VSHP Day on the Hill
Tuesday, January 31, 2017
Please join us for VSHP's annual Day on the Hill in Richmond on Tuesday, January 31. We will meet with our legislators in the afternoon and then end the day with light food and drinks at a reception. We had a great turnout last year and hope to have even more this year. Please submit this registration form to
contact@vshp.org . This will allow us enough time to schedule appointments with your legislators.
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Pharmacy School (if applicable)
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VSHP 2017 Spring Seminar
April 7-8
Portsmouth Renaissance
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Call for Posters - VSHP Spring Spring-Sign up NOW!
This is your opportunity to share your results with pharmacy colleagues from around
Virginia at the VSHP Spring Seminar Poster Session in Portsmouth on Saturday, April 8, 2017. Posters highlighting innovative services, evaluations and pharmacy practice model change initiatives are especially encouraged. Encore presentations from national meetings (ASHP, ACCP, etc.) are accepted. Presenting a peer-reviewed poster is an ideal professional development activity for preceptors, both seasoned and new practitioners, residents and students. The primary (first) poster presenter must be a VSHP member and results must be included on abstract to be accepted. Research-in-progress abstracts with background and methods can also present. Pharmacy students and residents are especially encouraged to participate. Students and residents presenting posters will receive free meeting registration if they are the primary (first author) on the poster.
The deadline for submission of abstracts is at 12:00 Noon on March 24th.
To submit your poster abstract, or for questions, contact Steve Glass, contact@vshp.org.
Each abstract email submission must contain the following:
1) Brief descriptive title (use title case)
2) Author information. Include full name, professional credentials and institutional affiliation (i.e., health care organization or college name) author(s), email address for corresponding author/presenter.
3) Body of the abstract with the following headings: Purpose, Methods, Results and Conclusions.
4) The submitted abstract must fit on the attached form and be no more than 300 words.
5) Abstract should be written using calibri font and should be 11-point font. Do not include tables, graphs, or illustrations in abstract. Spell out all pharmaceutical acronyms and special symbols (e.g., < or >).
6) Include which poster category applies (should be based only on first author's credentials)
- Pharmacy Student Poster
- Pharmacy Resident Poster
- Pharmacy Practitioner Poster
7) Include submission type
- Descriptive report - describes new, improved, or innovative roles or services in pharmacy practice, or case report.
- Evaluative study report - describes original research including clinical research, drug effects in humans, drug use evaluations, and evaluations of clinical pharmacy services
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Provider Status Bill Reintroduced in Senate with Strong Bipartisan Support
Senators Charles Grassley (R-Iowa), Robert Casey (D-Pa.), and Sherrod Brown (D-Ohio), along with 24 other original co-sponsors, reintroduced the
Pharmacy and Medically Underserved Areas Enhancement Act (S. 109). This legislation is the same as last year's provider status bill, with the exception of the new bill number, S. 109. This is significant not only because of the quick timing of the reintroduction, but also because of the high number of Senators who have signed on as original co-sponsors.
The Patient Access to Pharmacists' Care Coalition
(PAPCC), in which ASHP serves on the steering committee, set a goal late last year of introducing the new bill in 2017 with 20 co-sponsors. We are pleased to see that this goal was not only met but exceeded.
This legislation
would allow Medicare Part B to utilize pharmacists to their full capability by providing services to the underserved. The lack of pharmacist recognition as a provider limits the ability of pharmacists to provide services that they are qualified to perform and presents a barrier to care - this bill remedies this situation. It would also reduce overall healthcare costs and increased access to healthcare services and improved healthcare quality outcomes for a very vulnerable population. Take action TODAY!
ACT IN TWO SIMPLE STEPS!
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Mentorship Pearls
Brooke Brown, VCU Student
One can never have too many mentors to help guide them through the rigors of pharmacy school and a future career. I applied for a VSHP mentor to gain greater insight to the various aspects of pharmacy. I have recently been drawn toward a career with the Federal Government. I could not have asked for a better pharmacist than Dr. Eric Maroyka, who spent much of his career as an active duty U.S. Army Pharmacist and is now the Director, Center on Pharmacy Practice Advancement at ASHP.
Dr. Maroyka set up an incredibly unique experience for me to tour the ASHP Headquarters and the Walter Reed National Military Medical Center in Bethesda, MD while I was home for winter break. Having lost a close friend while he was in the United States Marine Corps, our U.S. military personnel hold a special place in my heart. My time at Walter Reed was a truly inspiring and encouraging experience. I had the opportunity to talk with numerous members of the pharmacy staff at Walter Reed, both Federal Civil Service civilians and commissioned military pharmacy officers.
I spoke with staff about their time in the military, their experiences before coming to Walter Reed, their typical schedules (which seemed to change on a daily basis), and how a Department of Defense military hospital operates. I walked away from the experience with a new sense of motivation for the remainder of my time in pharmacy school while feeling confident in the fact that I absolutely want to pursue a career with the Federal Government. I cannot begin to thank Dr. Maroyka or the pharmacy team at Walter Reed enough for the opportunity.
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The Role of Metformin in Weight Loss
Andrea Scott, PharmD, MPH, Stony Springs Hospital Center
Metformin is first-line pharmacologic treatment for patients with Type 2 Diabetes Mellitus (T2D) and can be useful in preventing or delaying diabetes in patients with prediabetes, defined as a glycated hemoglobin (A1C) from 5.7% to 6.4%.
1 Metformin is a valuable treatment for the majority of patients with T2D due to its efficacy, low risk for hypoglycemia, few side effects, ease of use, and low cost.
1 Additionally, metformin has beneficial effects on weight loss in T2D and possibly in polycystic ovary syndrome (PCOS) and obesity without diabetes. The only approved indication for metformin is T2D; thus, most of the understanding of the effect of metformin on weight loss has been gained from research in patients with T2D.
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The mechanism of action for metformin is unique compared with other antihyperglycemic agents. Metformin decreases the production of glucose in the liver, decreases the absorption of glucose in the intestine, and improves insulin sensitivity through increasing muscle glucose uptake and use.
2 Metformin induces weight loss most likely through a loss of adipose tissue, rather than a change in energy expenditure, as is seen with exercise.
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Two large studies by the Diabetes Prevention Program Research Group assessed weight loss with metformin. In the study published in 2009, patients randomly assigned to receive lifestyle treatment initially lost weight but gradually regained the lost weight over the 10-year follow-up period. Patients randomly assigned to receive metformin lost less weight at the beginning of the study (2.5 kg), but were able to sustain the weight loss over 10 years.
4 In the study published in 2012, participants in the original study were offered the chance to continue metformin in an open-label fashion. Overall weight loss during the open label period of 7-8 years was 1.9 kg. In patients considered highly adherent to metformin, the average weight loss was 3.1 kg compared with baseline.
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In a study comparing metformin, exercise (about 190 minutes per week), and the combination of the two in adults with impaired glucose tolerance (T2D patients excluded), metformin and metformin plus exercise decreased body weight more than exercise alone. Metformin alone also decreased caloric intake but not percent body fat or central body fat.
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Women with polycystic ovary syndrome (PCOS) have a higher risk of developing diabetes compared with women of similar age and weight. Metformin has been used off label in PCOS to prevent diabetes and increase ovulation through weight loss.
7 In a recent randomized controlled trial comparing metformin, oral contraceptive pills (OCPs), and the combination of the two in patients with PCOS without T2D, metformin alone or with OCPs decreased weight and BMI. The median decrease in weight with metformin at 12 months was 3 kg (25th and 75th quartiles; -10.3, 0.6). OCP use was associated with increased weight changes of 1.2 kg (25th and 75th quartiles; -0.8, 3.0), and the combination decreased weight by 1.9 kg (25th and 75th quartiles; -4.9, 0.1). One patient in the metformin group dropped out due to nausea; no other side effects or adverse events were reported.
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In a systematic review that included 12 randomized controlled trials in women with PCOS, metformin produced a significant decrease in BMI when compared with placebo; however, many of the studies were not adequately powered, so the conclusion must be interpreted with caution and other clinical factors for individual patients considered. The review did not mention risk for hypoglycemia or if patients had impaired glucose tolerance.
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Some studies have looked at metformin in overweight and obese euglycemic patients.
9,10 In a 6-month case control study, patients with a BMI of 27 kg/m2 or higher and an average A1c of 5.6% received metformin with a dose based on their BMI. The average weight loss over 6 months was 5.8 ± 7.0 kg, with a range of -35 kg to +13 kg. About 20% of the patients treated with metformin lost no weight. Gastrointestinal side effects were reported, which decreased with slower dose titration. No events of hypoglycemia were reported.
9 In a recent randomized controlled trial, women ages 35-55 with a with >20 pound weight gain after their twentieth decade, were randomized to receive placebo, metformin, or metformin + rosiglitazone for 12 months. At 12 months, patients in the metformin group had a weight decrease of 85.1 kg (+/-8.5 kg) to 79.8 kg (+\-9 kg), with a p-value of 0.0003. No adverse effects or side effects were reported by patients.
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In conclusion, metformin does have a modest effect on weight loss in patients with T2D, PCOS, and in overweight and obese euglycemic patients. More studies, especially randomized controlled trials, are needed to determine the duration and dose of metformin and potential long-term adverse effects in patients without T2D. Patients should be advised that metformin is unlikely to cause a drastic decrease in weight, and lifestyle modifications should be recommended and continued, even if metformin is started. Renal function and blood glucose should be monitored in patients receiving metformin.
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- American Diabetes Association. Standards of medical care in diabetes -- 2014. Diabetes Care. 2014;37(Suppl 1):S14-S80.
- Glucophage® [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2009.
- Stumvoll M, Nurjhan N, Perriello G, Dailey G, Gerich JE. Metabolic effects of metformin in non-insulin-dependent diabetes mellitus. N Engl J Med. 1995;333:550-554.
- Diabetes Prevention Program Research Group; Knowler WC, Fowler SE, Hamman RF, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374:1677-1686.
- Diabetes Prevention Program Research Group. Long-term safety, tolerability, and weight loss associated with metformin in the Diabetes Prevention Program Outcomes Study. Diabetes Care. 2012;35:731-737.
- Malin SK, Nightingale J, Choi SE, Chipkin SR, Braun B. Metformin modifies the exercise training effects on risk factors for cardiovascular disease in impaired glucose tolerant adults. Obesity (Silver Spring). 2013;21:93-100.
- Nieuwenhuis-Ruifrok AE, Kuchenbecker WK, Hoek A, Middleton P, Norman RJ. Insulin sensitizing drugs for weight loss in women of reproductive age who are overweight or obese: systematic review and meta-analysis. Hum Reprod Update. 2009;15:57-68.
- Glintborg D, Altinok ML, Mumm H, Hermann AP, Ravn P, Andersen M. Body composition is improved during 12 months' treatment with metformin alone or combined with oral contraceptives compared with treatment with oral contraceptives in polycystic ovary syndrome. J Clin Endocrinol Metab. 2014;99:2584-2591.
- Seifarth C, Schehler B, Schneider HJ. Effectiveness of metformin on weight loss in non-diabetic individuals with obesity. Exp Clin Endocrinol Diabetes. 2013;121:27-31.
- Mogul, H, Freeman, R, Nguyen, K. Metformin-sustained Weight Loss and Reduced Android Fat Tissue at 12 Months in EMPOWIR (Enhance the Metabolic Profile of Women with Insulin Resistance): A Double-Blind, Placebo-Controlled, Randomized Trial of Normoglycemic Women With Midlife Weight Gain. Endocrine Practice. 2016; 22 (5): 575-586. doi: 10.4158/EP151087.OR
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VSHP Leadership Profile
Amber
Wesner
What i
s your current leadership position in VSHP?
President-Elect Region VII (Winchester)
What benefits do you see in being active in a professional association such as VSHP?
- Educational opportunities
- Leadership development
- Networking
What initially motivated you to get involved in VSHP?
Initially, as a student, to learn more about inpatient practice and acute care, and continued to be involved to have a professional home once I left school.
Where did you go to pharmacy school?
Shenandoah University - Bernard J Dunn School of Pharmacy
Where have you trained or worked?
- PGY-1 Resident - Valley Health/Winchester Medical Center and Shenandoah University
- Associate Professor of Pharmacy Practice - Shenandoah University
Describe your current area of practice and practice setting:
Academia and Acute Care (Internal Medicine)
What advice would you give to student pharmacists?
Study hard. Investigate the different areas of pharmacy. Not only inpatient vs outpatient, but also different kinds of residencies, fellowships, managed care, Indian health service, academia, FDA, research, etc to find the right niche for you.
Do you have any special interests or hobbies outside of work?
Outside of teaching pharmacy I also teach dance (ballet, tap, jazz and lyrical)
What is your favorite place to vacation?
Europe
What 3 adjectives would people use to best describe you?
Loyal, organized, disciplined
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Virginia Health Practitioners' Monitoring Program (HPMP)
Health care professionals may suffer from an impairing physical, mental health or substance abuse issue. In fact, it is estimated that 10 to 15 percent of health care professionals will misuse drugs or alcohol at some point during their careers.
The Virginia Health Practitioners' Monitoring Program (HPMP) is here to help. We refer health care practitioners for appropriate treatment and continuously monitor treatment progress with the goals of restoring the practitioner to good health and assisting them with return to safe and productive clinical practice.
HPMP services are available to anyone who is licensed, certified or registered by one of the health regulatory boards of the Virginia Department of Health Professions, including: Audiology & Speech-Language Pathology | Counseling | Dentistry | Funeral Directors/Embalmers | Long-term Care Administrators | Medicine | Nursing | Optometry | Pharmacy | Physical Therapy | Psychology | Social Work | Veterinary Medicine
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Copyright© 2017, Virginia Society of Health-System Pharmacists. All rights reserved.
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