Christa M. George

As preceptors are responsible for the experiential education of future pharmacists, it is important to assess understanding and identify knowledge gaps for preceptor development. The purpose of this pilot study was to assess the exposure to social determinants of health (SDOH), comfort in addressing social needs, and awareness of social resources among the preceptors at one college of pharmacy. A brief online survey was sent to all affiliated pharmacist preceptors with screening criteria for pharmacists who had regular one-on-one patient interactions. Of 166 preceptor respondents (response rate = 30.5%), 72 eligible preceptors completed the survey. Self-reported SDOH exposure increased along the educational continuum (with increasingly more emphasis from the didactic to experiential to residency). Preceptors who graduated after 2016, practiced in either community or clinic settings and served >50% of underserved patients were the most comfortable addressing social needs and the most aware of social resources. Preceptor understanding of SDOH has implications for their ability to educate future pharmacists. Colleges of pharmacy should evaluate practice site placement as well as preceptor knowledge and comfort in addressing social needs in order to ensure that all students are exposed to the SDOH throughout the continuum of learning. Best practices for up-skilling preceptors in this area should also be explored.

A comprehensive, collaborative approach is necessary for optimal treatment of patients with type 2 diabetes mellitus. Treatment guidelines focus on nutrition, exercise, and pharmacologic therapies to prevent and manage complications. Patients with prediabetes or new-onset diabetes should receive individualized medical nutrition therapy, preferably from a registered dietitian, as needed to achieve treatment goals. Patients should be treated initially with metformin because it is the only medication shown in randomized controlled trials to reduce mortality and complications. Additional medications such as sulfonylureas, dipeptidyl-peptidase-4 inhibitors, thiazolidinediones, and glucagon-like peptide-1 receptor agonists should be added as needed in a patient-centered fashion. However, there is no evidence that any of these medications reduce the risk of diabetes-related complications, cardiovascular mortality, or all-cause mortality. There is insufficient evidence on which combination of hypoglycemic agents best improves health outcomes before escalating to insulin therapy. The American Diabetes Association recommends an A1C goal of less than 7% for many nonpregnant adults, with the option of a less stringent goal of less than 8% for patients with short life expectancy, cardiovascular risk factors, or long-standing diabetes. Randomized trials in middle-aged patients with cardiovascular risk factors have shown no mortality benefit and in some cases increased mortality with more stringent A1C targets. Copyright (C) 2015 American Academy of Family Physicians.

Background: Monitoring peak expiratory flow (PEF) values is one option as part of asthma action plans per national guidelines. PEF assessment is also recommended in emergency department and hospitalized patients. Incorrect use of peak flow meters (PFM) has obvious implications for appropriate decisions by patients and clinicians. Methods: We searched the English literature via PubMed and SCOPUS using the following search terms: PEF maneuver; incorrect use of PFM. When pertinent articles were found, we assessed publications cited in those papers. All studies related to incorrect use of PFM in patients with asthma were included. Results: Nine studies have reported errors in performing the PEF maneuver, including three pediatric and six adult studies. Errors were found at most steps of the maneuver, and inability to perform all steps correctly was common in these investigations. Examples of errors included failure to inhale fully or give maximum effort on exhalation, accelerating air with the tongue and buccal musculature, and performing only one attempt versus three. Gender differences in correct use of PFM are suggested by three adult studies. One study described falsifying PEF values by manipulating the PFM indicator, and another investigation assessed the PEF maneuver in two positions in bed versus the correct posture of standing. Conclusion: Many pediatric and adult patients do not use PFM correctly. Clinicians should regularly observe patients use PFM to detect errors and help ensure correct use and accurate PEF measurements.