Pharmacists and the next generation of HIV pre-exposure prophylaxis.

The use of pre-exposure prophylaxis (PrEP) has curtailed transmission of human immunodeficiency virus (HIV) in most industrialized nations. Despite the availability of PrEP, HIV infections continue to occur. Access and adherence are major limitations to PrEP. Long-acting injectable antiretroviral agents are now being added to the HIV armamentarium. Long-acting agents offer the advantage of less frequent dosing with intramuscular administration versus oral dosing. Cost, injection site pain, and needle hesitancy may be detriments to the use of these agents in certain patients. More studies are needed to completely discern the role of various products and future long-acting agents as options for PrEP. Even when we consider their limitations, long-acting agents may provide an eventual opportunity to transform the delivery of PrEP. Pharmacists should be aware of the potential impact of PrEP and the advantages and disadvantages of these new long-acting agents. In addition, pharmacists should proactively advocate for and contribute to PrEP expansion efforts.

Issues Surrounding Testosterone Replacement Therapy.

Testosterone is derived from Leydig cells and exerts its effects on androgen receptors to influence growth, mood, voice, and several other bodily functions. As men age, their testosterone levels decline. Human immunodeficiency virus (HIV) infection has also been associated with lowered serum testosterone levels. Subtherapeutic levels of testosterone may lead to fatigue, loss of libido, and dysphoria. Exogenous replacement of testosterone can be accomplished by several modalities (oral, topical, injection), with each having distinct advantages and disadvantages. Even though testosterone replacement has become a popular medical intervention, recent reports have made the practice increasingly controversial. Several small retrospective investigations have recently associated testosterone replacement with an increased risk of cardiovascular complications. Replacement should be used sparingly until further conclusive data regarding the efficacy and safety of testosterone become available.

The North American Pharmacist Licensure Examination (NAPLEX) Pass Rate Conundrum.

As first-time pass rates on the North American Pharmacy Licensure Examination (NAPLEX) continue to decrease, pharmacy educators are left questioning the dynamics causing the decline and how to respond. Institutional and student factors both influence first-time NAPLEX pass rates. Pharmacy schools established before 2000, those housed within an academic medical center, and public rather than private schools have been associated with tendencies toward higher first-time NAPLEX pass rates. However, these factors alone do not sufficiently explain the issues surrounding first-time pass rates. Changes to the NAPLEX blueprint may also have influenced first-time pass rates. The number of existing pharmacy schools combined with decreasing numbers of applicants and influences from the COVID-19 pandemic should also be considered as potential causes of decreased first-time pass rates. In this commentary, factors associated with first-time NAPLEX pass rates are discussed along with some possible responses for the Academy to consider.

Re-examining the Entry-to-Practice PharmD Experiment.

Since 2000, the Doctor of Pharmacy degree has served as the entry-level credential for pharmacy practice in the United States, Some 20-plus years following the complete transition to an entry-level clinical doctorate in pharmacy, a re-examination of the outcomes of this move and the trajectory of the profession is merited. Particular attention might be given to the increasing diversity within pharmacy and the myriad of practice types. Regardless of the path forward, intentional and critical appraisals of both the pros and cons of the entry-level Doctor of Pharmacy, as well as the future of pharmacy practice, are warranted. Nursing is a case study in contrast to pharmacy, with its multiple degree and training programs and its hierarchical and graded system of practice. Nursing practice clearly links progressive levels of education to increasing clinical privileges.

The Complicated Middle of the Academic Deanery.

The complicated and ever-growing roles of assistant and associate deans (A-deans) can often be compared to those of middle managers. With responsibilities that are rapidly expanding and often unclear or overlapping with other personnel, A-deans may face identity crises. Additionally, because they are often not at the full professor level, they may experience difficulty achieving promotion. In this commentary, the authors call for increased awareness of the challenges associated with these roles and suggest opportunities for change. To maximize effectiveness in their roles, the Academy and colleges/schools are encouraged to explore workload/expectations for A-deans and associated reward structures, including promotion and tenure guidelines with explicit recognition for the important role(s) they play. A-deans are also encouraged to advocate for infrastructure and responsibilities that support both their academic institution and their own individual professional goals.

The Nostalgia of Pencils, Chalk, and Typewriters.

Nostalgia is characterized by feelings of sentimentality and wistfulness. Once considered pathologic, nostalgia is now recognized as a normal and perhaps essential part of the human condition. Closely related to but distinct from nostalgia is a phenomenon known as "rosy retrospection." Rosy retrospection is a bias where individuals judge the past as being disproportionally superior to the present. Nostalgia plays a role in helping individuals and society gauge its progress and accomplishments. It also serves to offer comfort in difficult times. Individuals should be careful to understand the differences between nostalgia and rosy retrospection and make efforts to build nostalgic moments with colleagues and family members both inside and outside of the classroom.

Deficiencies of Traditional Grading Systems and Recommendations for the Future.

Objective. To review issues surrounding the use of grades in the educational process and provide evidence-based recommendations for how to redesign grading practices for optimal value.Findings. Traditional tiered grading systems (ie, A, B, C, etc) have historically been a major component of the formal educational process. The way grades are used and interpreted are typically based on some commonly held assumptions, including that they are accurate measures of learning, that they motivate students to learn, and that they provide feedback to learners. However, much of the research regarding grades indicates that flaws exist in these assumptions. Grades may not always accurately measure learning, they can have adverse effects on student motivation, and they are not a good form of feedback.Summary. The Academy should consider the evidence regarding the purpose, effects, and interpretation of grades in the educational process. Despite barriers and potential pushback, pharmacy educators should revise grading practices to be more accurate, interpretable, and beneficial to learner development.

Continuing to Challenge the Paradigm of What Is Possible in Pharmacy Education and Practice Post-COVID-19.

The COVID-19 pandemic has caused boundless disruptions to every element of life. It has also brought with it lessons from the past that will likely extend into the future as humans continue to interface with the ever-increasing threats of zoonotic diseases. The pandemic has challenged the profession and the Academy to adjust, modify, and adapt. It has also stretched the bounds of what had previously been thought possible within the realms of medicine. As the Academy begins to reach and crest the apex of the epidemic it should be reminded of the many lessons associated with the pandemic and of the constant need to challenge the paradigm of what is possible.

The Accuracy of Health Professions Students' Self-Assessments Compared to Objective Measures of Competence.

Objective. To review the literature related to potential associations between self-assessed perceptions of knowledge and/or confidence with actual competence.Findings. Twenty-two articles involving a variety of disciplines, including undergraduate studies, dentistry, medicine, and pharmacy were included following the screening process. Most studies focused on student self-reported confidence rather than competency assessed by a formative examination. Only a handful of studies were centered on pharmacy education.Summary. Educational research that evaluates student learning should employ measures of competency as the primary outcome rather than student perceptions. Using student perceptions as the primary measure of student learning should be avoided, but student perceptions may have some utility as an adjunct to competency data.

Long-Term Survival of Older Patients Hospitalized for COVID-19. Do Clinical Characteristics upon Admission Matter?

Older adults are particularly susceptible to COVID-19 in terms of both disease severity and risk of death. To compare clinical differences between older COVID-19 hospitalized survivors and non-survivors, we investigated variables influencing mortality in all older adults with COVID-19 hospitalized in Poznan, Poland, through the end of June 2020 (n = 322). In-hospital, post-discharge, and overall 180-day mortality were analyzed. Functional capacity prior to COVID-19 diagnosis was also documented. The mean age of subjects was 77.5 ± 10.0 years; among them, 191 were females. Ninety-five (29.5%) died during their hospitalization and an additional 30 (9.3%) during the post-discharge period (up to 180 days from the hospital admission). In our study, male sex, severe cognitive impairment, underlying heart disease, anemia, and elevated plasma levels of IL-6 were independently associated with greater mortality during hospitalization. During the overall 180-day observation period (from the hospital admission), similar characteristics, excluding male sex and additionally functional impairment, were associated with increased mortality. During the post-discharge period, severe functional impairment remained the only determinant. Therefore, functional capacity prior to diagnosis should be considered when formulating comprehensive prognoses as well as care plans for older patients infected with SARS-CoV-2.

Pharmacy, social media, and health: Opportunity for impact.

OBJECTIVE: To discuss opportunities and challenges for pharmacists' use of social media to affect health care. DATA SOURCES: Not applicable. SUMMARY: Evolutions in social media (e.g., Facebook, Twitter, YouTube) are beginning to alter the way society communicates. These new applications promote openness, user-generated content, social networking, and collaboration. The technologies, along with patient behaviors and desires, are stimulating a move toward more open and transparent access to health information. Although social media applications can reach large audiences, they offer message-tailoring capabilities that can effectively target specific populations. Another powerful aspect of social media is that they facilitate the organization of people and distribution of content-two necessary components of public health services. Although implementing health interventions via social media poses challenges, several examples exist that display the potential for pharmacists to use social media in health initiatives. CONCLUSION: Pharmacists have long played a role in educating patients on matters influencing health care. Social media offer several unique features that may be used to advance the role of pharmacy in health care initiatives. Public familiarity with social media, the economical nature of using social media, and the ability to disseminate information rapidly through social media make these new applications ideal for pharmacists wanting to provide innovative health care on both an individual and public level.

Curricular Hoarding.

As practice evolves and scientific advancements are achieved the natural inclination for educators and administrators is to add new content to existing curricula. Often pre-existing curricula that may be outdated or no longer relevant may go un-checked leading to excessive coursework and program completion times. Faculty may also have emotional or other attachments to certain topics or content and that may serve as an additional or independent barrier to removing extraneous material. To avoid and curtail curricular hoarding of material it may be prudent to periodically engage in reviews of material assessing them for not only adherence to accreditation standards but also in terms of their on-going appropriateness and relevance to contemporary pharmacy practice. These exercises may be especially important today given the rate of information creation and dissemination in the modern digital age.

A Recent Pharmacy Graduate's Perspectives on Faculty and Course Evaluations.

Written primarily by a recent pharmacy school graduate, this commentary aims to express the perceptions about pharmacy faculty members and course evaluations that students often hold. Colleges and schools of pharmacy use many different systems to administer and assess evaluations. While there are numerous published articles regarding these forms of evaluation, almost no literature exists that reflects the opinions of those actually completing the evaluations, ie, students. Explaining the purpose of evaluations and how they will be used, how to correctly complete evaluations, and the potential responsiveness of and receptivity of professors, as well as other factors, impact how students perceive and complete their evaluations. It is worthwhile to gather students' perspectives on evaluations as these assessments hold the potential to drive curricular change and faculty promotion. Considering students perspectives can help colleges and schools design and administer more effective evaluations, increasing the utility of these assessments.

Making Diagnostic Instruction Explicit in US Pharmacy Education.

The profession of pharmacy and standards directing the education of student pharmacists are constantly evolving. The profession continues to emphasize patient-centered practice as a model for the future. The US health care system is faced with an impending shortage of primary care providers, which will affect the ability of patients to access the health care system. The pharmacy profession should position itself to contribute to meeting this need. The explicit instruction of differential diagnosis within Doctor of Pharmacy degree programs is a critical consideration in advancing pharmacy practice and potential contributions to the primary care gap.

Pharmacy Education Crosses the Rubicon.

The pandemic caused by the novel coronavirus identified in 2019 (COVID-19) has resulted in seismic changes throughout society. Accordingly, academia has been forced to adapt. Changes across all aspects of teaching and instruction have occurred. Students have departed campuses and prospects of their return remain unclear. The Academy, which is generally reluctant to change, has been forced to make rapid adjustments. Among other issues, pharmacy schools and colleges have been forced to mitigate changes to experiential education. Tremendous resources and energy have been invested to actuate the changes that have occurred. In many ways, the disruptions forced upon pharmacy education may usher in a new normal. The likelihood for even a partial return to the customary way of doing things appears increasingly unlikely.

COVID-19 Test Strategy to Guide Quarantine Interval in University Student.

BACKGROUND: Following COVID-19 exposure, the CDC recommends a 10-14 day quarantine for asymptomatic individuals and more recently a 7 day quarantine with a negative PCR test. We performed a university-based prospective student cohort study to determine if early PCR negativity predicts day 14 negativity. METHODS: We enrolled 101 asymptomatic, quarantining, students, performed nasopharyngeal swabs for viral testing on days 3 or 4, 5, 7, 10 and 14 and determined the proportion of concordant negative results for each day versus day 14 with a two-sided 95% exact binomial confidence interval. RESULTS: Overall, 14 of 90 (16%, 95% CI: 9% - 25%) tested positive while in quarantine, with 7 initial positive tests on day 3 or 4, 5 on day 5, 2 on day 7, and none on day 10 or 14. Rates of concordant negative test results are: day 5 vs. day 14 = 45/50 (90%, 95% CI: 78% - 97%); day 7 vs. day 14 = 47/52 (90%, 95% CI: 79% - 97%); day 10 vs. day 14 = 48/53 (91%, 95% CI:79% - 97%), with no evidence of different negative rates between earlier days and day 14 by McNemar's test, p > 0.05. CONCLUSIONS: The 16% positive rate supports the ongoing need to quarantine close contacts of COVID-19 cases, but this prospective study provides the first direct evidence that exposed asymptomatic students ages 18-44 years in a university setting are at low risk if released from quarantine at 7 days if they test negative PCR test prior to release.

Maraviroc, a CCR5 coreceptor antagonist that blocks entry of human immunodeficiency virus type 1.

Inhibition of the human immunodeficiency virus type 1 (HIV-1) coreceptor is an encouraging new approach to pharmacotherapy against HIV. The HIV-1 strain makes use of either the CCR5 or the CXCR4 coreceptor to gain access into host CD4+ cells. Maraviroc, the first HIV-1 CCR5 coreceptor antagonist, blocks entry of HIV-1. This recently approved drug has demonstrated clinically significant decreases in plasma concentrations of HIV-1 RNA and increases in CD4+ cell counts; however, it is indicated only for use as salvage therapy. Drug resistance is a concern, as is selective pressure on viral coreceptor use, because viral coreceptor targets may switch as disease progresses. In addition, before maraviroc therapy can be started, costly assays are required to determine the host's viral coreceptor tropism. Emerging therapies targeting CXCR4, the other HIV coreceptor, have shown promise in decreasing plasma concentrations of HIV-1 RNA. Long-term studies with both targets are required to explore the critical issues of efficacy and immunologic safety, as the function of these coreceptors is linked to host chemokine pathways.

Dextromethorphan abuse: clinical effects and management.

OBJECTIVE: To describe the epidemiology, patient presentation, and clinical management associated with dextromethorphan (DM) abuse. DATA SOURCES: PubMed/Medline search using terms dextromethorphan and abuse through July 2008, bibliographies of selected publications, epidemiology tracking databases. STUDY SELECTION: By the authors. DATA EXTRACTION: English language-published review articles, clinical trials, and case reports that described the epidemiologic and toxicologic profile of DM were included. DATA SYNTHESIS: DM is a relatively inexpensive and easily accessible over-the-counter (OTC) medication intended for use as an antitussive. Increasingly, illicit use of the drug has been reported. At clinical doses, the drug produces few adverse effects. However, when abused in large quantities (>2 mg/kg), the drug has been associated with a dissociative effect similar to those described by ketamine and phencyclidine abusers. Massive ingestions of the drug may be associated with untoward effects, including tachycardia, hypertension, and respiratory depression. Overdose symptoms may also be associated with coformulated products such as antihistamines and sympathomimetic amines. Management is primarily supportive. Naloxone has been used to manage DM toxicity but with conflicting reports of effectiveness. CONCLUSION: Recent reports indicate that DM is often abused by individuals seeking its dissociative effects. Clinicians should be aware of the abuse potential of DM. Pharmacists might be particularly cognizant of the risks involved with DM abuse as they control OTC access to the drug.

Impact of Novel Active-Learning Approaches Through iBooks and Gamification in a Reformatted Pharmacy Course.

Objective. To compare pharmacy students' assessment and evaluation ratings of a newly formatted nonprescription products course that used innovative technology and gaming to that for a traditional nonprescription products course. Methods. Examination scores and course evaluations of students who completed the traditional course on nonprescription products were analyzed and compared with those of students who completed a revised course on nonprescription products that used teaching techniques in educational technology. Results. Students in the traditional course significantly outperformed those in the comparator group in eight nonprescription categories on examinations, while students in the new course significantly outperformed those in the comparator group in four categories. Students in the new course outperformed those in the traditional course in two additional examination categories, however these were not significant. Almost all students in both courses agreed or strongly agreed with each course evaluation item, including those items where use of gamification and iBooks were most likely considered. Conclusion. Improvements in student examination performance and course satisfaction may not be immediately seen in a course in which new teaching techniques using educational technology including gamification and iBooks are introduced.

Prospective Health Professions Students' Misperceptions About Pharmacists.

Public misperceptions about the pharmacy profession have the potential to impact pharmacy education, practice, and the health of those who pharmacists serve. Student misperceptions of the profession can lead to fewer applicants to pharmacy schools and frustration among pharmacy students and faculty members. With the recent decline in applicants to Doctor of Pharmacy (PharmD) programs, professional pharmacy organizations, colleges and schools of pharmacy, and individual pharmacists must implement strategies that mitigate these misperceptions. This commentary discusses the potential impact of prospective health students' (ie, students pursuing admission to health professional programs) misperceptions on the supply of quality candidates to PharmD programs. Strategies to elevate the image of the profession at the individual and collegiate level are discussed.