Efficacy and impact of monophasic versus biphasic countershocks for transthoracic cardioversion of persistent atrial fibrillation

This report compares the cumulative efficacy of cardioversion and skeletal muscle injury after either damped sine wave monophasic or truncated exponential biphasic transthoracic cardioversion of persistent atrial fibrillation. The trial sought to refute the null hypothesis of therapeutic equivalence between monophasic and biphasic waveforms. Results of the study reveal similar cumulative efficacy of waveforms and greater levels of skeletal muscle damage when patients are younger and male, and when monophasic waveforms are used.     

Assessment programs to enhance learning

Background: Assessment is an essential part of the educational system. Usually, assessment is used to measure students’ knowledge, but it can also be used to drive students’ learning and behaviors. Assessment programs should be constructed in a well-balanced way allowing not only measuring students’ knowledge but also changing students’ behavior.

Objectives: In this paper, we will discuss different strategies that can be used to change students’ behaviors which may improve their learning.

Main findings: Assessment as well as the learning material should be congruent with the objectives. Based on the literature, we summarize findings that would address key points to allow assessment for learning instead of learning.

Conclusions: When constructing an assessment program, choices have to be made that depend on aspects like logistics, financial, organizational, managerial, educational culture, and cooperation of individual and key faculty members. It is important to realize that whatever decisions you make, students will always adapt their behavior to the way you construct your assessment program.     

Career Placement of Doctor of Pharmacy Graduates at Eight U.S. Midwestern Schools

Objective. To characterize postgraduation placement plans of 2013 doctor of pharmacy (PharmD) graduates.Methods. A cross-sectional survey of PharmD graduates from 8 midwestern colleges of pharmacy was designed to capture a comprehensive picture of graduating students’ experiences and outcomes of their job search.Results. At graduation, 81% of 2013 respondents had postgraduate plans, with approximately 40% accepting jobs and 40% accepting residencies or fellowships. Eighty-four percent of graduates reported being pleased with offers received, and 86% received placement in their preferred practice setting. Students perceived that securing residencies was more difficult than securing jobs. Students who participated in key activities had a nearly sevenfold increase in successful residency placement.Conclusion. While the demand for pharmacists decreased in recent years, responses indicated successful placement by the majority of 2013 graduates at the time of graduation.     

Efficacy and safety of telaprevir (TVR) triple therapy in a ‘real‐life’ cohort of 102 patients with HCV genotype 1: interim analysis after 24 weeks of treatment

Since 2011, telaprevir (TVR)‐based triple therapy is the new treatment standard for hepatitis C genotype 1 virus infection. The aim of our retrospective interim analysis encompassing the first 24 weeks on TVR‐based triple therapy was to assess ‘real‐life’ antiviral efficacy and side effects in a large single‐centre cohort, both in comparison with the data obtained in large prospective clinical trials. In total, we treated 102 patients: 24 treatment‐naïve patients, 58 patients pretreated with PEG‐IFN/RBV (thereof: 28 with nonresponse, 25 with relapse, five unknown) and 20 patients who previously had received nonpegylated interferon. 74 of 102 patients were assigned with HCV genotype 1b; 34 of 102 patients were treated in the context of liver cirrhosis. 72 of 102 patients have reached treatment week 24 (mean treatment duration 31 weeks). In the ITT analysis, overall response rates were at: week 4: 66%; week 12: 85%; and week 24: 78%. So far, 24 patients discontinued treatment prematurely, of those, 10 patients were due to virological failure. Haematological side effects were frequent (40% anaemia), as were ‘flu‐like’ symptoms (94%), rash (65%) and pruritus (79%). According to our interim ITT analysis encompassing up to 24 weeks of TVR‐based triple therapy, our ‘real‐life’ antiviral effects are comparable to the results of large multicentric clinical trials. However, TVR‐based triple therapy exhibited a high frequency of side effects requiring multiple therapeutic interventions. Notably, in our ‘real‐life’ cohort, no lethal case was observed so far.     

Adipokines and proinflammatory cytokines,the key mediators in the pathogenesis of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a condition in which excess fat accumulates in the liver of a patient with no history of alcohol abuse or other causes for secondary hepatic steatosis. The pathogenesis of NAFLD and nonalcoholic steatohepatitis (NASH) has not been fully elucidated. The “two-hit“ hypothesis is probably a too simplified model to elaborate complex pathogenetic events occurring in patients with NASH. It should be better regarded as a multiple step process, with accumulation of liver fat being the first step, followed by the development of necroinflammation and fibrosis. Adipose tissue, which has emerged as an endocrine organ with a key role in energy homeostasis, is responsive to both central and peripheral metabolic signals and is itself capable of secreting a number of proteins. These adipocyte-specific or enriched proteins, termed adipokines, have been shown to have a variety of local, peripheral, and central effects. In the current review, we explore the role of adipocytokines and proinflammatory cytokines in the pathogenesis of NAFLD. We particularly focus on adiponectin, leptin and ghrelin, with a brief mention of resistin, visfatin and retinol-binding protein 4 among adipokines, and tumor necrosis factor-α, interleukin (IL)-6, IL-1, and briefly IL-18 among proinflammatory cytokines. We update their role in NAFLD, as elucidated in experimental models and clinical practice.