Objectives. To develop and establish validity for a grading rubric to evaluate diabetes SOAP note writing on primary care (PC) advanced pharmacy practice experiences (APPEs), as well as to assess reliability and student perceptions of the rubric.Methods. Ten PC APPE faculty members collaborated to develop a rubric to provide formative and summative feedback on three written SOAP notes per APPE student over a 10-month period. Correlation analyses were conducted between rubric scores and three criterion variables to assess criterion-related validity: APPE grades, Pharmaceutical Care Ability Profile Scores, and Global Impression Scores. Interrater and intra-rater reliability testing were completed using Cohen's kappa and Intraclass Correlation Coefficients (ICC). Student perceptions were assessed through an anonymous student survey.Results. A total of 51 students and 167 SOAP notes were evaluated using the final rurbric. The mean score significantly increased from the first to second SOAP note (p<.001) and from the first to third SOAP note (p<.001). Statistically significant positive correlations were found between final rubric scores and criterion variables. The ICC for inter-rater reliability was fair (.59) for final rubric scores and excellent for intra-rater reliability (.98-1.00). A majority of students responded that the rubric improved their ability and confidence to write SOAP notes. Conclusions.The findings provide evidence that the rubric developed may be used to make valid decisions about students' SOAP note writing ability and may increase their confidence in this area. The use of the rubric allows for greater reliability among multiple graders, supporting grading consistency.

Optimization of glycemic control is a fundamental aspect of diabetes management, and rates of diabetes-related microvascular complications are significantly decreased when glycemic control is improved. Currently, > 5 million Americans require insulin therapy to manage their diabetes, and this number is expected to multiply as the prevalence of type 2 diabetes increases secondary to several factors. The distinct pharmacodynamic properties of each insulin product help physicians decide which type of insulin is the most appropriate for each patient. The method of delivery that will ensure both patient and provider satisfaction must also be carefully considered. Insulin pen devices are designed to provide a convenient and easy means of insulin administration for the patient and can be divided into 2 categories: the reusable, durable pen, and the disposable, prefilled pen. These insulin pen devices are an alternative to the traditional insulin vial-and-syringe method and offer many advantages. Insulin pens have also been found to be less painful than the vial-and-syringe method and are often associated with greater patient preference and social acceptability. As a result, this method of insulin delivery may ultimately help to improve glycemic control and should be considered when prescribing insulin products.

Introduction: Current guidelines for the diagnosis and management of asthma suggest that patients perform peak expiratory flow (PEF) measurements while standing; however, recent literature suggests this may not be necessary. The purpose of this study was to determine the impact of patient position on PEF measurements.Methods: A randomized observational analysis of PEF measurements for 211 patients in sitting and standing positions was performed. The highest PEF measurement from tests performed with correct technique in both the sitting and standing position was compared.Results: Overall, PEF measurements did not significantly differ between the sitting and standing positions (506 ؎ 2 L/min versus 508 ؎ 2 L/min; P ‫؍‬ .45). No differences were seen between mean PEF measurements in the sitting or standing positions for either women or men, nor were there significant differences between mean PEF values for the sitting and standing positions in participants who reported a history of asthma.Conclusions: PEF measurements do not significantly differ based on sitting or standing measurements among healthy participants. Based on the results of this study it may not be necessary for the patient to stand while performing PEF measurements.

The prevalence of diabetes mellitus (DM) in the elderly population currently represents almost one-half of the overall diabetic population. Treatment of DM often requires a multidrug regimen that includes insulin therapy; however, due to concomitant comorbidities such as dementia, vision loss, neuropathies, poor mobility, and poor manual dexterity, elderly patients may be at increase risk for hypoglycemia and other dosing errors that are associated with insulin administration. Insulin pen devices have been shown to provide more reliable, accurate, and simplified dosing, and therefore may be a safer, easier, and more acceptable method of insulin delivery in the elderly population. This review will describe the various insulin pen devices available today, as well as discuss the potential advantages of these devices in the elderly population.

:Treatment-resistant hypertension (TRH) is associated with increased cardiovascular risks and progression of chronic kidney disease. The pathophysiology of TRH is multifactorial, including overactivity of the renin–angiotensin–aldosterone system and sympathetic nervous system, endothelial dysfunction, and volume overload. Endothelin-1 is a vasoconstrictive peptide that causes neurohormonal and sympathetic activation, increased aldosterone synthesis and secretion, endothelial dysfunction, vascular hypertrophy and remodeling, and fibrosis. Endothelin-1 acts through 2 receptors, ETA and ETB. Activation of ETA receptors in vascular smooth muscle cells results in vasoconstriction, whereas ETB receptor activation results in vasoconstriction in the vascular smooth muscle cells and vasodilation through nitric oxide release in endothelial cells. Aprocitentan is novel, oral, dual endothelin-receptor antagonist that has demonstrated a more favorable tolerability and safety profile in early clinical trials compared with other endothelin-receptor antagonists studied. Phase 2 trial data support a significant reduction in blood pressure compared to placebo and similar blood pressure reduction compared to a moderately dosed angiotensin-converting enzyme inhibitor in patients with essential hypertension. An ongoing phase 3 randomized clinical trial is evaluating aprocitentan's efficacy and safety in patients with TRH receiving multiple antihypertensives. Additional research is needed to determine aprocitentan's role in therapy, but this agent may be a suitable treatment option for TRH.

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