The purposes of this study were to assess the differential effects of a single strategy (schema-based instruction; SBI) versus multiple strategies (general strategy instruction, GSI) in promoting mathematical problem solving and mathematics achievement as well as to examine the influence of word problem-solving instruction on the development of computational skills. Eighty-eight 3rd graders and their teachers were assigned randomly to conditions (SBI and GSI). Students were pre- and posttested on mathematical problem-solving and computation tests and were posttested on the Pennsylvania System of School Assessment Mathematics test, a criterion-referenced test that measures student attainment of academic standards. Results revealed SBI to be more effective than GSI in enhancing students' mathematical word problem-solving skills at posttest and maintenance. Further, results indicate that the SBI groups' performance exceeded that of the GSI group on the Pennsylvania System of School Assessment measure. On the computation test, both groups made gains over time.

We conducted a prospective, open-label trial to evaluate the effectiveness of a pharmacist-based, comprehensive, smoking-cessation program with 31 self-referred subjects. A secondary goal was to measure changes in health-related quality of life (HRQOL) during the cessation attempt. The program consisted of weekly, 1-hour group sessions over 12 weeks. It incorporated nicotine replacement therapy (patch, gum) with extensive behavior modification counseling. Trained pharmacists served as program facilitators. Smoking cessation was chemically verified at 3 and 6 months by exhaled carbon monoxide. The patients' HRQOL was measured using the smoking-cessation quality of life questionnaire at baseline, 2 weeks, and 1, 2, 3, and 6 months. Chemically verified abstinence rates at 3 and 6 months were 42% (13 patients) and 26% (8 patients), respectively. Among patients who quit, vitality, mental health, and self-control significantly improved during the 3-month program. Six-month cessation rates were modest, although HRQOL improved within 3 months of abstinence.

BackgroundEvidence suggests that patients with type 2 diabetes (T2DM) suffer from a high rate of “clinical inertia” or “recognition of the problem but failure to act.” ObjectiveThe aim of this study is to quantify the rate of clinical inertia between two models of care: Pharmacist-Managed Diabetes Clinic (PMDC) vs. Usual Medical Care (UMC).MethodsPatients in a university based medical clinic with type 2 diabetes (T2DM) were analyzed in this retrospective cohort study. Patients were exposed to either PMDC or UMC. The difference in days to intervention in response to suboptimal laboratory values and time to achieve goal hemoglobin A1c (A1c), systolic blood pressure (SBP) and low-density lipoprotein (LDL) was compared in the two models of care.ResultsA total of 113 patients were included in the analysis of this study, 54 patients were in the PMDC and 59 patients were in the UMC group. Median time (days) to intervention for A1c values >7% was 8 days and 9 days in the PMDC and UMC groups, respectively (p>0.05). In patients with baseline A1c values >8%, median time to achieving A1c<7% was 259 days vs. 403 days in the PMDC and UMC groups, respectively (p<0.05). Median time to goal SBP was 124 days in the PMDC group and 532 days in the UMC group (p<0.05). Median time to goal LDL was 412 days in the PMDC group vs. 506 days in the UMC group (p<0.05).ConclusionsRates of clinical inertia, defined as time to intervention of suboptimal clinical values, did not differ significantly between patients enrolled in a PMDC compared to patients with UMC with respect to A1c, SBP and LDL. Participation in PMDC, however, was associated with achieving goal A1c, SBP, and LDL levels sooner compared to UMC.

The most frequently prescribed administration routes for vitamin K1 were subcutaneous and intravenous, indicating that the oral route is often not used as recommended. The vitamin K1 doses prescribed for reversal of warfarin anticoagulation were highly variable, and for most (83%) patients, the recommended guidelines were not followed. The clinical significance of noncompliance with the ACCP guidelines for vitamin K1 administration warrants further study.

Orthostatic hypotension, a symptomatic drop in blood pressure on standing, can have detrimental effects for orthopedic patients in the postoperative period. It is essential for orthopedic practitioners to understand the causes, risk factors, treatment options, and prevention techniques for orthostatic hypotension.