there are so many ED jokes: from t-shirts to Family Guy episodes
To Help Erectile Dysfunction, Treat the Heart
To Help Erectile Dysfunction, Treat the Heart
Thursday, September 1, 2011
Take a Higher Dose of Aspirin if you have Diabetes
Take a Higher Dose of Aspirin if you have Diabetes
This post relates to Dr. Nuffer and Dr. Trujillo's Nutritiion lecture. Together they have shared the impact of obesity and the complicating factors that result, such as diabetes. I also learned that you can be specifically focused on Diabetes Education. Take a look here
Other than that, this post relates to the lecture in Experiential Learning and our OTC lectures, Aspirin specifically, for Professional Skills.
Until next time,
-Nicole
This post relates to Dr. Nuffer and Dr. Trujillo's Nutritiion lecture. Together they have shared the impact of obesity and the complicating factors that result, such as diabetes. I also learned that you can be specifically focused on Diabetes Education. Take a look here
Other than that, this post relates to the lecture in Experiential Learning and our OTC lectures, Aspirin specifically, for Professional Skills.
Until next time,
-Nicole
Saturday, August 13, 2011
Day 1. or Day zero/ 0 of Pharmacy School
Although it was my first day in Colorado, and on Campus, it was orientation day today here in UC Denver.
The "trek" to school: a 5 minute walk (Where art thou bike?)
ID pictures/ badges
student office
Experiential Office
campus tour
New people everywhere from all walks of life At first seemed like more women than men, but then by the end of the afternoon definitely balanced out
library for sidework: Nutrition's effect on Dental Caries abstract
barbeque
CPR training: 1/2 awake.... lack of sleep + relaxing environment+ bbq lunch burger
First bus ride since ages and ages ago (more like 2007: Hawaii style?) Yay for RTD cards and student fares. Boo for not knowing how to wait patiently at a bus stop with no phone or electronics and avoiding awkward stares from fellow bus patrons
Verizon wireless- because the droid2 was an epic fail on the first day of Colorady: NO PHONE: no text, no calls out, since the touch screen failed even after a hard reset :( :(
Ms. Gina called while I was at Verizon: Made me more sad... Miss back home,Jhonny and the Excelsius crew::Sigh::
If only flying home spontaneously were under 300, 498 doesn't sound like the Price is Right.
Orange Julius: Pina Colada: after a frustrating phone and trek experience
Quick Bus ride home: saw BJ's Brewery while waiting for the bus and thought "Damn, a happy hour would be nice right about now" .......hefeweizen where are you!??!?!?! Only because I had to move because the sprinklers turned on HAHAHAHAHah out of a movie right??
Quick busride back:
Taco stop and spanish speaking skills: yay Rigoberto's training! but epic fail to non-80 centavo adobada tacos and no horchata alli :(
Being love and home sick on a Friday night with no car to explore city.
Yay to catnaps in the middle of the night and mental energy at the break of dawn.
The "trek" to school: a 5 minute walk (Where art thou bike?)
ID pictures/ badges
student office
Experiential Office
campus tour
New people everywhere from all walks of life At first seemed like more women than men, but then by the end of the afternoon definitely balanced out
library for sidework: Nutrition's effect on Dental Caries abstract
barbeque
CPR training: 1/2 awake.... lack of sleep + relaxing environment+ bbq lunch burger
First bus ride since ages and ages ago (more like 2007: Hawaii style?) Yay for RTD cards and student fares. Boo for not knowing how to wait patiently at a bus stop with no phone or electronics and avoiding awkward stares from fellow bus patrons
Verizon wireless- because the droid2 was an epic fail on the first day of Colorady: NO PHONE: no text, no calls out, since the touch screen failed even after a hard reset :( :(
Ms. Gina called while I was at Verizon: Made me more sad... Miss back home,Jhonny and the Excelsius crew::Sigh::
If only flying home spontaneously were under 300, 498 doesn't sound like the Price is Right.
Orange Julius: Pina Colada: after a frustrating phone and trek experience
Quick Bus ride home: saw BJ's Brewery while waiting for the bus and thought "Damn, a happy hour would be nice right about now" .......hefeweizen where are you!??!?!?! Only because I had to move because the sprinklers turned on HAHAHAHAHah out of a movie right??
Quick busride back:
Taco stop and spanish speaking skills: yay Rigoberto's training! but epic fail to non-80 centavo adobada tacos and no horchata alli :(
Being love and home sick on a Friday night with no car to explore city.
Yay to catnaps in the middle of the night and mental energy at the break of dawn.
Tuesday, August 2, 2011
On the 10 day countdown...
With 10 days left, I may have even considered using a POD moving solution. It just seems more easy than purchasing and transporting everything there. Or maybe, psychologically, it may be a way for me to recreate "home" in a new state or in a foreign environment. Hopefully in that way, I can gain some sanity, peace and ultimately serenity amidst the rigors of graduate life and being away from the boyfriend, family, work and friends. :(
On a positive note, this week before the big move is a chance to help a dental hygienist student work on some projects. It's forced me to become more familiarized with my last year of Pharmacotherapy at UC Irvine. For now, the simple things have been broken down as far as drug-drug interactions and contraindications. Even simple things as physical and psychological evaluations have become a primary area of study for other health professionals.
Here's what we have so far....
• Medical History Questionaire @ initial office visit
o Updated regularly
o Short versus long form
o Long form: in-depth questions to adequately assess patients, especially those with significant medical disorders
o Question 1: will determine immediacy of attention
o Question 3: psychological outlook toward dentistry
o Question 6: prevent drug-drug interactions
• Multiple local anesthetics
• Anesthetics with opiods
• VasConstrictor and beta-adrenoreceptor antagonist, general anesthetic and TCA’s
o Question 7: Allergic reactions
o Question 8: excessive bleeding risks
• Selection of supraperiosteal, periodontal ligament or intraosseous or other techniques VERSUS
• AVOID these: (page 141)
o Question 9:
• Cardiovascular events or those with cardiovascular health are at put those at risk for overdose to local anesthetic because of an associated decrease liver metabolism which leads to longer half-lives of anesthetics
• Recent heart attacks: those within <6 months, reinfarction more likely
• Angina pectoris:angina episode may be induced by anxiety or inability to manage pain control.
• High blood pressure: patients regularly monitored and encouraged to follow recommended medications prescribed by doctors.
•
On a positive note, this week before the big move is a chance to help a dental hygienist student work on some projects. It's forced me to become more familiarized with my last year of Pharmacotherapy at UC Irvine. For now, the simple things have been broken down as far as drug-drug interactions and contraindications. Even simple things as physical and psychological evaluations have become a primary area of study for other health professionals.
Here's what we have so far....
• Medical History Questionaire @ initial office visit
o Updated regularly
o Short versus long form
o Long form: in-depth questions to adequately assess patients, especially those with significant medical disorders
o Question 1: will determine immediacy of attention
o Question 3: psychological outlook toward dentistry
o Question 6: prevent drug-drug interactions
• Multiple local anesthetics
• Anesthetics with opiods
• VasConstrictor and beta-adrenoreceptor antagonist, general anesthetic and TCA’s
o Question 7: Allergic reactions
o Question 8: excessive bleeding risks
• Selection of supraperiosteal, periodontal ligament or intraosseous or other techniques VERSUS
• AVOID these: (page 141)
o Question 9:
• Cardiovascular events or those with cardiovascular health are at put those at risk for overdose to local anesthetic because of an associated decrease liver metabolism which leads to longer half-lives of anesthetics
• Recent heart attacks: those within <6 months, reinfarction more likely
• Angina pectoris:angina episode may be induced by anxiety or inability to manage pain control.
• High blood pressure: patients regularly monitored and encouraged to follow recommended medications prescribed by doctors.
•
Saturday, July 30, 2011
Friday, July 15, 2011
Paper Done. Friday Start. Weekend Begin!
After a long week, we have officially fnished the DNA lab.
More promising is the fact that Jhonny and I have written our 34230948230 paper together again tonight. Yes, it is a Friday, but after a great Peruvian appetizer with Blue Moon's we put another Dental paper on Furcations in the books!
Great collaborative effort!
Time for a high five!
This weekend:
1) Coaching
2) Symphony
3) Luncheon
4) BIKING + BEACHES! yay!
and Denver is nearing....
More promising is the fact that Jhonny and I have written our 34230948230 paper together again tonight. Yes, it is a Friday, but after a great Peruvian appetizer with Blue Moon's we put another Dental paper on Furcations in the books!
Great collaborative effort!
Time for a high five!
This weekend:
1) Coaching
2) Symphony
3) Luncheon
4) BIKING + BEACHES! yay!
and Denver is nearing....
Tuesday, July 12, 2011
Wednesday, July 6, 2011
Friday, July 1, 2011
First Week of Summer
The first week of summer school at the center is officially over. It seemed to go by way too fast. Mostly new faces, and some returning students from last summer. I will post pictures from today when I get a chance.
The best news this week: the email for my white coat!
Yay! Who's Excited???
The best news this week: the email for my white coat!
Yay! Who's Excited???
Friday, June 24, 2011
Nutrition and Anatomy
Since the beginning of the month, I've been working with students and their nutrition class. Last week, they looked at carbohydrates and this week's lecture topic is lipids. In order to encourage participation, the teacher requires that the students post onto a discussion board.
Here's what we came up with together in response to the given prompt:
Fat Digestion
How would removal of the gallbladder impact fat digestion? You might want to do a little research before answering this question since the answer to this question may not be as obvious as it first seems.
The gallbladder is an organ that lies directly under and abutting the liver. A duct system allows the gallbladder to be connected to the liver and the upper portion of the small intestine. The removal of the gallbladder would not entirely inhibit fat digestion. Instead, by removing the gallbladder, the rate at which lipids are emulsified and the total quantity of lipids emulsified would decrease.
Fat that arrives at the duodenum of the small intestine triggers a hormonal response that causes the gallbladder to release bile into the duodenum to deal with the fat. The enzymes that digest fat can only work on the surface of the fat globules. Indirectly, chemical digestion and ultimately absorption would be affected in the small intestine. Here in the small intestine chemical digestion occurs via lipase, which is assisted by bile from the liver and gallbladder. The positive feedback of a hormone trigger from the small intestine would no longer exist. Once a fat or lipid arrives in the duodenum of the small intestine, there would be no affect like triggering the gallbladder contraction of bile into the small intestine. There would also be a decrease in lipase activity since the presence of bile normally increases lipase action.
Bile is originally produced in the liver. This bile is made from cholesterol and stored in the gallbladder. The gallbladder stores excess, unused bile and concentrates it. This bile is only then secreted via feedback mechanisms when needed. As an emulsifying agent, bile breaks down large fat droplets into smaller droplets known as micelles, whose surface area allows for lipase activity. In other words, the bile acts as a detergent on the fat and causes the large fat globules to break down.
The removal of the gallbladder would mean that there would just be no storage center for excess, unused bile. However, at the time of digestion by lipase, there would be adequate, yet limited amounts of bile. When this initial amount is used up, the body and digestive system would have to wait accordingly until the liver can produce more necessary bile for emulsification. This waiting period indicates that there is a lag time where no emulsification is occurring, or decreased rate, and the presence un-emulsified lipids, halting digestion.
In real life stories, patients have reported their own gallbladder removal. Their post-operative comments and lifestyle adjustments have indicated changes from less fat consumption in their daily diet, reduction of spicy foods as well as alcohol, which are shared in an online blog found here at http://www.hgriggs.com/gallbladder.html#threeyears .
"2001: A Gall Bladder Removal." Hedonism with Henry. 30 May 2004. Web. 22 June 2011..
"Digestive System." MCAT Review. MCAT Review and MCAT Prep Online, 2008. Web. 22 June 2011..
Farr, Gary. "The Gallbladder." BecomeHealthyNow.com - Your Source for Natural Health Care with Results. BecomeHealthyNow.com, 20 June 2003. Web. 22 June 2011.
Here's what we came up with together in response to the given prompt:
Fat Digestion
How would removal of the gallbladder impact fat digestion? You might want to do a little research before answering this question since the answer to this question may not be as obvious as it first seems.
The gallbladder is an organ that lies directly under and abutting the liver. A duct system allows the gallbladder to be connected to the liver and the upper portion of the small intestine. The removal of the gallbladder would not entirely inhibit fat digestion. Instead, by removing the gallbladder, the rate at which lipids are emulsified and the total quantity of lipids emulsified would decrease.
Fat that arrives at the duodenum of the small intestine triggers a hormonal response that causes the gallbladder to release bile into the duodenum to deal with the fat. The enzymes that digest fat can only work on the surface of the fat globules. Indirectly, chemical digestion and ultimately absorption would be affected in the small intestine. Here in the small intestine chemical digestion occurs via lipase, which is assisted by bile from the liver and gallbladder. The positive feedback of a hormone trigger from the small intestine would no longer exist. Once a fat or lipid arrives in the duodenum of the small intestine, there would be no affect like triggering the gallbladder contraction of bile into the small intestine. There would also be a decrease in lipase activity since the presence of bile normally increases lipase action.
Bile is originally produced in the liver. This bile is made from cholesterol and stored in the gallbladder. The gallbladder stores excess, unused bile and concentrates it. This bile is only then secreted via feedback mechanisms when needed. As an emulsifying agent, bile breaks down large fat droplets into smaller droplets known as micelles, whose surface area allows for lipase activity. In other words, the bile acts as a detergent on the fat and causes the large fat globules to break down.
The removal of the gallbladder would mean that there would just be no storage center for excess, unused bile. However, at the time of digestion by lipase, there would be adequate, yet limited amounts of bile. When this initial amount is used up, the body and digestive system would have to wait accordingly until the liver can produce more necessary bile for emulsification. This waiting period indicates that there is a lag time where no emulsification is occurring, or decreased rate, and the presence un-emulsified lipids, halting digestion.
In real life stories, patients have reported their own gallbladder removal. Their post-operative comments and lifestyle adjustments have indicated changes from less fat consumption in their daily diet, reduction of spicy foods as well as alcohol, which are shared in an online blog found here at http://www.hgriggs.com/gallbladder.html#threeyears .
"2001: A Gall Bladder Removal." Hedonism with Henry. 30 May 2004. Web. 22 June 2011.
"Digestive System." MCAT Review. MCAT Review and MCAT Prep Online, 2008. Web. 22 June 2011.
Farr, Gary. "The Gallbladder." BecomeHealthyNow.com - Your Source for Natural Health Care with Results. BecomeHealthyNow.com, 20 June 2003. Web. 22 June 2011.
Thursday, June 23, 2011
Current Update for the Transition
As the day looms sooner until school, the last minute details of the move are panning out. I was debating on flying there. The only problem with this option is that I wouldn't have a car while there...not necessary if I live close to campus. The school has a "Ride your Bike to School Week!"
I can't really imagine a life without one, even if that means going to the grocery store and running simple errands. The go-green in me thinks a bike or fixie will be my next best friend.
The apartment situation is panning out, all the options are within the 3 mile radius of the campus.
Driving there is plausible and the option I'm leaning more towards. I google mapped it with my dad, its 18 hour trip. I figure 2 days on the road by myself, or 1 whole day if I combine with someone. I'd ask my mom and dad to come with me, but it doesn't make sense to go there the first or second week of August, if the white coat ceremony is on August 19th. I don't think I would enjoy the back and forth.
So best bet sounds like a good personal and reflective road trip and have the parents fly out the weekend starting Thursday August 18th.
As far as scheduling this whole move is conflicting with work and I have to see if filter out of the summer program by the beginning of August pans out. If not, these road trip hopes are out of the door and i'll be flying there August 11th in time for Friday's orientation. Then, I can ask the 'rents to drive out there the next week with the car. Mind you, my dad dislikes airplanes, so it works out :)
On a lighter note, my CPR training for re-certification will be done this weekend and my immunization records are now on file. Yay for being 90% completed with everything! Now just waiting for another reforwar of official transcripts!
Until the next Rx,
- Nicole
I can't really imagine a life without one, even if that means going to the grocery store and running simple errands. The go-green in me thinks a bike or fixie will be my next best friend.
The apartment situation is panning out, all the options are within the 3 mile radius of the campus.
Driving there is plausible and the option I'm leaning more towards. I google mapped it with my dad, its 18 hour trip. I figure 2 days on the road by myself, or 1 whole day if I combine with someone. I'd ask my mom and dad to come with me, but it doesn't make sense to go there the first or second week of August, if the white coat ceremony is on August 19th. I don't think I would enjoy the back and forth.
So best bet sounds like a good personal and reflective road trip and have the parents fly out the weekend starting Thursday August 18th.
As far as scheduling this whole move is conflicting with work and I have to see if filter out of the summer program by the beginning of August pans out. If not, these road trip hopes are out of the door and i'll be flying there August 11th in time for Friday's orientation. Then, I can ask the 'rents to drive out there the next week with the car. Mind you, my dad dislikes airplanes, so it works out :)
On a lighter note, my CPR training for re-certification will be done this weekend and my immunization records are now on file. Yay for being 90% completed with everything! Now just waiting for another reforwar of official transcripts!
Until the next Rx,
- Nicole
White Collar Meets Pharma's Squalor
If you don't know what squalor means, and trust mean, dictionary.com definitely helped,
squal·or/ˈskwälər/
Noun: A state of being extremely dirty
In other TV news, the hit series "White Collar" featured a quick glimpse of a Big Pharma company. In this episode a Pullitzer journalist is on the brink of uncovering a Pharmaceutical companies ploy to internally destroy any evidence of a recall and repackaging of their blockbuster drug. Undercover FBI agents pose as FDA and meet with Pharma executives and threaten them with potential lawsuits if the relevance "smoking gun" of sample numbers isn't revealed. It turns out that the list of sample numbers were packaged from a "bad batch." In that case, the company did not nationally recall the batch, fearing economic backlash. Instead, they took the samples that were not dispensed and exchanged them from newly designed packages, which the company indicated was for marketing purposes. This steps were taken to prevent any liability and backlash that would result from those that were actually administered as prescriptions.
Spoiler alert: the R & D scientist was the journalist's source, who ends up being murdered at the end! Imagine that!
From a realistic analysis, this picture painted by thriller suspenseful TV proves to be a glimpse and inadequate picture of Pharmaceutical companies. In essence, most companies try to remain as transparent as possible. FDA is also the governmental agency that ensures situations like these won't happen. Credit to the R & D scientist, but a Pharmaceutical company should follow ethical procedures to not only serve their business demands, but more importantly, the needs of the public and their own customers and patients.
White Collar full episode gallery:
squal·or/ˈskwälər/
Noun: A state of being extremely dirty
In other TV news, the hit series "White Collar" featured a quick glimpse of a Big Pharma company. In this episode a Pullitzer journalist is on the brink of uncovering a Pharmaceutical companies ploy to internally destroy any evidence of a recall and repackaging of their blockbuster drug. Undercover FBI agents pose as FDA and meet with Pharma executives and threaten them with potential lawsuits if the relevance "smoking gun" of sample numbers isn't revealed. It turns out that the list of sample numbers were packaged from a "bad batch." In that case, the company did not nationally recall the batch, fearing economic backlash. Instead, they took the samples that were not dispensed and exchanged them from newly designed packages, which the company indicated was for marketing purposes. This steps were taken to prevent any liability and backlash that would result from those that were actually administered as prescriptions.
Spoiler alert: the R & D scientist was the journalist's source, who ends up being murdered at the end! Imagine that!
From a realistic analysis, this picture painted by thriller suspenseful TV proves to be a glimpse and inadequate picture of Pharmaceutical companies. In essence, most companies try to remain as transparent as possible. FDA is also the governmental agency that ensures situations like these won't happen. Credit to the R & D scientist, but a Pharmaceutical company should follow ethical procedures to not only serve their business demands, but more importantly, the needs of the public and their own customers and patients.
White Collar full episode gallery:
Rachel Ray Meets GABA: an haphazard revelation?
I happened to catch a glimpse of Rachel Ray's morning talk show.
Show link
Actual Clip Excerpt
On this particular episode, her guest star was a doctor applying a facial cream on an audience member. In any case, looks like a standard information. However, this clip stands out because this guest star doctor mentioned that this particular treatment was unique in that the cream was synthesized from GABA, or "mimicked Botox." In my mind, I was just shaking my head. Totally two different things: if only everyday people knew of this. One was a topical ointment, Botox is usually administered via injection. Besides this simple comparison, the doctor also mentioned to the audience GABA is a natural transmitted. Little did he distinguish that Botox is synthesized to a toxin made by the bacterium Clostridium botulinum.
Not that I've taken pharmacotherapy or pharmacology II recently, but I definitely know that these GABA receptors in the brain and hypothalamus have a different effect.
Not saying that the topical ointment can diffuse and have those therapeutic outcomes, but I definitely suggesting holding off using this type of wrinkle-remedy so soon. Continue with caution and just wait for the long term effects of such effects. Wrinkles are bad, but too much or too little GABA definitely is worse.
GABA interesting article:
Show link
Actual Clip Excerpt
On this particular episode, her guest star was a doctor applying a facial cream on an audience member. In any case, looks like a standard information. However, this clip stands out because this guest star doctor mentioned that this particular treatment was unique in that the cream was synthesized from GABA, or "mimicked Botox." In my mind, I was just shaking my head. Totally two different things: if only everyday people knew of this. One was a topical ointment, Botox is usually administered via injection. Besides this simple comparison, the doctor also mentioned to the audience GABA is a natural transmitted. Little did he distinguish that Botox is synthesized to a toxin made by the bacterium Clostridium botulinum.
Not that I've taken pharmacotherapy or pharmacology II recently, but I definitely know that these GABA receptors in the brain and hypothalamus have a different effect.
Not saying that the topical ointment can diffuse and have those therapeutic outcomes, but I definitely suggesting holding off using this type of wrinkle-remedy so soon. Continue with caution and just wait for the long term effects of such effects. Wrinkles are bad, but too much or too little GABA definitely is worse.
GABA interesting article:
Who's Excited? 2011 Mock Draft | NBADraft.net
Aside from the application, I've had NBA TV and Espn on all day for the NBA Draft Preview:
Who knows will Cleaveland rebuild?
Yes Lakers have 4 picks, but can Lakers really come back after the Dallas upset with the newbies?
What's Utah going to look like? Still excited to see how Howard plays this year.
What's the mark left by international players this year? Thinking Pau, (before his 2011 western conference debacle)
2011 Mock Draft | NBADraft.net
Who knows will Cleaveland rebuild?
Yes Lakers have 4 picks, but can Lakers really come back after the Dallas upset with the newbies?
What's Utah going to look like? Still excited to see how Howard plays this year.
What's the mark left by international players this year? Thinking Pau, (before his 2011 western conference debacle)
2011 Mock Draft | NBADraft.net
Pharmacy Intern Position
So this week has been light as it the week before Summer School Program starts at work.
So glad it worked out, because I finally had time to work on my Pharmacy Intern application.
Take a look! All together, the intern questions and an updated resume took about 3 hours. Time well-spent, what do you think? Any comments or suggestions before final submission?
Until the next Rx
Nicole
College Activities/Honors/Achievements
• UCI's Share Tutorial Program: coordinated with fellow club members and students at low-income high school Saddleback High School, collaborated with school teacher’s to distinguish student’s areas of focus
• Community Care Health Center: Grand opening El Modena Women’s Health Center and Clinica Medica De Ella, Teen Clinic Outreach Volunteer, Collaborated with Dr. Tomlinson on increasing foot traffic and community awareness through neighboring high schools
• Development and Marketing Volunteer: coordinating grant paperwork and media publications for the center at Huntington Beach Community Clinic
• Sacred Heart of Jesus Retreat Center After School Program: Arts and Crafts coordinator
• Hobbies and Interests: Family, Fitness, IWFL,Buddhism, Rockclimbing, Entrepreneurship, Blogging
What are your pharmacy career goals?
I foresee myself organizing clinical trials and communicating within a Pharmaceutical company’s divisions. I would also serve in a community relations capacity to assure new and current drug adherence and improve therapeutic outcomes. In the community setting, my position can help improve the quality of life. As a pharmacist, I can aid in affecting local and global change and work towards a positive future. My interest in Pharmacy is not strictly limited to the immediate and long-term effects on a patients’ health. Instead, the statement “think globally, act locally,” highlights my passion for Pharmacy extends to Pharmaceutical Outcomes as well as Research and Policy. My future career aspirations include graduating with a dual degree PharmD/MBA or MS in Research and Policy.
What do you hope to experience and or gain from this internship?
This internship would provide valuable experience in private health care to and to prepare me for a career in the Managed Health Care specialty. In the end, I hope that this intern experience can help me provide a strong background to step into a pharmacy advocate role and serve the community's healthcare needs. This internship experience combined with (insert school name) Pharm.D. program would only enhance my perspective in Pharmaceutical Industry and future contribution to the policies that currently exist. I believe that the altruism, think globally, act locally will allow me to collaborate with other pharmacists and medical professionals to better our health community. This internship will serve as exposure for me to gain valuable clinical experience to create a pharmacy that provides quality care for the members and families and contribute to the well-being of communities.
What is the job of an intern, and why are you a good candidate?
An intern’s job is to work with and report to the pharmacist and staff in order to facilitate their duties in helping patients and fulfilling the mission of the Kaiser health care organization for members and families. Under direct supervision of a licensed pharmacist dispenses and distributes pharmacy products. As an intern I would be consulting with Kaiser patients and medical personnel about medication therapy and product identification. While upholding Kaiser Permanente's policies and procedures, I would be considering cognitive, physical, emotional & chronological maturation process in the delivery of services to patients, interviewing patients and assessing the patient's needs & provides pharmaceutical care needed in accordance w/ department policy. This intern position requires that I am evaluating and resolving medication therapy problems and discuss with medical personnel pharmaceutical care and treatment of patients.
Growing up I was a Kaiser member and I realize the utmost quality of care that Kaiser health professionals and staff provide for their members. My first-hand experience with their professional has shown me how to act in an empathetic and consistent way. Their professionalism and my own experience has enabled me to deal with problem solving situations. When caring for a person it is important to be sympathetic and supportive and not to lose one’s patience. Indeed, when working in a hospital, pharmacists can show compassion and respect in addition to their pharmacological competency. This same compassion, respect and competency are traits I wish to learn from and emulate. Kaiser's environment focuses on patient-centered care and my experiences have prepared me to pool resources and work efficiently especially when dealing with the dynamics of health care and specific patients.
As a Kaiser intern, I would be able to communicate effectively with members and staff. I am capable of shaping my words and my message for not only to my Kaiser preceptors about my assigned tasks, but also Kaiser members and families about their prescriptions. Most importantly, as a professional, I act in a manner that is not only best for all but also contributes to a positive and harmonious health care environment. I am a candidate best suited to this intern position because I can be professional as I can cope with the challenges and conflicts inherent in professional health care setting.
How will your academic and extracurricular activities contribute to your success as an intern?
I feel that the culture and diversity here has imprinted an appreciation of new cultures and traditions that my preceptors, fellow interns and other staff members bring to the table. My educational foundation at UC Irvine has brought me in close contact with research-based professors in the field of pharmacology and pharmacotherapy. An extraordinary caring yet adventurous attitude to help people has excited me and made the pharmacy profession my role model. The changing global environment, increased life expectancy, and ever-increasing population are offering unmet challenges. These challenges offer an opportunity to use my abilities to find new and innovative solutions. Over the years I have developed myself in countless ways in terms of a hardworking, persistent and focused personality. My UC Irvine education and Orange County community health experience has prepared me to engage with the faculty and front-line clinicians to be in service within the Kaiser organization. With this, I believe the Kaiser's program can help me face these current health care challenges.
With my diverse perspective and experiences, I have a strong feeling that I will able to finish the Kaiser organization Pharm.D. program as a professional who will advance patient care and facilitate the discovery, understanding and cost-effective use of medicines for the community and society.
In order to prepare myself I have immersed myself in multi-cultural setting to help me develop the skills necessary to interact with Kaiser and community members and other healthcare professionals. From those under-served within my health community to my students and parents of different ethnic backgrounds, these various settings have allowed me to interact with those from diverse backgrounds.
More recently, I have recently been able to return to school to fulfill pharmacy requirements. At that time I earned an A's in all three courses: Statistics, Chemistry and Calculus all while working full-time and managing over private clientele of students. I believe this work ethic and time management skills can carry over into my Pharmacy intern experience, because I am fully capable of managing the responsibilities as a Kaiser intern while completing my Pharmacy education.
Applicant Signature (electronic) Date
So glad it worked out, because I finally had time to work on my Pharmacy Intern application.
Take a look! All together, the intern questions and an updated resume took about 3 hours. Time well-spent, what do you think? Any comments or suggestions before final submission?
Until the next Rx
Nicole
College Activities/Honors/Achievements
• UCI's Share Tutorial Program: coordinated with fellow club members and students at low-income high school Saddleback High School, collaborated with school teacher’s to distinguish student’s areas of focus
• Community Care Health Center: Grand opening El Modena Women’s Health Center and Clinica Medica De Ella, Teen Clinic Outreach Volunteer, Collaborated with Dr. Tomlinson on increasing foot traffic and community awareness through neighboring high schools
• Development and Marketing Volunteer: coordinating grant paperwork and media publications for the center at Huntington Beach Community Clinic
• Sacred Heart of Jesus Retreat Center After School Program: Arts and Crafts coordinator
• Hobbies and Interests: Family, Fitness, IWFL,Buddhism, Rockclimbing, Entrepreneurship, Blogging
What are your pharmacy career goals?
I foresee myself organizing clinical trials and communicating within a Pharmaceutical company’s divisions. I would also serve in a community relations capacity to assure new and current drug adherence and improve therapeutic outcomes. In the community setting, my position can help improve the quality of life. As a pharmacist, I can aid in affecting local and global change and work towards a positive future. My interest in Pharmacy is not strictly limited to the immediate and long-term effects on a patients’ health. Instead, the statement “think globally, act locally,” highlights my passion for Pharmacy extends to Pharmaceutical Outcomes as well as Research and Policy. My future career aspirations include graduating with a dual degree PharmD/MBA or MS in Research and Policy.
What do you hope to experience and or gain from this internship?
This internship would provide valuable experience in private health care to and to prepare me for a career in the Managed Health Care specialty. In the end, I hope that this intern experience can help me provide a strong background to step into a pharmacy advocate role and serve the community's healthcare needs. This internship experience combined with (insert school name) Pharm.D. program would only enhance my perspective in Pharmaceutical Industry and future contribution to the policies that currently exist. I believe that the altruism, think globally, act locally will allow me to collaborate with other pharmacists and medical professionals to better our health community. This internship will serve as exposure for me to gain valuable clinical experience to create a pharmacy that provides quality care for the members and families and contribute to the well-being of communities.
What is the job of an intern, and why are you a good candidate?
An intern’s job is to work with and report to the pharmacist and staff in order to facilitate their duties in helping patients and fulfilling the mission of the Kaiser health care organization for members and families. Under direct supervision of a licensed pharmacist dispenses and distributes pharmacy products. As an intern I would be consulting with Kaiser patients and medical personnel about medication therapy and product identification. While upholding Kaiser Permanente's policies and procedures, I would be considering cognitive, physical, emotional & chronological maturation process in the delivery of services to patients, interviewing patients and assessing the patient's needs & provides pharmaceutical care needed in accordance w/ department policy. This intern position requires that I am evaluating and resolving medication therapy problems and discuss with medical personnel pharmaceutical care and treatment of patients.
Growing up I was a Kaiser member and I realize the utmost quality of care that Kaiser health professionals and staff provide for their members. My first-hand experience with their professional has shown me how to act in an empathetic and consistent way. Their professionalism and my own experience has enabled me to deal with problem solving situations. When caring for a person it is important to be sympathetic and supportive and not to lose one’s patience. Indeed, when working in a hospital, pharmacists can show compassion and respect in addition to their pharmacological competency. This same compassion, respect and competency are traits I wish to learn from and emulate. Kaiser's environment focuses on patient-centered care and my experiences have prepared me to pool resources and work efficiently especially when dealing with the dynamics of health care and specific patients.
As a Kaiser intern, I would be able to communicate effectively with members and staff. I am capable of shaping my words and my message for not only to my Kaiser preceptors about my assigned tasks, but also Kaiser members and families about their prescriptions. Most importantly, as a professional, I act in a manner that is not only best for all but also contributes to a positive and harmonious health care environment. I am a candidate best suited to this intern position because I can be professional as I can cope with the challenges and conflicts inherent in professional health care setting.
How will your academic and extracurricular activities contribute to your success as an intern?
I feel that the culture and diversity here has imprinted an appreciation of new cultures and traditions that my preceptors, fellow interns and other staff members bring to the table. My educational foundation at UC Irvine has brought me in close contact with research-based professors in the field of pharmacology and pharmacotherapy. An extraordinary caring yet adventurous attitude to help people has excited me and made the pharmacy profession my role model. The changing global environment, increased life expectancy, and ever-increasing population are offering unmet challenges. These challenges offer an opportunity to use my abilities to find new and innovative solutions. Over the years I have developed myself in countless ways in terms of a hardworking, persistent and focused personality. My UC Irvine education and Orange County community health experience has prepared me to engage with the faculty and front-line clinicians to be in service within the Kaiser organization. With this, I believe the Kaiser's program can help me face these current health care challenges.
With my diverse perspective and experiences, I have a strong feeling that I will able to finish the Kaiser organization Pharm.D. program as a professional who will advance patient care and facilitate the discovery, understanding and cost-effective use of medicines for the community and society.
In order to prepare myself I have immersed myself in multi-cultural setting to help me develop the skills necessary to interact with Kaiser and community members and other healthcare professionals. From those under-served within my health community to my students and parents of different ethnic backgrounds, these various settings have allowed me to interact with those from diverse backgrounds.
More recently, I have recently been able to return to school to fulfill pharmacy requirements. At that time I earned an A's in all three courses: Statistics, Chemistry and Calculus all while working full-time and managing over private clientele of students. I believe this work ethic and time management skills can carry over into my Pharmacy intern experience, because I am fully capable of managing the responsibilities as a Kaiser intern while completing my Pharmacy education.
Applicant Signature (electronic) Date
Wednesday, June 22, 2011
Cards to help with Rx
Hi everyone,
It is literally getting down to the wire. Two months until school starts
Today I was sent an email about supplies I need to purchase! I am more excited
Check it out! Look what I'm going to have in my handy-dandy pocket at all times!
A Sincere Rx
It is literally getting down to the wire. Two months until school starts
Today I was sent an email about supplies I need to purchase! I am more excited
Check it out! Look what I'm going to have in my handy-dandy pocket at all times!
A Sincere Rx
Saturday, June 18, 2011
Thursday, June 9, 2011
Sunday, June 5, 2011
Late Night TV
So a recent showing on MTV proved valuable, True Life, I'm on Steroids.
Midway through the showing, I googled the True Life Synopsis and was sad to find
It surreal to read this, especially after working with students who were preparing for their Biology exam studying the macromolecules of life.
Weird to think how something so simple and essential in life can be utilized in a way that causes these side effects.
Midway through the showing, I googled the True Life Synopsis and was sad to find
It surreal to read this, especially after working with students who were preparing for their Biology exam studying the macromolecules of life.
Weird to think how something so simple and essential in life can be utilized in a way that causes these side effects.
Friday, June 3, 2011
Friday, May 27, 2011
Thursday, May 26, 2011
Saturday, May 21, 2011
Friday, May 20, 2011
Sunday, May 8, 2011
To start
I really can't wait until summer...the sooner summer comes the sooner I am to starting pharmacy school.
Helping other students with anatomy, immunology and science only reinforces my love to pursue education within these fields and specialties
Helping other students with anatomy, immunology and science only reinforces my love to pursue education within these fields and specialties
Saturday, May 7, 2011
Monday, March 14, 2011
Saturday, March 12, 2011
Friday, March 11, 2011
Saturday, March 5, 2011
Pharmacy Times on a Saturday Morning:
Bea Riemschneider, Editorial Director
The Next-Generation Pharmacist Profile: Vision for the Future (Source)
As Riemschneider communicates her ideas in this editorial, I see many points for reflection coming from a future pharmacist.
Delving into the thought processes of members of a select profession, especially in the health care arena, is a tough proposition.
- Questions asked at interviews: Although they correlate to one another, each school and therefore each program fill theirs positions according to their mission and values system.
the key ingredient for making it all work for them revolves around the joy of helping people and “making a difference.”
- Why Pharmacy? I think this statement answers that. However, the key here is that it was made more personal in my case through my dad's experience and my own experience with sports nutrition. What a difference can knowing what you are taking makes with patient compliance? What a difference can knowing how to cycle through sport supplements can make in your fitness regiment and more easily, liver's health?
Along with the deeper passion and benefits of the profession, this article in Pharmacy Times analyzes respondent's comments on disadvantages.
First and foremost, responding pharmacists were concerned about their work hours. A total of 25% said that this was the biggest disadvantage of being a pharmacist. Followed closely at 20% was “insurance/administrative burden,” which voiced the concern of many in the profession that too much time is spent on administrative work. Pharmacists from the institutional and chain pharmacies responded with a total of 5% saying they were “understaffed,” and 4% responded that “standing” was the biggest disadvantage for pharmacists as a profession. Another 4% added “stress” as a major disadvantage, with some responses referring to the large responsibilities of pharmacists in general by saying “stress of having to get it right 100% of the time.”
- I think outside looking in, Pharmacists appear to have the flexibility. From Industry to Academia I believe that there are specific hours per week. However, with Industry and Academia, there can be additional responsibilities with committees and membership roles. For those in retail, I believe these hours can effect the quality of the work environment. Those who list hours as a disadvantage may not see the need to stay longer or may have other obligations outside of the profession that they need attend to.
The understaffed comment is a relevant detail. However, with this comes the idea, that those who work hand-in-hand with drug experts, must come with the appropriate background, training and expertise to take on the supportive role of the pharmacy profession.
Lastly, the 100% of the time disadvantage. With their own ethical and moral responsibility, all actions align with these personal values. Yes, pharmacists are human. Although the public may have the expectation of being right 10 out of 10 times, we have to understand that there may be flaws or inconsistencies that make 9 out of 10 a possibility. With that we have to understand that with their ethical responsibility, pharmacists will make every attempt to get it right the first time, considering patients health and lives are on the line. Any such instance where there is a mistake, one must consciously respond and bear the consequences of such actions.
The Next-Generation Pharmacist Profile: Vision for the Future (Source)
As Riemschneider communicates her ideas in this editorial, I see many points for reflection coming from a future pharmacist.
Delving into the thought processes of members of a select profession, especially in the health care arena, is a tough proposition.
- Questions asked at interviews: Although they correlate to one another, each school and therefore each program fill theirs positions according to their mission and values system.
the key ingredient for making it all work for them revolves around the joy of helping people and “making a difference.”
- Why Pharmacy? I think this statement answers that. However, the key here is that it was made more personal in my case through my dad's experience and my own experience with sports nutrition. What a difference can knowing what you are taking makes with patient compliance? What a difference can knowing how to cycle through sport supplements can make in your fitness regiment and more easily, liver's health?
Along with the deeper passion and benefits of the profession, this article in Pharmacy Times analyzes respondent's comments on disadvantages.
First and foremost, responding pharmacists were concerned about their work hours. A total of 25% said that this was the biggest disadvantage of being a pharmacist. Followed closely at 20% was “insurance/administrative burden,” which voiced the concern of many in the profession that too much time is spent on administrative work. Pharmacists from the institutional and chain pharmacies responded with a total of 5% saying they were “understaffed,” and 4% responded that “standing” was the biggest disadvantage for pharmacists as a profession. Another 4% added “stress” as a major disadvantage, with some responses referring to the large responsibilities of pharmacists in general by saying “stress of having to get it right 100% of the time.”
- I think outside looking in, Pharmacists appear to have the flexibility. From Industry to Academia I believe that there are specific hours per week. However, with Industry and Academia, there can be additional responsibilities with committees and membership roles. For those in retail, I believe these hours can effect the quality of the work environment. Those who list hours as a disadvantage may not see the need to stay longer or may have other obligations outside of the profession that they need attend to.
The understaffed comment is a relevant detail. However, with this comes the idea, that those who work hand-in-hand with drug experts, must come with the appropriate background, training and expertise to take on the supportive role of the pharmacy profession.
Lastly, the 100% of the time disadvantage. With their own ethical and moral responsibility, all actions align with these personal values. Yes, pharmacists are human. Although the public may have the expectation of being right 10 out of 10 times, we have to understand that there may be flaws or inconsistencies that make 9 out of 10 a possibility. With that we have to understand that with their ethical responsibility, pharmacists will make every attempt to get it right the first time, considering patients health and lives are on the line. Any such instance where there is a mistake, one must consciously respond and bear the consequences of such actions.
Friday, March 4, 2011
Legislative Approach and Pharmacy Services
In a recent youtube post, University of Maryland has published a short clip of these aspects.
Thursday, March 3, 2011
Cold Medicines: The Importance of Adapting
WebMD Article FDA Pulls 500 Cold Medicines From the Market
Wednesday, March 2, 2011
Science from a Fitness Enthusiast
A recent article from T-Nation incorporates the science of liver pathways. Take a look. I must say, they did a pretty great job at simplifying the P450 liver mechanisms.
Article
Article
Monday, February 28, 2011
The Sports Science Desk
Why Pharmacy?
Well, this is one of interesting manners in which I became interested in Pharmacology.
Here is your summarized version of an article from bodybuilding.com. As great as it is, look at the bottom sources. Fifteen Sources! Imagine that, 15 sources summarized into 1 page. That is your science! This is what a pharmacist is: a drug expert, a leader.
With the new year approaching perhaps it's time to look into new ways of prolonging and supporting your physical health and mental prowess. Read on for 5 supplements that may be able to help you function at full capacity.
By: Marie Spano
Article Summary:
Several B vitamins are essential for proper brain and nervous system functioning.
For athletes, Phosphatidyl Serine has been shown to minimize physical and mental stress.
Before taking any supplement, talk to your physician.
5 New Year Supplements For Better Brain Power And Focus
If you are one of those people who can multi-task effectively and have your email, tweetdeck, facebook messaging and text messaging turned on at the same time and still work while simultaneously answering constant interruptions, I need to meet you. Focusing on one thing is hard enough these days without the growing number of distractions that consume our time. And, even though multitasking isn't the most effective way to get anything done it may seem like a necessity at times. So how can you shut out distractions when you need to concentrate yet multitask when your time is being stretched in multiple directions? Try our Top 5 Supplements for fine tuning your brain power and focus.
1. B Vitamins:
Have you ever run low on fuel (especially carbohydrates) and felt fuzzy and irritable? And then you eat and all of the sudden you feel better and your ability to think and concentrate returns to normal. Well, it isn't just the food and increase in blood sugar that is helping you function. The B Vitamins play an integral role in brain functioning. The Bs are a part of the enzymes and coenzymes in your body that take the energy from carbohydrates, fat and protein and help turn it into a form your body can use to function. In addition, several B vitamins are absolutely essential for proper brain and nervous system functioning.
Click To Enlarge.
Several B Vitamins Are Absolutely Essential For
Proper Brain And Nervous System Functioning.
2. L-Carnitine:
L-Carnitine is a conditionally essential micronutrient. It is considered "conditional" because our body can make it but, at times our demand for L-Carnitine exceeds our supply and supplementation may be the best route for increasing our L-Carnitine levels. Our body's stores of L-Carnitine are concentrated in our heart and skeletal muscle where this micronutrient plays a vital role in energy production. Studies in rats indicate that L-Carnitine supplementation may put up a roadblock against age-related declines in memory and cognitive impairment. Does it help humans too? Some scientists believe that giving a nutrient cocktail of Alpha-Lipoic Acid, L-Carnitine and Coenzyme Q10 may be one of the most effective nutrition-based solutions for improving cognitive decline in older adults.
3. L-Tyrosine:
Tyrosine is a nonessential amino acid that our body can make from the amino acid Phenylalanine (although people with PKU must consume Tyrosine). Some studies indicate that supplementation with Tyrosine may improve alertness after sleep deprivation and delay a decline in performance on psychomotor tests after skimping on sleep.
Click To Enlarge.
Tyrosine May Improve Alertness After Sleep Deprivation.
In addition to possibly helping people perform better during times of sleep deprivation, supplemental L-Tyrosine may also be beneficial during times of stress. Under stressful conditions, the human brain may not synthesize enough Tyrosine to manufacture essential compounds like your flight-or-fight Catecholamines: Epinephrine and Norepinephrine as well as the neurotransmitter Dopamine, which has a number of functions in the brain from helping control behavior to learning and memory. Therefore, supplemental Tyrosine may improve performance, memory and learning during times of psychological stress.
4. Phosphatidyl Serine:
Phosphatidyl Serine is a phospholipid that is present in cell membranes and plays a role in cell functioning. Most research has examined the role supplemental Phosphatidyl Serine plays in enhancing memory and cognitive functioning. For the athlete, Phosphatidyl Serine has been shown to minimize physical and mental stress. Doses used in sports studies range from 200 - 800 mg. A study in golfers found that just 200 mg phosphatidylserine taken daily (in a bar) for six weeks had a tendency to improve perceived stress as well as a statistically significant improvement in the number of good ball flights during tee-off.
Click To Enlarge.
Most Research Has Examined The Role Supplemental Phosphatidyl Serine Plays In Enhancing Memory And Cognitive Functioning.
5. Theanine:
Studies show that L-Theanine reduces psychological and physiological stress and increases alpha-brain wave activity to produce a dose-dependent relaxed yet alert state about 40 minutes after it is ingested. Take it with Caffeine and you have one dynamic duo that stimulates areas of the brain to increase alertness, boost reaction time, memory and performance on cognitive functioning tasks.
In one study, L-Theanine (250 mg) and Caffeine (150 mg) together led to faster simple reaction time, faster numeric working memory reaction time and improved sentence verification accuracy - all functions we perform on a daily basis.
Conclusion
If you want your brain functioning at maximum capacity you need to treat it the same way you treat your body - exercise your mind by reading, solving puzzles and figuring out tasks that take brain power. And, feed your brain with the right foods including a good mix of protein, healthy fats, and carbohydrate (focus on fruits and vegetables since these are among the best sources of antioxidants and essential nutrients). Lastly, try one or more of these powerful supplements that support brain functioning.
Before taking any supplement, talk to your physician. The supplements listed here are not intended to diagnose, treat or cure disease. And keep in mind, more isn't always better.
References:
Am J Clin Nutr. 2000;71(4):859-860.
Am J Clin Nutr. 2000;71(4):993-998.
Proc Natl Acad Sci U S A. 2002;99(4):2356-2361.
Proc Natl Acad Sci U S A. 2002;99(4):1870-1875.
Neuroendocrinology 1990;52(3):243-248.
Eur J Clin Pharmacol 1992;42(4):385-388.
Biol Sport 1998;15(2):135-144
J Int Soc Sports Nutr 2007, 4(1):5.
Asia Pac J Clin Nutr 2008;17 Suppl 1:167-8.
Altern Med Rev 2005;10(2):136-8.
Biol Psychol 2007;74(1):39-45.
Biol Psychol 2008;77(2):113-22.
Aviat Space Environ Med 1995;66:313-9.
Neurochem Res 2008;33(1):194-203.
Food and Nutrition Board, Institute of Medicine. The Role of Protein and Amino Acids in Sustaining and Enhancing Performance. Washington, DC: National Academy Press, 1999. Available at: http://www.nap.edu/books/0309063469/html/.
Well, this is one of interesting manners in which I became interested in Pharmacology.
Here is your summarized version of an article from bodybuilding.com. As great as it is, look at the bottom sources. Fifteen Sources! Imagine that, 15 sources summarized into 1 page. That is your science! This is what a pharmacist is: a drug expert, a leader.
With the new year approaching perhaps it's time to look into new ways of prolonging and supporting your physical health and mental prowess. Read on for 5 supplements that may be able to help you function at full capacity.
By: Marie Spano
Article Summary:
Several B vitamins are essential for proper brain and nervous system functioning.
For athletes, Phosphatidyl Serine has been shown to minimize physical and mental stress.
Before taking any supplement, talk to your physician.
5 New Year Supplements For Better Brain Power And Focus
If you are one of those people who can multi-task effectively and have your email, tweetdeck, facebook messaging and text messaging turned on at the same time and still work while simultaneously answering constant interruptions, I need to meet you. Focusing on one thing is hard enough these days without the growing number of distractions that consume our time. And, even though multitasking isn't the most effective way to get anything done it may seem like a necessity at times. So how can you shut out distractions when you need to concentrate yet multitask when your time is being stretched in multiple directions? Try our Top 5 Supplements for fine tuning your brain power and focus.
1. B Vitamins:
Have you ever run low on fuel (especially carbohydrates) and felt fuzzy and irritable? And then you eat and all of the sudden you feel better and your ability to think and concentrate returns to normal. Well, it isn't just the food and increase in blood sugar that is helping you function. The B Vitamins play an integral role in brain functioning. The Bs are a part of the enzymes and coenzymes in your body that take the energy from carbohydrates, fat and protein and help turn it into a form your body can use to function. In addition, several B vitamins are absolutely essential for proper brain and nervous system functioning.
Click To Enlarge.
Several B Vitamins Are Absolutely Essential For
Proper Brain And Nervous System Functioning.
2. L-Carnitine:
L-Carnitine is a conditionally essential micronutrient. It is considered "conditional" because our body can make it but, at times our demand for L-Carnitine exceeds our supply and supplementation may be the best route for increasing our L-Carnitine levels. Our body's stores of L-Carnitine are concentrated in our heart and skeletal muscle where this micronutrient plays a vital role in energy production. Studies in rats indicate that L-Carnitine supplementation may put up a roadblock against age-related declines in memory and cognitive impairment. Does it help humans too? Some scientists believe that giving a nutrient cocktail of Alpha-Lipoic Acid, L-Carnitine and Coenzyme Q10 may be one of the most effective nutrition-based solutions for improving cognitive decline in older adults.
3. L-Tyrosine:
Tyrosine is a nonessential amino acid that our body can make from the amino acid Phenylalanine (although people with PKU must consume Tyrosine). Some studies indicate that supplementation with Tyrosine may improve alertness after sleep deprivation and delay a decline in performance on psychomotor tests after skimping on sleep.
Click To Enlarge.
Tyrosine May Improve Alertness After Sleep Deprivation.
In addition to possibly helping people perform better during times of sleep deprivation, supplemental L-Tyrosine may also be beneficial during times of stress. Under stressful conditions, the human brain may not synthesize enough Tyrosine to manufacture essential compounds like your flight-or-fight Catecholamines: Epinephrine and Norepinephrine as well as the neurotransmitter Dopamine, which has a number of functions in the brain from helping control behavior to learning and memory. Therefore, supplemental Tyrosine may improve performance, memory and learning during times of psychological stress.
4. Phosphatidyl Serine:
Phosphatidyl Serine is a phospholipid that is present in cell membranes and plays a role in cell functioning. Most research has examined the role supplemental Phosphatidyl Serine plays in enhancing memory and cognitive functioning. For the athlete, Phosphatidyl Serine has been shown to minimize physical and mental stress. Doses used in sports studies range from 200 - 800 mg. A study in golfers found that just 200 mg phosphatidylserine taken daily (in a bar) for six weeks had a tendency to improve perceived stress as well as a statistically significant improvement in the number of good ball flights during tee-off.
Click To Enlarge.
Most Research Has Examined The Role Supplemental Phosphatidyl Serine Plays In Enhancing Memory And Cognitive Functioning.
5. Theanine:
Studies show that L-Theanine reduces psychological and physiological stress and increases alpha-brain wave activity to produce a dose-dependent relaxed yet alert state about 40 minutes after it is ingested. Take it with Caffeine and you have one dynamic duo that stimulates areas of the brain to increase alertness, boost reaction time, memory and performance on cognitive functioning tasks.
In one study, L-Theanine (250 mg) and Caffeine (150 mg) together led to faster simple reaction time, faster numeric working memory reaction time and improved sentence verification accuracy - all functions we perform on a daily basis.
Conclusion
If you want your brain functioning at maximum capacity you need to treat it the same way you treat your body - exercise your mind by reading, solving puzzles and figuring out tasks that take brain power. And, feed your brain with the right foods including a good mix of protein, healthy fats, and carbohydrate (focus on fruits and vegetables since these are among the best sources of antioxidants and essential nutrients). Lastly, try one or more of these powerful supplements that support brain functioning.
Before taking any supplement, talk to your physician. The supplements listed here are not intended to diagnose, treat or cure disease. And keep in mind, more isn't always better.
References:
Am J Clin Nutr. 2000;71(4):859-860.
Am J Clin Nutr. 2000;71(4):993-998.
Proc Natl Acad Sci U S A. 2002;99(4):2356-2361.
Proc Natl Acad Sci U S A. 2002;99(4):1870-1875.
Neuroendocrinology 1990;52(3):243-248.
Eur J Clin Pharmacol 1992;42(4):385-388.
Biol Sport 1998;15(2):135-144
J Int Soc Sports Nutr 2007, 4(1):5.
Asia Pac J Clin Nutr 2008;17 Suppl 1:167-8.
Altern Med Rev 2005;10(2):136-8.
Biol Psychol 2007;74(1):39-45.
Biol Psychol 2008;77(2):113-22.
Aviat Space Environ Med 1995;66:313-9.
Neurochem Res 2008;33(1):194-203.
Food and Nutrition Board, Institute of Medicine. The Role of Protein and Amino Acids in Sustaining and Enhancing Performance. Washington, DC: National Academy Press, 1999. Available at: http://www.nap.edu/books/0309063469/html/.
Sunday, February 27, 2011
Pharmacology and Dentistry
I had recently helped a nursing student with her research.
According to the American Academy of Periodontology (2004), has identified gingivitis as the inflammation of the gingiva that does not result in clinical attachment loss. Similarly, periodontitis is inflammation of the gingiva and the adjacent attachment structures and ultimately results in connective tissue attachment and alveolar bone loss and this disease state is causes connective tissue attachment and alveolar bone loss. Caregiivers and health professionals have outlined specific standards of assessment for periodontitis. Accordingly, the necessary steps of assessment include integrating a patient's medical history, dental history and periodontal risk factors. The most discriminating indicator of periodontitis is the presence of gram-negative, anaerobic bacteria, like Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis (Heitz-Mayfield 3) The presence of these types of bacteria competes with the normal flora within the mouth, teeth and gum line. As a result, the clinical indications of periodontal disease include the following factors such as probing depth (PD), bleeding on probing (BOP), clinical attachment level (CAL), degree of furcation involvement, extent of gingival recession, tooth mobility, and plaque score and the amount and location of bone loss (Sweeting, Davis, and Cobb 18). These probing depths are also interrelated to the extraoral and interoral structures and tissues of the patient. The assessment of teeth is also thorough with the primary focus of initial assessments dedicated to mobility patterns that would indicate occlusions, inflammation and potential loss of bone, caries and furcation involvement.
The diagnostic and planning phases for a patient's treatment plan is correlated to soft tissue assessment and periodontal risk factors. The clinical presentation of periodontitis requires that tissues must be evaluated for qualitative factors such color, contour, and keratinization. The probing of the depth, or PD, from the gingival margin and of the periodontal pocket will indicate the presence of the pathogenic bacteria. If this probing depth is more than 3 mm, then the affected tissue is used to select final periodontal treatment and management. Additionally, any sort of bleeding upon probing would indicate the inflammation of the gingiva, as any increase in bleeding increases the likelihood of disease progression (Sweeting, Davis, and Cobb 18)
Finally, soft tissue assessment locating any gingival recessions and evaluating clinical attachment levels, or CAL, to calculate the total amount of CAL. Outside of any of these quantitative findings, patients should be evaluated for their risk factors. Studies have focused on age, gender, medications, the quantity and distribution of plaque and calculus, smoking and oral hygiene. Other researchers have evaluated secondary factors such as race and/or ethnicity, genetics. epidemiological relations, and patient’s secondary diseases such as diabetes, osteoporosis, and in some cases an entirely compromised immune system .
Periodontists, hygienists, and other health care professionals utilize specific diagnostic tools. Radiographic evaluation of alveolar bone loss, bone density, furcations, root shape, and proximity can help in the periodontal treatment outcomes. During these radiographs, specific scans will help clinicians evaluate their patient more effectively. Such scans include a full-mouth periapical survey, including vertical bite-wings, and in some cases a panographic radiograph that includes selected periapical films. Aside from these diagnostic tools,treatment requires effective communication, education, and listening skills are of particular importance to today’s dental patient. According to Sweeting, Davis, and Cobb (18) ,there are specific words that are highly-recommended to communicate diagnostic findings with patients. For example, the office staff and care givers should demonstrate their communication skills with the correct terminology and diction. In order to be effectively communicate a patient’s periodontal conditions, word choices such as “infection” over “gum inflammation” would help the patient understand that having periodontal disease is an urgent matter. Likewise, using the word “hemorrhage” would indicate the degree of seriousness in caring for periodontal disease. This communication style can complement the periodontal disease diagnosis and prepare a patient for treatment implementation, such as that of non-invasive periodontal treatment.
The aim of non-invasive surgical treatment of periodontitis is considred a Phase I therapy to minimize the bacterial floral present. As Sweeting, Davvis and Cobb (22) stated, this therapy is an “opportune time for the clinician to introduce adjunctive therapies to the patient such as the use of locally delivered antimicrobials.” Similarly, periodontitis patients with special circumstances, like dental implants, should still be wary with the findings of a recent study, that outlines specific phases of treatment to be selected. Therapy of specific types of periodontal disease have shown that periodontitis has little to minimal effects on bone loss in dental implants. In Aloufi et al study (38) , 61 patients randomly selected from patients treated and rehabilitated with dental implants from 1996 to 2001. In the study, participants were separated based on the periodontitis severity: group A with history of the generalized severe chronic form and group B with a history of mild or no chronic. Although the results of diagnostic evaluations such as radiographic bone measurements indicate greater attachment loss around implants placed in patients with severe periodontitis, the results were not statistically significant from the group B, no/mild periodontitis group. In such cases, rehabilitation of patients with periodontitis by dental implant was shown to be successful. Although the study doesn’t label these dental-implant patients as high risk bone-loss groups, this finding’s conclusions advocate close monitoring of patients to prevent development of peri-implantitis and/or reemergence of periodontal disease. Similarily, chronic periodontitis therapy is aimed at repairing the affected area and ultimately allow for regeneration of periodontal structures through future procedures. In Al-Omari, Al-Habashneh and Taani’s findings (847), periodontal structures show little difference between those with aggressive (AgP) and chronic(CP) periodontitis. In this study, age was not used as a limiting factor for diagnosis, as AgP can occur at any age. Using the same diagnostic methods previously mentioned, like radiographic examinations, the subjects of this study were identified as chronic if they had at least a 4-mm attachment loss on more than a quarter of the pocket sites and more than 20% of visible bone loss. Anything short of this quantities would be considered aggressive. Al-Omari, Al-Habashneh and Taani (848) stated, “the common features of the generalized aggressive form of periodontitis were as follows: clinical health of subjects, except for the presence of periodontitis; rapid attachment loss and bone destruction; and familial aggregation.” This study must be taken into consideration as it highlights how AgP and dental caries could be helpful in understanding the etiology and pathogenesis of both caries and periodontal disease.
In a later study, researchers focused on chronic periodontitis treatment. Graziani et al (2009) discused short-term adjunctive effect of systemic neridronate in non-surgical periodontal therapy of advanced generalized chronic periodontitis. This study evaluated the accompanying benefits of complementary neidronate with periodontal treatment. In this study, neidronate was selected for both its safety and therapeutic effects on bone metabolism. Ultimately, the study did not provide new findings for adjunctive non-surgical treatment of chronic periodontitis. Even with the ultimate treatment focus of eliminating subgingival plaque biofilm of dentition, bisphosphonates or BP’s were selected because its ability to to decrease ostoblastic differentiation and inhibit osteoclast recruitment (Graziani et al 420). The total dosage of 12.5 mg/week was within the therapeutic effective range for management of osteoporosis. However, the results illustrate that it was sufficient enough to have an effective outcome on osseous development of the alveolar bone. Nevertheless, neridronate has shown to be generally safe. The only adverse effects of treatment management of this sort include complications such as flu and musculo–skeletal pain occurred and there no incidents of hypocalcaemia reported in this study. Above all, these findings have illustrated the need for future studies to include longer observational periods to establish a long-term complementary treatment medication similar to neridronate.
The overall goal of non-invasive periodontal treatment is to reduce of etiologic factors to reduce or eliminate inflammation, thereby allowing gingival tissues to heal. Supportive treatment of periodontitis should be selected based on this therapeutic outcome. One such supportive therapy includes scaling and root planing.Removal of dental calculus is accomplished by scaling and root planing procedures using various modalities such as hand, sonic, or ultrasonic instruments (American Academy of Periodontology page number). The hope of scaling and root planning is to remove plaque and calculus so that the subgingival bacteria is below capable of initiating clinical inflammation. The objectives of scaling and root planning would allow for inflammation reduction. By reducing the amount of inflammation, the quantitative evaluations of probing depth, clinical attachment levels would thereby decrease. Consequently, root and scaling procedures decrease bacterial flora and ultimately reduces disease progression.
According to Heitz-Mayfield (Citation), microbial treatment monotherapy targets the bacteria that are present in the biofilm structure. Mechanical debridgement is an essential method for removing biofilm bacteria. This debridgement process must coincide with antibiotic treatment as both aim to reduce the amount of bacteria present and lower the amount of inflammation in the periodontal pocket. Together mechanical debridgement and systemic antibiotics must be complementary to be effective factors of periodontitis treatment. Their conclusions illustrate that the antibiotic is most effective when it is initiated within less than a week of mechanical debridgement. Research has shown that monotherapy is not as efficacious: four studies that utilized metronidazole and combined metranidazole and amoxicillin experimental groups concluded that antiobiotic monotherapy has little to minimal effect. Additionally, antibiotics, without subgingival debridgement, will not disrupt the biofilm, and instead will result only in periodontal abscesses. The periodontal abscess is a lesion with extensive periodontal breakdown occurring during a short period of time with localized accumulation of pus. In other cases, isolated mechanical debridement and drainage through the periodontal pocket without any antibiotic treatments usually only effective in the management of the periodontal abscess.
Therapeutic success of an antimicrobial depends on the activity of the antimicrobial agent against the infecting organisms. Periodontitis is a mixed microbial infection making the choice of antibiotic regimen difficult. Certain antibiotics target specific parts of the subgingival biofilm.
The most commonly used antibiotics include tetracyclines, penicillins, like amoxicillin, metronidazole, various macrolides, clindamycin and ciprofloxacin, of which the most common combination is metronidazole and amoxicillin combined. The other antibiotic option of azithromycin is advantageous because of its pharmacologic properties and long half life, which allows patients to take one tablet per day for three straight days, rather than three times a day for seven days for other drug options.
.Drug therapy adds as an accessory non-invasive therapy to scaling and root planning. Previous studies by researchers have questioned the benefits ofl topical antibacterial agents over a period of at least 6 months, which is the standard therapeutic index recommended by ADA . The approved ingredients included in this type of treatment include thymol, methol, eucalpytol and methyl salicylate. Secondary active ingredients include chlorhexidine digluconate and triclosan. Although minimal experimental evidence has supported it’s effects on gingivitis, a complementary topical agent is recommended (American Academy of Periodontology page number) Treatment agents combat the surface and not the deeper plaque. As part of the drug therapy, non-steroidal anti-inflammation drugs and subantimicrobial dose of doxycycline have illustrated some benefits. Recent FDA publishings have shown the use of 20 mg dosage of doxycycline hyclate have demonstrated reducing probing depths, gain in clinical attachments levels and a reduction of disease progression. The only risks of this form of therapy is that there are additional risks such as administered antibiotics include development of resistant bacterial strains,emergence of opportunistic infections, and possible allergic sensitization of patients(Citation). FDA has approved of a tetracycline based fiber along with doxycyclitie in a bioabsorbable polymer gel as a stand-alone therapy for thereduction of probing depths and bleeding upon probing, PD and BOP, respectively. However, this aspect of treatment has limited risks compared to those of using NSAIDS as previously mentioned. The only adverse effects include allergic reaction, possible inability to disrupt biofilms, and failure to remove calculus." Also, direct application drug delivery systems as a form of chemotherapeutic agents provide several benefits; the drug can be delivered to the site of disease activity at a bactericidal concentration and it can help with continued drug delivery and absorption. The ultimate aim of this type of therapy is to halt the progression of periodontal attachment loss by removing etiologic factors.
Additionally, patient compliance is another factor in ultimate therapeutic outcomes of antibiotic administration. Compliance in terms of oral hygiene and maintenance care should also be addressed. It should be recognized that in studies where beneficial results following adjunctive antibiotics were reported, patients had received maintenance care and had good plaque control. Recall that for the other aspects of non-invasive therapy to be effective, personal concern of hygiene is essential. For the dual therapy of debridgement and systemic antibiotics to be effective, patients should utilize oral rinses, hygiene and pain management. The limited side effects of fever and malaise for such dual therapy treatment are far outweighed by the benefits of reducing inflammation by reducing the number of gram-negative anaerobes. The other reported minor and major effects of antibiotic treatment is gastrointestinal problems such as diarrhoea and nausea. However, serious adverse events such as allergic andanaphlyactic reaction and pseudomembranous colitis. In very isolated cases, anaphylactic responses to penicillin have occurred in .01% of the times penicillin was administered (Heitz-Mayfield (Citation).
Supportive treatment modalities must coincide with the patient’s own personal preventative actions. The patient must follow personal plaque control measures. Furthermore, surface, or supragingival irrigation by the patient will allow for bacterial flushing, with the previously mentioned medications can reduce inflammation more effectively than brushing alone. In Radnai et al study "Benefits of Periodontal Therapy when Preterm birth Threatens" has highlighted the importance of personal oral hygiene instructions. The findings highlight significant differences between treatment and control groups relative to each newborn's birthweight and time. The primary advantageous outcomes of periodontal treatment for women were an increase in the mean weight of the newborns and the longer duration of gestation times (APA citation here) This study’s results showed that women had a significant lower chance of adverse pregnancy outcome if they received periodontal therapy before the 35th gestational week. Current results might also provide indirect evidence for the assumption that maternal periodontitis may cause pre-term birth.For this treatment group, oral hygiene instruction and periodontal therapy were provided in the third trimester, while those 42 patients in the control group did not receive any periodontal treatment. I The incidence of pre-term birth and low birthweight in the treatment group was significantly less than in the control group). Periodontal treatment completed before the 35th week appeared to have a beneficial effect on birth weight and time of delivery.
The preventative treatment aspect of periodontitis include detailed and properly communicated patient education process, including plaque control and counseling in management of periodontal and systemic risk factors mentioned previously. The effects of treatment have been supported through research. In Sweeting, Davis, and Cobb’s research (17), the time interval of three months for an indefinite period of time following active therapy, appears to be effective in reducing disease progression, preserving teeth, and controlling the subgingival bacterial burden. These findings illustrate the importance of health care professionals’ commitment to the future outcomes and maintenance of healthy periodontal tissue should include regular re-evaluations after non-surgical treatment. Again, periodontal treatment requires that the patient shows the basic understanding of the etiology of periodontal diseases, treatment options, consequences of nontreatment, and direct benefits of therapy. The inflammatory components of plaque induced gingivitis and chronic periodontitis can be managed effectively for the majority of patients with a plaque control program and non-surgical root debridgement coupled with continued periodontal maintenance procedures and actions such as regenerative therapies. Collectively, health professionals should ensure routine prophylaxis appointments, and ongoing periodontal maintenance to insure no patient is overlooked regarding diagnosis of developing periodontal disease or recurring disease (Citation). .
According to the American Academy of Periodontology (2004), has identified gingivitis as the inflammation of the gingiva that does not result in clinical attachment loss. Similarly, periodontitis is inflammation of the gingiva and the adjacent attachment structures and ultimately results in connective tissue attachment and alveolar bone loss and this disease state is causes connective tissue attachment and alveolar bone loss. Caregiivers and health professionals have outlined specific standards of assessment for periodontitis. Accordingly, the necessary steps of assessment include integrating a patient's medical history, dental history and periodontal risk factors. The most discriminating indicator of periodontitis is the presence of gram-negative, anaerobic bacteria, like Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis (Heitz-Mayfield 3) The presence of these types of bacteria competes with the normal flora within the mouth, teeth and gum line. As a result, the clinical indications of periodontal disease include the following factors such as probing depth (PD), bleeding on probing (BOP), clinical attachment level (CAL), degree of furcation involvement, extent of gingival recession, tooth mobility, and plaque score and the amount and location of bone loss (Sweeting, Davis, and Cobb 18). These probing depths are also interrelated to the extraoral and interoral structures and tissues of the patient. The assessment of teeth is also thorough with the primary focus of initial assessments dedicated to mobility patterns that would indicate occlusions, inflammation and potential loss of bone, caries and furcation involvement.
The diagnostic and planning phases for a patient's treatment plan is correlated to soft tissue assessment and periodontal risk factors. The clinical presentation of periodontitis requires that tissues must be evaluated for qualitative factors such color, contour, and keratinization. The probing of the depth, or PD, from the gingival margin and of the periodontal pocket will indicate the presence of the pathogenic bacteria. If this probing depth is more than 3 mm, then the affected tissue is used to select final periodontal treatment and management. Additionally, any sort of bleeding upon probing would indicate the inflammation of the gingiva, as any increase in bleeding increases the likelihood of disease progression (Sweeting, Davis, and Cobb 18)
Finally, soft tissue assessment locating any gingival recessions and evaluating clinical attachment levels, or CAL, to calculate the total amount of CAL. Outside of any of these quantitative findings, patients should be evaluated for their risk factors. Studies have focused on age, gender, medications, the quantity and distribution of plaque and calculus, smoking and oral hygiene. Other researchers have evaluated secondary factors such as race and/or ethnicity, genetics. epidemiological relations, and patient’s secondary diseases such as diabetes, osteoporosis, and in some cases an entirely compromised immune system .
Periodontists, hygienists, and other health care professionals utilize specific diagnostic tools. Radiographic evaluation of alveolar bone loss, bone density, furcations, root shape, and proximity can help in the periodontal treatment outcomes. During these radiographs, specific scans will help clinicians evaluate their patient more effectively. Such scans include a full-mouth periapical survey, including vertical bite-wings, and in some cases a panographic radiograph that includes selected periapical films. Aside from these diagnostic tools,treatment requires effective communication, education, and listening skills are of particular importance to today’s dental patient. According to Sweeting, Davis, and Cobb (18) ,there are specific words that are highly-recommended to communicate diagnostic findings with patients. For example, the office staff and care givers should demonstrate their communication skills with the correct terminology and diction. In order to be effectively communicate a patient’s periodontal conditions, word choices such as “infection” over “gum inflammation” would help the patient understand that having periodontal disease is an urgent matter. Likewise, using the word “hemorrhage” would indicate the degree of seriousness in caring for periodontal disease. This communication style can complement the periodontal disease diagnosis and prepare a patient for treatment implementation, such as that of non-invasive periodontal treatment.
The aim of non-invasive surgical treatment of periodontitis is considred a Phase I therapy to minimize the bacterial floral present. As Sweeting, Davvis and Cobb (22) stated, this therapy is an “opportune time for the clinician to introduce adjunctive therapies to the patient such as the use of locally delivered antimicrobials.” Similarly, periodontitis patients with special circumstances, like dental implants, should still be wary with the findings of a recent study, that outlines specific phases of treatment to be selected. Therapy of specific types of periodontal disease have shown that periodontitis has little to minimal effects on bone loss in dental implants. In Aloufi et al study (38) , 61 patients randomly selected from patients treated and rehabilitated with dental implants from 1996 to 2001. In the study, participants were separated based on the periodontitis severity: group A with history of the generalized severe chronic form and group B with a history of mild or no chronic. Although the results of diagnostic evaluations such as radiographic bone measurements indicate greater attachment loss around implants placed in patients with severe periodontitis, the results were not statistically significant from the group B, no/mild periodontitis group. In such cases, rehabilitation of patients with periodontitis by dental implant was shown to be successful. Although the study doesn’t label these dental-implant patients as high risk bone-loss groups, this finding’s conclusions advocate close monitoring of patients to prevent development of peri-implantitis and/or reemergence of periodontal disease. Similarily, chronic periodontitis therapy is aimed at repairing the affected area and ultimately allow for regeneration of periodontal structures through future procedures. In Al-Omari, Al-Habashneh and Taani’s findings (847), periodontal structures show little difference between those with aggressive (AgP) and chronic(CP) periodontitis. In this study, age was not used as a limiting factor for diagnosis, as AgP can occur at any age. Using the same diagnostic methods previously mentioned, like radiographic examinations, the subjects of this study were identified as chronic if they had at least a 4-mm attachment loss on more than a quarter of the pocket sites and more than 20% of visible bone loss. Anything short of this quantities would be considered aggressive. Al-Omari, Al-Habashneh and Taani (848) stated, “the common features of the generalized aggressive form of periodontitis were as follows: clinical health of subjects, except for the presence of periodontitis; rapid attachment loss and bone destruction; and familial aggregation.” This study must be taken into consideration as it highlights how AgP and dental caries could be helpful in understanding the etiology and pathogenesis of both caries and periodontal disease.
In a later study, researchers focused on chronic periodontitis treatment. Graziani et al (2009) discused short-term adjunctive effect of systemic neridronate in non-surgical periodontal therapy of advanced generalized chronic periodontitis. This study evaluated the accompanying benefits of complementary neidronate with periodontal treatment. In this study, neidronate was selected for both its safety and therapeutic effects on bone metabolism. Ultimately, the study did not provide new findings for adjunctive non-surgical treatment of chronic periodontitis. Even with the ultimate treatment focus of eliminating subgingival plaque biofilm of dentition, bisphosphonates or BP’s were selected because its ability to to decrease ostoblastic differentiation and inhibit osteoclast recruitment (Graziani et al 420). The total dosage of 12.5 mg/week was within the therapeutic effective range for management of osteoporosis. However, the results illustrate that it was sufficient enough to have an effective outcome on osseous development of the alveolar bone. Nevertheless, neridronate has shown to be generally safe. The only adverse effects of treatment management of this sort include complications such as flu and musculo–skeletal pain occurred and there no incidents of hypocalcaemia reported in this study. Above all, these findings have illustrated the need for future studies to include longer observational periods to establish a long-term complementary treatment medication similar to neridronate.
The overall goal of non-invasive periodontal treatment is to reduce of etiologic factors to reduce or eliminate inflammation, thereby allowing gingival tissues to heal. Supportive treatment of periodontitis should be selected based on this therapeutic outcome. One such supportive therapy includes scaling and root planing.Removal of dental calculus is accomplished by scaling and root planing procedures using various modalities such as hand, sonic, or ultrasonic instruments (American Academy of Periodontology page number). The hope of scaling and root planning is to remove plaque and calculus so that the subgingival bacteria is below capable of initiating clinical inflammation. The objectives of scaling and root planning would allow for inflammation reduction. By reducing the amount of inflammation, the quantitative evaluations of probing depth, clinical attachment levels would thereby decrease. Consequently, root and scaling procedures decrease bacterial flora and ultimately reduces disease progression.
According to Heitz-Mayfield (Citation), microbial treatment monotherapy targets the bacteria that are present in the biofilm structure. Mechanical debridgement is an essential method for removing biofilm bacteria. This debridgement process must coincide with antibiotic treatment as both aim to reduce the amount of bacteria present and lower the amount of inflammation in the periodontal pocket. Together mechanical debridgement and systemic antibiotics must be complementary to be effective factors of periodontitis treatment. Their conclusions illustrate that the antibiotic is most effective when it is initiated within less than a week of mechanical debridgement. Research has shown that monotherapy is not as efficacious: four studies that utilized metronidazole and combined metranidazole and amoxicillin experimental groups concluded that antiobiotic monotherapy has little to minimal effect. Additionally, antibiotics, without subgingival debridgement, will not disrupt the biofilm, and instead will result only in periodontal abscesses. The periodontal abscess is a lesion with extensive periodontal breakdown occurring during a short period of time with localized accumulation of pus. In other cases, isolated mechanical debridement and drainage through the periodontal pocket without any antibiotic treatments usually only effective in the management of the periodontal abscess.
Therapeutic success of an antimicrobial depends on the activity of the antimicrobial agent against the infecting organisms. Periodontitis is a mixed microbial infection making the choice of antibiotic regimen difficult. Certain antibiotics target specific parts of the subgingival biofilm.
The most commonly used antibiotics include tetracyclines, penicillins, like amoxicillin, metronidazole, various macrolides, clindamycin and ciprofloxacin, of which the most common combination is metronidazole and amoxicillin combined. The other antibiotic option of azithromycin is advantageous because of its pharmacologic properties and long half life, which allows patients to take one tablet per day for three straight days, rather than three times a day for seven days for other drug options.
.Drug therapy adds as an accessory non-invasive therapy to scaling and root planning. Previous studies by researchers have questioned the benefits ofl topical antibacterial agents over a period of at least 6 months, which is the standard therapeutic index recommended by ADA . The approved ingredients included in this type of treatment include thymol, methol, eucalpytol and methyl salicylate. Secondary active ingredients include chlorhexidine digluconate and triclosan. Although minimal experimental evidence has supported it’s effects on gingivitis, a complementary topical agent is recommended (American Academy of Periodontology page number) Treatment agents combat the surface and not the deeper plaque. As part of the drug therapy, non-steroidal anti-inflammation drugs and subantimicrobial dose of doxycycline have illustrated some benefits. Recent FDA publishings have shown the use of 20 mg dosage of doxycycline hyclate have demonstrated reducing probing depths, gain in clinical attachments levels and a reduction of disease progression. The only risks of this form of therapy is that there are additional risks such as administered antibiotics include development of resistant bacterial strains,emergence of opportunistic infections, and possible allergic sensitization of patients(Citation). FDA has approved of a tetracycline based fiber along with doxycyclitie in a bioabsorbable polymer gel as a stand-alone therapy for thereduction of probing depths and bleeding upon probing, PD and BOP, respectively. However, this aspect of treatment has limited risks compared to those of using NSAIDS as previously mentioned. The only adverse effects include allergic reaction, possible inability to disrupt biofilms, and failure to remove calculus." Also, direct application drug delivery systems as a form of chemotherapeutic agents provide several benefits; the drug can be delivered to the site of disease activity at a bactericidal concentration and it can help with continued drug delivery and absorption. The ultimate aim of this type of therapy is to halt the progression of periodontal attachment loss by removing etiologic factors.
Additionally, patient compliance is another factor in ultimate therapeutic outcomes of antibiotic administration. Compliance in terms of oral hygiene and maintenance care should also be addressed. It should be recognized that in studies where beneficial results following adjunctive antibiotics were reported, patients had received maintenance care and had good plaque control. Recall that for the other aspects of non-invasive therapy to be effective, personal concern of hygiene is essential. For the dual therapy of debridgement and systemic antibiotics to be effective, patients should utilize oral rinses, hygiene and pain management. The limited side effects of fever and malaise for such dual therapy treatment are far outweighed by the benefits of reducing inflammation by reducing the number of gram-negative anaerobes. The other reported minor and major effects of antibiotic treatment is gastrointestinal problems such as diarrhoea and nausea. However, serious adverse events such as allergic andanaphlyactic reaction and pseudomembranous colitis. In very isolated cases, anaphylactic responses to penicillin have occurred in .01% of the times penicillin was administered (Heitz-Mayfield (Citation).
Supportive treatment modalities must coincide with the patient’s own personal preventative actions. The patient must follow personal plaque control measures. Furthermore, surface, or supragingival irrigation by the patient will allow for bacterial flushing, with the previously mentioned medications can reduce inflammation more effectively than brushing alone. In Radnai et al study "Benefits of Periodontal Therapy when Preterm birth Threatens" has highlighted the importance of personal oral hygiene instructions. The findings highlight significant differences between treatment and control groups relative to each newborn's birthweight and time. The primary advantageous outcomes of periodontal treatment for women were an increase in the mean weight of the newborns and the longer duration of gestation times (APA citation here) This study’s results showed that women had a significant lower chance of adverse pregnancy outcome if they received periodontal therapy before the 35th gestational week. Current results might also provide indirect evidence for the assumption that maternal periodontitis may cause pre-term birth.For this treatment group, oral hygiene instruction and periodontal therapy were provided in the third trimester, while those 42 patients in the control group did not receive any periodontal treatment. I The incidence of pre-term birth and low birthweight in the treatment group was significantly less than in the control group). Periodontal treatment completed before the 35th week appeared to have a beneficial effect on birth weight and time of delivery.
The preventative treatment aspect of periodontitis include detailed and properly communicated patient education process, including plaque control and counseling in management of periodontal and systemic risk factors mentioned previously. The effects of treatment have been supported through research. In Sweeting, Davis, and Cobb’s research (17), the time interval of three months for an indefinite period of time following active therapy, appears to be effective in reducing disease progression, preserving teeth, and controlling the subgingival bacterial burden. These findings illustrate the importance of health care professionals’ commitment to the future outcomes and maintenance of healthy periodontal tissue should include regular re-evaluations after non-surgical treatment. Again, periodontal treatment requires that the patient shows the basic understanding of the etiology of periodontal diseases, treatment options, consequences of nontreatment, and direct benefits of therapy. The inflammatory components of plaque induced gingivitis and chronic periodontitis can be managed effectively for the majority of patients with a plaque control program and non-surgical root debridgement coupled with continued periodontal maintenance procedures and actions such as regenerative therapies. Collectively, health professionals should ensure routine prophylaxis appointments, and ongoing periodontal maintenance to insure no patient is overlooked regarding diagnosis of developing periodontal disease or recurring disease (Citation). .
Thursday, February 24, 2011
Maryland Meets Irvine
While researching more information about the recent drug shortages across health-system agencies across the country, a local Pharma company made the local headlines...
In this case, where do pharmacists stand as far as FDA regulations and what steps can be taken on behalf of pharmaceutical companies and legislators to ensure that errors in manufacturing and quality control don't have a long-term effect in healthcare procedures and the overall quality of life for patients.
According to the L.A. Times,
For example, Teva Pharmaceuticals makes generic forms of certain cancer medications. So when quality issues temporarily closed its plant in Irvine in April, medical professionals were faced with limited supplies of an array of cancer drugs.
In addition, some drug companies have exited the business of making older, generic injectable drugs, which typically aren't as profitable as newer brand-name medicines. That puts additional production pressure on the remaining makers of these generic treatments.
Take propofol, a popular anesthetic for surgeries and other medical procedures. Teva decided to exit the propofol business last year after a quality issue with the drug in 2009. In a statement, the company said it believed its "existing, approved technology is not suitable to ensure that we can consistently produce the product to Teva's high quality standard."
In this case, where do pharmacists stand as far as FDA regulations and what steps can be taken on behalf of pharmaceutical companies and legislators to ensure that errors in manufacturing and quality control don't have a long-term effect in healthcare procedures and the overall quality of life for patients.
According to the L.A. Times,
For example, Teva Pharmaceuticals makes generic forms of certain cancer medications. So when quality issues temporarily closed its plant in Irvine in April, medical professionals were faced with limited supplies of an array of cancer drugs.
In addition, some drug companies have exited the business of making older, generic injectable drugs, which typically aren't as profitable as newer brand-name medicines. That puts additional production pressure on the remaining makers of these generic treatments.
Take propofol, a popular anesthetic for surgeries and other medical procedures. Teva decided to exit the propofol business last year after a quality issue with the drug in 2009. In a statement, the company said it believed its "existing, approved technology is not suitable to ensure that we can consistently produce the product to Teva's high quality standard."
Wednesday, February 23, 2011
What is the Need?
The Need
The 2000 Report to the U.S. Congress on Pharmacist Workforce, a study of the supply and demand for pharmacists, indicates there is a shortage of pharmacists. According to the report, the reasons for the shortage include: increased use of prescription medications, expansion of pharmacy practice, role and opportunities, market growth and competition in community pharmacy practice, and changes in the pharmacist workforce. The shortage in pharmacists has a negative impact on the profession and public. Those who are most affected are the underserved, elderly, residents of rural communities, and persons dependent of publicly supported services such as Veterans. Several factors contribute to the challenges of maintaining an adequate supply of pharmacists in rural areas, such as the Eastern Shore. These include remoteness, isolation from other professionals, lower economic returns, reduced opportunities for advancement, and proximity to pharmacy schools, availability of rural training, and economic status of rural communities.
There is also a need for more minority pharmacists. The importance of increasing racial and ethnic diversity in pharmacy schools was explored in a 2008 article published in the American Journal of Pharmaceutical Education (Hayes, B. Increasing the Representation of Underrepresented Minority Groups in US Colleges and Schools of Pharmacy. Am J Pharm Educ. 2008 February 15; 72(1): 14). The article noted that the number of Blacks, Hispanics and Native Americans in colleges and schools of pharmacy is considerably lower than their representation in the general population. Blacks, Hispanics, and Native Americans made up 28% of the US population (Black, 12.4%; Hispanic or Latino 14. 8%, and Native American, 0.8%) in 2006, yet these underrepresented minority groups accounted for only 12% of the total number of doctor of pharmacy (PharmD) degrees conferred as first professional degrees (Black, 7.4%; Hispanic, 4.2% and Native American, 0.4%). Increasing racial and ethnic diversity in health care professionals has many benefits including: improved access to care for racial and ethnic patients; better patient-provider communication; greater patient choice and satisfaction; and improved educational experiences for health professions students.
From "University of Maryland Eastern Shore Website"
The 2000 Report to the U.S. Congress on Pharmacist Workforce, a study of the supply and demand for pharmacists, indicates there is a shortage of pharmacists. According to the report, the reasons for the shortage include: increased use of prescription medications, expansion of pharmacy practice, role and opportunities, market growth and competition in community pharmacy practice, and changes in the pharmacist workforce. The shortage in pharmacists has a negative impact on the profession and public. Those who are most affected are the underserved, elderly, residents of rural communities, and persons dependent of publicly supported services such as Veterans. Several factors contribute to the challenges of maintaining an adequate supply of pharmacists in rural areas, such as the Eastern Shore. These include remoteness, isolation from other professionals, lower economic returns, reduced opportunities for advancement, and proximity to pharmacy schools, availability of rural training, and economic status of rural communities.
There is also a need for more minority pharmacists. The importance of increasing racial and ethnic diversity in pharmacy schools was explored in a 2008 article published in the American Journal of Pharmaceutical Education (Hayes, B. Increasing the Representation of Underrepresented Minority Groups in US Colleges and Schools of Pharmacy. Am J Pharm Educ. 2008 February 15; 72(1): 14). The article noted that the number of Blacks, Hispanics and Native Americans in colleges and schools of pharmacy is considerably lower than their representation in the general population. Blacks, Hispanics, and Native Americans made up 28% of the US population (Black, 12.4%; Hispanic or Latino 14. 8%, and Native American, 0.8%) in 2006, yet these underrepresented minority groups accounted for only 12% of the total number of doctor of pharmacy (PharmD) degrees conferred as first professional degrees (Black, 7.4%; Hispanic, 4.2% and Native American, 0.4%). Increasing racial and ethnic diversity in health care professionals has many benefits including: improved access to care for racial and ethnic patients; better patient-provider communication; greater patient choice and satisfaction; and improved educational experiences for health professions students.
From "University of Maryland Eastern Shore Website"
Sunday, February 20, 2011
Umami Burger @ Fred Segal's Santa Monica
After having an umami burger at Fred Segal's, I had an inquisitive look at taste receptors on the basis of neuroscience.
Biochemical studies have identified the taste receptors responsible for the sense of umami, a modified form of mGluR4, mGluR1 and taste receptor type 1 (T1R1 + T1R3).[21][22][23] The New York Academy of Sciences corroborated their acceptance stating that "Recent molecular biological studies have now identified strong candidates for umami receptors, including the heterodimer T1R1/T1R3, and truncated tye 1 and 4 metabotropic glutamate receptors missing most of the N-terminal extracellular domain (taste-mGluR4 and truncated-mGluR1) and brain-mGluR4 …The finding that human T1R1/T1R3 heterologously expressed in human embryonic kidney cells preferentially responds to glutamate, provides strong molecular evidence for specific umami detection in humans. However, these other receptors remain candidates and the role of each type of receptor in taste bud cells remains unclear."[8]
Umami tastes are initiated by these specialized receptors, with subsequent steps involving secretion of neurotransmitters including serotonin.[24] Other evidence indicates guanosine derivatives may interact with and boost the initial umami signal.[25]
Cells responding to umami taste stimuli do not possess typical synapses, but instead secrete the neurotransmitter ATP in a mechanism exciting sensory fibers that convey taste signals to the brain.
In monkey studies, most umami signals from taste buds excite neurons in the orbitofrontal cortex of the brain, showing spatially specific characteristics:[26]
* Single neurons having vigorous responses to sodium glutamate also respond to glutamic acid
* Some neurons display a mechanism of satiety.
The stomach can "taste" sodium glutamate using glumate receptors[27] and this information is passed to the lateral hypothalamus and limbic system in the brain as a palatability signal through the vagus nerve.[28]
Biochemical studies have identified the taste receptors responsible for the sense of umami, a modified form of mGluR4, mGluR1 and taste receptor type 1 (T1R1 + T1R3).[21][22][23] The New York Academy of Sciences corroborated their acceptance stating that "Recent molecular biological studies have now identified strong candidates for umami receptors, including the heterodimer T1R1/T1R3, and truncated tye 1 and 4 metabotropic glutamate receptors missing most of the N-terminal extracellular domain (taste-mGluR4 and truncated-mGluR1) and brain-mGluR4 …The finding that human T1R1/T1R3 heterologously expressed in human embryonic kidney cells preferentially responds to glutamate, provides strong molecular evidence for specific umami detection in humans. However, these other receptors remain candidates and the role of each type of receptor in taste bud cells remains unclear."[8]
Umami tastes are initiated by these specialized receptors, with subsequent steps involving secretion of neurotransmitters including serotonin.[24] Other evidence indicates guanosine derivatives may interact with and boost the initial umami signal.[25]
Cells responding to umami taste stimuli do not possess typical synapses, but instead secrete the neurotransmitter ATP in a mechanism exciting sensory fibers that convey taste signals to the brain.
In monkey studies, most umami signals from taste buds excite neurons in the orbitofrontal cortex of the brain, showing spatially specific characteristics:[26]
* Single neurons having vigorous responses to sodium glutamate also respond to glutamic acid
* Some neurons display a mechanism of satiety.
The stomach can "taste" sodium glutamate using glumate receptors[27] and this information is passed to the lateral hypothalamus and limbic system in the brain as a palatability signal through the vagus nerve.[28]
Thursday, February 10, 2011
Pharm.D. and MBA Dual Program Interest Questions
Bnet.com Article on the Impact of a Dual Degree
Comments from an experienced pharmacy management professional
http://www.facebook.com/notes/student-doctor-network/20-questions-craig-s-stern-rph-pharmd-mba/460931983284
Comments from an experienced pharmacy management professional
http://www.facebook.com/notes/student-doctor-network/20-questions-craig-s-stern-rph-pharmd-mba/460931983284
Friday, January 28, 2011
Outside the NFL Lines: 1,000 Vicodin a Month?
Beyond the turf and outside the lines, lies a larger issue within As the Super Bowl approaches next weekend, the recent sports coverage has centered on current NFL teams. However, beyond the current players, retired NFL players are making other headlines with prescription pain killers.
A recent study commissioned by ESPN has featured Miami Dolphins and former tight end in the 1980's, Dan Johnson. In an interview, Johnson revealed there was a time where he would average 1,000 Vicodin's a month to deal with the chronic pain suffered during his reign as "King Pain" in the NFL. Today's study also shares relevant information about the athletes even in the 21st century. Of the retired NFL athletes surveyed, 71% of the athletes have misuse the drugs prescribed . Of these 71%, 15% of them continue to misuse them to this day. These are significant numbers far from the common talk of championship rings, Superbowl commercials and Monday Night Football.
Not using this to compare this to the normal sample population, but at the same time, one must consider the study's relevance. What is the percentage of athletes in high school, college and professional leagues that encounter injuries and/or pain?
With that being said, this study sets a precedent of what to examine and what pharmacists and healthcare providers must be aware of. Instead, this ESPN study provides a pivotal study of what teams' health care staff including physicians and athletic trainers need to be aware of. At the same time, just as new rules impose fines for illegal contact, Roger Goodell should make athletes accountable for prescription medicines. Not that 1,000 Vicodin's a month is a realistic situation, but the situation addresses the issues of patient compliance and overall health.
Source:
Healthland Article
ESPN
A recent study commissioned by ESPN has featured Miami Dolphins and former tight end in the 1980's, Dan Johnson. In an interview, Johnson revealed there was a time where he would average 1,000 Vicodin's a month to deal with the chronic pain suffered during his reign as "King Pain" in the NFL. Today's study also shares relevant information about the athletes even in the 21st century. Of the retired NFL athletes surveyed, 71% of the athletes have misuse the drugs prescribed . Of these 71%, 15% of them continue to misuse them to this day. These are significant numbers far from the common talk of championship rings, Superbowl commercials and Monday Night Football.
Not using this to compare this to the normal sample population, but at the same time, one must consider the study's relevance. What is the percentage of athletes in high school, college and professional leagues that encounter injuries and/or pain?
With that being said, this study sets a precedent of what to examine and what pharmacists and healthcare providers must be aware of. Instead, this ESPN study provides a pivotal study of what teams' health care staff including physicians and athletic trainers need to be aware of. At the same time, just as new rules impose fines for illegal contact, Roger Goodell should make athletes accountable for prescription medicines. Not that 1,000 Vicodin's a month is a realistic situation, but the situation addresses the issues of patient compliance and overall health.
Source:
Healthland Article
ESPN
Patient Satisfaction and Compliance
Five Tips for Generating Patient Satisfaction and Compliance
These lessons from the business world can work in your practice, too.
Manoj Pawar MD, MMM
Fam Pract Manag. 2005 Jun;12(6):44-46.
I recently attended a conference on diabetes where the presenter stressed the importance of getting patients to check their blood sugars three times per day, in keeping with the latest clinical guidelines. Almost immediately the speaker received a strong objection from one physician in the audience. “We can't get our patients to check their blood sugars that often,” he protested. “We're lucky to get them to check once a day!”
In her response, the presenter said that to get patients to change their behavior, whether in the context of smoking cessation or diabetes management, there is an element of “selling” that's required of the physician. In other words, the physician has to recognize the opportunity for intervention, reframe it in a way that makes it meaningful to the patient and generate a sufficient sense of urgency to compel the patient to take action. At the same time, the physician has to maintain a partnership with the patient, based on trust and understanding.
In many ways, this is the same approach taken by great salespeople. Although that comparison may make some physicians uncomfortable, we can find value in examining how other fields have approached similar challenges. What follows are five key lessons from the sales profession that have the potential to strengthen physician-patient relationships, improve patient satisfaction and enhance patient compliance.
KEY POINTS
Physicians can find ways to improve the doctor-patient relationship by examining what works in other fields, such as sales.
When patients trust their physician, they are more likely to adhere to treatment plans and follow advice.
Effective listening and inquiry will help you uncover patients' real needs and goals.
1. Establish a sense of trust
This is a crucial first step in any patient encounter. In their book Primal Leadership: Realizing the Power of Emotional Intelligence, Daniel Goleman and his colleagues outline the importance of trust in conveying a message successfully.1 He explains that as an event takes place, such as hearing a recommendation or a sales pitch, the amygdala (which produces our “fight-or-flight” response) filters the perceived event and attaches an emotional context to it. If the amygdala perceives the event to be unsafe, either physically or psychologically, then it initiates an appropriate response. This response ultimately interrupts the path of the incoming information so that it does not reach the prefrontal cortex effectively.
Imagine a pharmaceutical representative presenting information to you in a fashion that makes you feel manipulated. Psychologically, you perceive a threat, which triggers a response from your amygdala. Goleman calls this process an “amygdala hijack.” From this point on, the remainder of the representative's message becomes irrelevant, as it never engages the prefrontal cortex and the information is not absorbed.
If we are to have any hope of having our message heard and understood by our patients, we need to become skilled at not triggering a state of psychological fear. To do so means we must learn to be perceptive listeners and careful observers of small details that give us a glimpse into the lives of patients and enable us to understand their values, goals, challenges and interests over time. Effective salespeople know this tactic, and they gather pieces of important information about their customers. Effective physicians must do the same, using the skills in the next step.
2. Uncover patients' actual needs
Perhaps the most critical skill in uncovering the needs of a client or patient is the skill of inquiry. Central to good dialogue, inquiry involves asking questions with a spirit of curiosity and with a goal of trying to understand how others perceive the world around them. Great salespeople probe to meet customer expectations and to see how they can be of assistance in the future. In essence, they establish themselves as trusted partners and lay the foundation for future business, even if they may not be of immediate assistance.
At first glance, the way to uncover patients' needs may seem straightforward: Simply ask an open-ended question such as, “What brings you in today?” But there is more to it than that.
Many cases of patient dissatisfaction can be traced to an inadequate discovery of patient needs. For example, I recently saw a patient who indicated, when I asked, that she had come to get her iron levels checked. Given the hectic nature of the day, I was tempted to draw the lab tests and call it a day. Suspecting that this would not have met her needs, I responded with interest: “It sounds like this is worrying you. What brings you to want to get these levels checked?”
As the conversation unfolded, she proceeded to tell me that she had resolved to improve her health by losing weight. Her plan included eating right and exercising, but she said that she lacked the energy to exercise. She had done some preliminary research that had led her to think about her iron levels. As a result of our conversation, we were able to enhance her trust, gain insight into her goals and identify other areas where our office's clinical services could be helpful. By taking the time to probe a bit deeper, we created the foundation for a stronger long-term physician-patient relationship.
I use this approach often, especially with new patients or with those who come for annual physical exams. Asking patients to describe how they see themselves in five years and how I can help them attain their goals is a good starting point. Physical exams become “game plans” for meeting needs over time, and they allow us to pace our progress.
3. Think dialogue, not monologue
Just as physicians dislike salespeople who seem to dominate the interaction, patients dislike us when we do the same. The days of patients accepting prescriptive and paternalistic advice from their physician are nearing their end. Leave the didactic monologues behind.
Instead, ask questions, explore values and make a connection with every patient. Rather than hearing patients' complaints and immediately responding with a solution, dig deeper. Find out how their problems affect their day-to-day lives, or how they have approached the problem and what their results have been. Support their internal knowledge, and recognize that they often do know their own bodies. Only after they have finished speaking should you address other options. Ask patients how these other options sound in the context of their overall goals.
4. Don't force “the close”
“The close” is a sales term that describes the phase of the interaction during which the salesperson obtains a commitment from the customer to close the deal and proceed to the next step. The timing of this step, however, is critical for success. You can't get people to “sign on the dotted line” before they are ready. If you push it too soon, you'll instill a sense of mistrust and even anger.
How do you know if a patient is ready? One technique is called a “test close.” For example, if a patient with uncontrolled diabetes says he's too busy to exercise, try saying: “It sounds like time has been your biggest concern when it comes to exercising. If we could find an exercise plan that doesn't take a lot of time, would you be willing to move forward?”
If the proposal is acceptable to the patient, then you can move to the “close.” In this example, it may be prescribing just 15 minutes of walking three times per week. In our practice, we would then ask, “Does this approach sound OK to you?” to confirm a commitment or invite negotiation.
5. Always follow up
Effective salespeople always follow up with their customers on prior sales to determine whether they were satisfied with their solutions. They also follow up just to say hi, which demonstrates that the customer is important to them.
Physicians should do the same. I also ask patients to follow up with me by phone or e-mail in a week to update me on how our plan is working, or, even better, I ask permission to contact them within the same time frame. If you don't have time to follow up yourself, have your staff call patients after their visits to ask how things are going, whether their goals are progressing and whether they would like to make another appointment to see you. Patients appreciate when our office staff is able to support them as they work toward their goals. Your office can also show patients they are important by sending birthday cards, e-mailing health tips and pursuing other avenues of contact. These build commitment and place minimal burden on your staff.
Happier, healthier patients
Developing strong patient relationships with high levels of satisfaction is challenging, but it is a realistic goal. These lessons can provide fresh insight into our approach with patients and can lead to a greater understanding of patients' needs and increased levels of compliance. The trust that evolves will create a foundation we can build on for years to come.
Dr. Pawar is a managing partner for Nivek Consulting, which helps teams and individual leaders in health care to enhance their effectiveness and maximize their potential.
Conflicts of interest: none reported.
Send comments to fpmedit@aafp.org.
1. Goleman D, McKee A, Boyatzis RE. Primal Leadership: Realizing the Power of Emotional Intelligence. Boston: Harvard Business School Press; 2002.
These lessons from the business world can work in your practice, too.
Manoj Pawar MD, MMM
Fam Pract Manag. 2005 Jun;12(6):44-46.
I recently attended a conference on diabetes where the presenter stressed the importance of getting patients to check their blood sugars three times per day, in keeping with the latest clinical guidelines. Almost immediately the speaker received a strong objection from one physician in the audience. “We can't get our patients to check their blood sugars that often,” he protested. “We're lucky to get them to check once a day!”
In her response, the presenter said that to get patients to change their behavior, whether in the context of smoking cessation or diabetes management, there is an element of “selling” that's required of the physician. In other words, the physician has to recognize the opportunity for intervention, reframe it in a way that makes it meaningful to the patient and generate a sufficient sense of urgency to compel the patient to take action. At the same time, the physician has to maintain a partnership with the patient, based on trust and understanding.
In many ways, this is the same approach taken by great salespeople. Although that comparison may make some physicians uncomfortable, we can find value in examining how other fields have approached similar challenges. What follows are five key lessons from the sales profession that have the potential to strengthen physician-patient relationships, improve patient satisfaction and enhance patient compliance.
KEY POINTS
Physicians can find ways to improve the doctor-patient relationship by examining what works in other fields, such as sales.
When patients trust their physician, they are more likely to adhere to treatment plans and follow advice.
Effective listening and inquiry will help you uncover patients' real needs and goals.
1. Establish a sense of trust
This is a crucial first step in any patient encounter. In their book Primal Leadership: Realizing the Power of Emotional Intelligence, Daniel Goleman and his colleagues outline the importance of trust in conveying a message successfully.1 He explains that as an event takes place, such as hearing a recommendation or a sales pitch, the amygdala (which produces our “fight-or-flight” response) filters the perceived event and attaches an emotional context to it. If the amygdala perceives the event to be unsafe, either physically or psychologically, then it initiates an appropriate response. This response ultimately interrupts the path of the incoming information so that it does not reach the prefrontal cortex effectively.
Imagine a pharmaceutical representative presenting information to you in a fashion that makes you feel manipulated. Psychologically, you perceive a threat, which triggers a response from your amygdala. Goleman calls this process an “amygdala hijack.” From this point on, the remainder of the representative's message becomes irrelevant, as it never engages the prefrontal cortex and the information is not absorbed.
If we are to have any hope of having our message heard and understood by our patients, we need to become skilled at not triggering a state of psychological fear. To do so means we must learn to be perceptive listeners and careful observers of small details that give us a glimpse into the lives of patients and enable us to understand their values, goals, challenges and interests over time. Effective salespeople know this tactic, and they gather pieces of important information about their customers. Effective physicians must do the same, using the skills in the next step.
2. Uncover patients' actual needs
Perhaps the most critical skill in uncovering the needs of a client or patient is the skill of inquiry. Central to good dialogue, inquiry involves asking questions with a spirit of curiosity and with a goal of trying to understand how others perceive the world around them. Great salespeople probe to meet customer expectations and to see how they can be of assistance in the future. In essence, they establish themselves as trusted partners and lay the foundation for future business, even if they may not be of immediate assistance.
At first glance, the way to uncover patients' needs may seem straightforward: Simply ask an open-ended question such as, “What brings you in today?” But there is more to it than that.
Many cases of patient dissatisfaction can be traced to an inadequate discovery of patient needs. For example, I recently saw a patient who indicated, when I asked, that she had come to get her iron levels checked. Given the hectic nature of the day, I was tempted to draw the lab tests and call it a day. Suspecting that this would not have met her needs, I responded with interest: “It sounds like this is worrying you. What brings you to want to get these levels checked?”
As the conversation unfolded, she proceeded to tell me that she had resolved to improve her health by losing weight. Her plan included eating right and exercising, but she said that she lacked the energy to exercise. She had done some preliminary research that had led her to think about her iron levels. As a result of our conversation, we were able to enhance her trust, gain insight into her goals and identify other areas where our office's clinical services could be helpful. By taking the time to probe a bit deeper, we created the foundation for a stronger long-term physician-patient relationship.
I use this approach often, especially with new patients or with those who come for annual physical exams. Asking patients to describe how they see themselves in five years and how I can help them attain their goals is a good starting point. Physical exams become “game plans” for meeting needs over time, and they allow us to pace our progress.
3. Think dialogue, not monologue
Just as physicians dislike salespeople who seem to dominate the interaction, patients dislike us when we do the same. The days of patients accepting prescriptive and paternalistic advice from their physician are nearing their end. Leave the didactic monologues behind.
Instead, ask questions, explore values and make a connection with every patient. Rather than hearing patients' complaints and immediately responding with a solution, dig deeper. Find out how their problems affect their day-to-day lives, or how they have approached the problem and what their results have been. Support their internal knowledge, and recognize that they often do know their own bodies. Only after they have finished speaking should you address other options. Ask patients how these other options sound in the context of their overall goals.
4. Don't force “the close”
“The close” is a sales term that describes the phase of the interaction during which the salesperson obtains a commitment from the customer to close the deal and proceed to the next step. The timing of this step, however, is critical for success. You can't get people to “sign on the dotted line” before they are ready. If you push it too soon, you'll instill a sense of mistrust and even anger.
How do you know if a patient is ready? One technique is called a “test close.” For example, if a patient with uncontrolled diabetes says he's too busy to exercise, try saying: “It sounds like time has been your biggest concern when it comes to exercising. If we could find an exercise plan that doesn't take a lot of time, would you be willing to move forward?”
If the proposal is acceptable to the patient, then you can move to the “close.” In this example, it may be prescribing just 15 minutes of walking three times per week. In our practice, we would then ask, “Does this approach sound OK to you?” to confirm a commitment or invite negotiation.
5. Always follow up
Effective salespeople always follow up with their customers on prior sales to determine whether they were satisfied with their solutions. They also follow up just to say hi, which demonstrates that the customer is important to them.
Physicians should do the same. I also ask patients to follow up with me by phone or e-mail in a week to update me on how our plan is working, or, even better, I ask permission to contact them within the same time frame. If you don't have time to follow up yourself, have your staff call patients after their visits to ask how things are going, whether their goals are progressing and whether they would like to make another appointment to see you. Patients appreciate when our office staff is able to support them as they work toward their goals. Your office can also show patients they are important by sending birthday cards, e-mailing health tips and pursuing other avenues of contact. These build commitment and place minimal burden on your staff.
Happier, healthier patients
Developing strong patient relationships with high levels of satisfaction is challenging, but it is a realistic goal. These lessons can provide fresh insight into our approach with patients and can lead to a greater understanding of patients' needs and increased levels of compliance. The trust that evolves will create a foundation we can build on for years to come.
Dr. Pawar is a managing partner for Nivek Consulting, which helps teams and individual leaders in health care to enhance their effectiveness and maximize their potential.
Conflicts of interest: none reported.
Send comments to fpmedit@aafp.org.
1. Goleman D, McKee A, Boyatzis RE. Primal Leadership: Realizing the Power of Emotional Intelligence. Boston: Harvard Business School Press; 2002.
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