The activity of beta-carotene in patients with oral leukoplakia was confirmed. The responses produced were durable for 1 year.

Reinnervation of paralyzed intralaryngeal muscles by axonal sprouting from adjacent intact muscles (the phenomenon of muscular neurotization) has been observed, but the source is uncertain. The potential for laryngeal reinnervation of the posterior cricoarytenoid muscle (PCA) from contralateral PCA motor nerve sprouting in a rabbit model was investigated. Unilateral PCA denervation was produced by vagotomy. The rabbits were examined for signs of PCA recovery for up to 6 months using fiberoptic endoscopy, electromyography (EMG), and histology. No return of vocal cord abduction, EMG activity, or any nerve sprouting across the midline from the intact PCA was found. We conclude that there is no significant spontaneous intralaryngeal muscular neurotization to the paralyzed PCA. The clinical ramifications of our data will be discussed.

Objective. To assess the impact of a multipreceptor approach to facilitating topic discussions on students' knowledge and confidence in clinical decision-making during an ambulatory care advanced pharmacy practice experiences (APPEs). Design. Faculty members with relevant expertise and experience facilitated discussions with fourthyear doctor of pharmacy (PharmD) students regarding 7 ambulatory care topics. A student self-assessment survey and knowledge-assessment instrument was administered before and after discussions. Assessment. Students' examination scores increased significantly from 59.1% 6 13.9% at baseline to 76.5% 6 12.6% at the end of the 5-week experience (p,0.001). The majority of participants were comfortable making therapeutic decisions regarding medication use as it related to all discussion topics except heart failure. Conclusions. Participation in topic discussions led by faculty members with expertise and experience for each ambulatory care topic was associated with a significant improvement in knowledgeassessment scores.

Introduction As the role of pharmacists in providing direct patient care continues to expand, the need for and interest in a method for assessing and measuring clinical productivity is becoming more paramount. Unfortunately, there is no consensus on how, when, and which quality indicators or clinical productivity measures should be collected. The primary objective of this study was to assess the landscape of clinical productivity tracking across practice sites. Methods A 13‐item Qualtrics questionnaire was administered through email lists from several national pharmacy organizations in the Spring of 2018. There were eight items related to quality indicators or clinical productivity measures. The information gathered included the type of indicator/measure collected, how it was collected, and perceived benefits and barriers. The remaining five items were basic demographic questions. Results A total of 349 participants responded, with 231 reporting that they currently track some type of patient quality indicator. Of these, 166 reported collecting a total of 903 indicators or measures using a variety of tracking systems. The most frequently reported measures collected were the number of patients seen and the type of recommendation or intervention made. The most cited reason for collecting these data was to demonstrate the impact to a practice site. The time required to collect data and the limitations of data collection systems were the two most frequently cited perceived barriers to collecting information. Conclusions A majority of respondents are collecting some form of quality indicator or clinical productivity measure. However, there is extensive variety in the exact indicators or measures being collected and the tracking systems being utilized for their collection. Although implementation would be difficult, a more standardized approach to tracking clinical productivity may be beneficial.

Dietary and herbal supplements, a US$20.3 billion entity, are used by more than half of the adult population in the United States. Since weight loss is beneficial in obese patients at high risk for cardiovascular disease, many obese Americans are ingesting herbal weight loss supplements under the assumption that they are inherently safe. We report the case of a 55-year-old morbidly obese Caucasian female with diabetes, who started multiple polyherbal supplements. Six months after starting several herbal products, the patient’s A1C increased from 7.8% to 9.4% and the AST/ALT were markedly elevated. After discontinuation, transaminases normalized in 28 days. On follow-up visit, the patient reported compliance with prescribed medications and denied use of herbal products. The patient’s A1C approached target goal. The potential for counterfeit herbal supplement production exists. Our patient’s products were analyzed for purity, and 0% Hoodia gordonii was found. A misconception of herbal products is that they are safe because they are natural. Unfortunately, many natural products can act in the same capacity as drugs, educing both benefit and harm. Health care providers, particularly pharmacists, should be aware of counterfeit herbal supplements and closely monitor for dangers of herbal supplement use.