While in-store clinics are providing a convenient, affordable way for consumers to receive some medical services, challenges abound for the formats, one speaker told attendees at the recent Academy of Managed Care Pharmacy (AMCP) Annual Meeting & Showcase.

NACDS Chairman Andrew A. Giancamilli told attendees at the 2009 opening business session that the association went through a self-assessment and rebirth well before the recession and is primed to move the industry forward in 2009 and beyond.

NACDS President and CEO Steven C. Anderson tells 2009 annual meeting attendees that the days of pharmacists serving as an easy target are over.

The Genitourinary Cancers Symposium -- co-sponsored by the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, and the Society of Urologic Oncology — took place Feb. 26 to 28 in Orlando. Among the abstract topics addressed were: In radical cystectomy cases, overall survival and bladder cancer-specific survival are higher among those whose surgeons perform a high volume of the operations. Statin use in men is linked to a 50 percent or greater reduced risk of death from prostate cancer. Healthy men should discuss with their physician whether to take a 5-alpha reductase inhibitor (5-ARI) to reduce risk of prostate cancer

Healthy men should talk to their doctors about taking a 5-alpha reductase inhibitor (5-ARI) to reduce their risk of prostate cancer, according to a joint guideline published online Feb. 24 in the Journal of Clinical Oncology by the American Society of Clinical Oncology and the American Urological Association, and released to coincide with the American Society of Clinical Oncology's Genitourinary Cancers Symposium held Feb. 26 to 28 in Orlando.

The American Stroke Association's International Stroke Conference took place Feb. 18 to 20 in San Diego. Conference highlights included: JUPITER study showed that rosuvastatin may lower risk of stroke. Low-radiation infrared laser therapy failed to significantly reduce stroke disability in another study. Caution may be warranted when performing carotid endarterectomy in very elderly patients. Early menopause may be a risk factor for ischemic stroke. Substantial tea or coffee consumption is associated with reduced risk of ischemic stroke. In stroke patients, adherence to recommended therapy could be associated with improved clinical outcomes. Younger patients with stroke-like symptoms may be misdiagnosed. In middle age, people are significantly more likely to have a silent cerebral infarction than a clinical stroke.

Increased consumption of tea or coffee is associated with reduced risk of ischemic stroke, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 17 to 20 in San Diego.

Early menopause may be a risk factor for ischemic stroke, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 17 to 20 in San Diego.

Nearly two-thirds of the nation's hospitals do not report treating acute ischemic stroke patients with recombinant tissue-type plasminogen activator, leaving many Americans without access to the brain-saving therapy, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 17 to 20 in San Diego.

In acute stroke patients, sonothrombolysis with microspheres and tPA may be associated with higher rates of early recanalization and clinical recovery than treatment with tPA alone, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 17 to 20 in San Diego.

Nearly two-thirds of the nation's hospitals do not report treating acute ischemic stroke patients with recombinant tissue-type plasminogen activator, leaving many Americans without access to the brain-saving therapy, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 17 to 20 in San Diego.

In stroke patients, good adherence to recommended therapy could be associated with improved clinical outcomes. In patients with known cardiovascular disease, a homocysteine-lowering vitamin regimen also may be associated with better outcomes, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 17 to 20 in San Diego.

In middle age, people are significantly more likely to have a silent cerebral infarction than a clinical stroke, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 17 to 20 in San Diego.

Women may be less likely than men to receive tissue plasminogen activator (tPA) for stroke, but may be increasingly likely to be aware of acute stroke symptoms and quickly present at emergency departments, according to research presented during a "Women and Stroke" press conference at the American Stroke Association's International Stroke Conference held Feb. 17 to 20 in San Diego.

When younger patients present to the emergency department with stroke-like symptoms, they are often misdiagnosed and sent home. In addition, pharmacists often give inappropriate advice to patients who call to complain about stroke-like symptoms, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 17 to 20 in San Diego.

At hospitals participating in the Get With The Guidelines-Stroke program, patients who arrive within one hour of symptom onset (the "golden hour") are twice as likely to receive tissue plasminogen activator (tPA) as those who arrive with one to three hours. But hospital overcrowding can lengthen the time it takes stroke patients to receive needed care, according to two studies presented at the American Stroke Association's International Stroke Conference held Feb. 17 to 20 in San Diego.

When dealing with Clostridium difficile infections in the healthcare setting, "if we don't do the right thing, patients die," said Rob Owens, PharmD, co-director of the Antimicrobial Stewardship Program at Maine Medical Center and assistant clinical professor at the University of Vermont, College of Medicine, at a talk on the diagnosis and treatment of C difficile.

Steve Stoner, PharmD, BCPP, chair and clinical professor of the Division of Pharmacy Practice University of Missouri-Kansas City School of Pharmacy, presented data on suicidality. The data came from various studies done throughout the United States. He used the data to help give some perspective as to where the country is in comparison to other countries and to identify common risk factors associated with the use of antidepressants and increased suicidal behavior and ideation.

Pharmacists can educate patients and providers to help reduce the number and severity of osteoporotic fractures, says Mary Beth O'Connell, PharmD, BCPS, FASHP, FCCP, associate professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit.

James A. Jorgenson, MS, FASHP, executive director of Clarian Health Partners Department of Pharmacy Services in Indiana, received the Distinguished Leadership Award during the opening session of the American Society of Health-System Pharmacists (ASHP) clinical meeting in Orlando, Fla.

A multifaceted pharmacy intervention improves medication adherence in seniors, according to Jeannie Kim Lee, PharmD.

Novant Health, a not-for-profit healthcare system based in Winston Salem, NC, received the American Society of Health-System Pharmacists' 2008 Award for Excellence in Medication-Use Safety for an innovative program that significantly reduced adverse drug events and hospital admissions.

Rosuvastatin treatment of patients with better than average lipid profiles but with elevated high-sensitivity C-reactive protein (hsCRP) resulted in a 44% relative risk reduction in cardiovascular events and a 20% reduction in all-cause mortality, reports Paul Ridker, MD (pictured), lead investigator for the JUPITER Trial Study Group. JUPITER was an investigator-initiated trial sponsored by AstraZeneca.

Pioglitazone prevented progression to type 2 diabetes in patients with impaired glucose tolerance (IGT), reported Ralph DeFronzo, MD. The effect was marked?81% fewer patients assigned to pioglitazone compared with placebo converted from IGT to type 2 diabetes in a randomized, double-blind, placebo-controlled clinical study.

Pramlintide injection added to basal insulin at mealtime is similar to titrated rapid-acting insulin in achieving glycemic control but with a lower risk of hypoglycemia and no weight gain in patients with type 2 diabetes, said Matthew Riddle, MD, head, section of diabetes, division of endocrinology/diabetes/clinical nutrition, Oregon Health and Sciences University, Portland.

Surrogate endpoints in clinical trials (ie, hemoglobin [Hb] A1c) on which drug approvals may be based only explain narrow aspects of complex conditions. For this reason, even when using a drug as labeled, there is always a level of uncertainty over outcomes with the drug, said Saul Malozowski, MD, PhD, MPH.

Hyperglycemia is involved in the dysregulation of endothelial nitric oxide (NO) synthase, leading to endothelial dysfunction and an increased risk of vasculopathy, said Markku Laakso, MD.

Coronary artery calcium and abdominal aortic calcium both predicted future cardiovascular events in a Veterans Administration population with type 2 diabetes. The relationship between calcium scores and cardiovascular events was independent of standard cardiovascular risk factors, said Peter Reaven, MD.

Clinicians should be wary of health claims made for trace elements such as iron or chromium. While there is no doubt that trace elements are needed for health, there is significant doubt about their utility in preventing or curing diabetes and other diseases, said Eliseo Guallar, MD, DrPH, Johns Hopkins Bloomberg School of Public Health, Baltimore. There are many hypotheses about the beneficial effects of trace elements, but little high-quality data, little reliable population data, few useful biomarkers, relatively crude analytical methods and few mechanistic studies.

The range of endothelial interventions for peripheral artery disease (PAD) is proliferating. Today's choices include traditional balloon angioplasty, stents, drug eluting stents and fabric-covered stents. Newer technologies allow clinicians to cut out occlusions, freeze them, scrape them, laser them and kill them.

An intense glucose-lowering strategy in high-risk patients with type 2 diabetes was associated with an excess of mortality in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial, the U.S. counterpart to the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation) study.

British women who have poorer glycemic control before and during pregnancy have poorer outcomes and less-healthy babies. That's the take home message from CEMACH, the Confidential Enquiry into Maternal and Child Health, a year-long survey of pregnant women with type 1 and type 2 diabetes across the United Kingdom.

Several novel classes of agents designed to treat hyperglycemia are under investigation. These agents were the subjects of a symposium here. One such novel class is the sodium glucose co-transporter (SGLT) type 2 inhibitors, which reduce glucose levels by increasing kidney excretion of glucose. The kidney plays an important role in the handling of glucose, said Robert R. Henry, MD, professor of medicine and chief of VA endocrinology and metabolism at the University of California, San Diego. SGLT-2 is expressed almost exclusively in the kidney. About 90% of glucose reabsorption by the kidney is mediated by SGLT-2 under normal circumstances.

Translating weight loss research into clinical programs is not easy. Too many clinical protocols exist in isolation, according to Donald Williamson, PhD, Pennington Biomedical Research Center, Baton Rouge, LA. The key gap is extending methods that contribute to weight loss into programs that maintain weight loss.

Atherosclerosis and its complications develop in stages. Each of each of these stages is affected by different metabolic abnormalities, said Scott Grundy, MD, PhD, during the annual Edwin Bierman lecture.

Current research suggests that pedal osteolysis, the loss of bone mineral density (BMD) in the foot, may be a useful biomarker for Charcot's arthropathy and other diabetic foot diseases.

Real-time continuous glucose monitoring (CGM) can significantly improve glycemic control, but it will not help all patients. "Real-time CGM will add significantly to glucose management for some people, but not for all," said Irl Hirsch, MD, University of Washington, Seattle. "Human factors make all the difference between success and failure. Some patients will never figure it out. That?s why real-time control is so challenging.

Good glycemic control is not sufficient to relieve painful diabetic neuropathy, necessitating investigation of other modalities to achieve analgesic efficacy. Dan Ziegler, MD, German Diabetes Clinic, German Diabetes Center, and professor of internal medicine, Leibniz Institute at the Heinrich Heine University, Düsseldorf, provided an overview of pharmacologic treatments that have been explored for painful diabetic neuropathy and the success achieved with each.

Clinicians and type 2 diabetes patients have a new worry: hepatic steatosis, or nonalcoholic fatty liver disease. Liver disease is a less-obvious problem than kidney disease but may have equally grave consequences.

Researchers at Stanford University are reporting positive results in healing diabetic wounds with a pharmaceutical agent already approved by the FDA?but only in mice so far.

Islet cell transplants are effective in both the short- and long-term in freeing patients with diabetes from insulin injections and have proven to be safe, said Bernhard J. Hering, MD. The use of embryonic pig pancreatic precursor tissue as the source of islets appears promising and would expand the number of transplant recipients, which is currently limited by number of potential donors.

Take another look at the popular hypothesis that suggests type 2 diabetes has an acute effect on the secretion of GLP-1 and that lower GLP-1 secretion has an acute effect on insulin. It doesn?t work that way, said Michael Nauck, MD, PhD, Diabeteszentrum Bad Lauterberg, Bad Lauterberg, Germany. Decreased GLP-1 secretion is not part of the pathophysiology of type 2 diabetes.

The risk of fracture is probably only slightly increased in persons with type 2 diabetes, said Peter Vestergaard, MD, PhD, DrMedSc, from the Osteoporosis Clinic, Aarhus Amtssygehus, Denmark.

Forget the arguments over fit and fat in the development of diabetes and the resulting complications. Both fitness and fatness can be addressed by the same prescription: physical activity.

Intensive blood glucose control in patients with type 2 diabetes resulted in a significant reduction in the risk of microvascular complications compared with standard blood glucose control. This was driven by a reduction in the occurrence of nephropathy, in the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) study.

Endothelial dysfunction is both a marker for and a cause of diabetic complications. Researchers are teasing out pathways that involve oxidative stress and endothelial dysfunction, said Per-Henrik Groop, MD, PhD, Helsinki University Central Hospital, Helsinki, Finland. The challenge is in finding drugs that show the same activity in vivo that they show in cell studies or animal models.

Periodontal disease makes glycemic control more difficult in patients with type 2 diabetes, said George W. Taylor, DrPH, DMD, associate professor of dentistry, School of Dentistry and Public Health at the University of Michigan, Ann Arbor.

The editorial teams in the Modern Medicine Primary Care Content Group, with content from our legacy brands ? Medical Economics, Drug Topics, Geriatrics, Formulary and Contemporary OB/Gyn ? will cover key medical meetings, bringing you breaking news, the latest research findings and reports from the general sessions.