Reevaluating Core Elements of Emotional Intelligence in Professional Identity Formation for Inclusion in Pharmacy Education.

OBJECTIVES: The objectives of this review are to (1) analyze the core concepts of emotional intelligence self-perception, self-expression, interpersonal relationships, decision-making skills, and stress management and their role in professional identity formation, and (2) investigate the methods and strategies to incorporate emotional intelligence in pharmacy education. FINDINGS: A literature review of emotional intelligence in health care education was conducted by searching the electronic databases PubMed, Google Scholar, ProQuest, and ERIC. The following search terms were included: emotional intelligence, emotional quotient, in association with professional identity formation, pharmacy curriculum, pharmacy cocurriculum, entrustable professional activities, medicine, and nursing. Only full-length, free-access, English-text articles were included. Twenty articles addressed the inclusion and/or assessment of core elements of emotional intelligence in pharmacy education. Commonly taught, cultivated, and assessed core elements include self-awareness, empathy, and interdisciplinary relationships. Assessment tools used to evaluate emotional intelligence in pharmacy education are subjective, qualitative, and semiquantitative, and may include pre and postcourse surveys, event surveys, and questionnaires. SUMMARY: The pharmacy literature is scarce on how best to analyze emotional intelligence and the role it plays in the pharmacist's education and practice. A comprehensive integration of emotional intelligence into the pharmacy curriculum is a challenging task and requires additional in-depth discussions on how best to incorporate it in the pharmacist's professional identity formation. The Academy will benefit from re-engaging its constituents in addressing the gaps of emotional intelligence in the professional curriculum in preparation for the Accreditation Council for Pharmacy Education 2025 standards.

Associating Growth Mindset with Emotional Intelligence and Why It's Needed for Professional Identity Formation.

Nurturing professional identity formation (PIF) is incumbent for the future of a pharmacist. The process of PIF incorporates norms, roles, and expectations of the profession into existing identities. This process can be particularly challenging when there are conflicting identities that provoke strong emotional experiences. Emotions are driven by beliefs and thoughts which serve as the catalyst for our reactions and behavior. Dealing with strong emotions can be uncomfortable, requiring proper regulation and management. Emotional intelligence and a growth mindset are fundamental traits that significantly influence a learner's ability to navigate the emotional complexities and thoughts associated with PIF. Although there is some evidence in the literature on the benefits of cultivating emotionally intelligent pharmacists there is a paucity of information on its association with growth mindset and PIF. Emotional intelligence and growth mindset are not mutually exclusive traits and development of both is needed for a learner's professional identity.

The impact of COVID-19 on select considerations in patients of reproductive age: Brief talking points for pharmacists.

The coronavirus disease 2019 (COVID-19) pandemic has elicited many health concerns, including the impact of the infection and vaccine on reproductive health. Although robust evidence demonstrates the safety of all available COVID-19 vaccines, misinformation and disinformation related to the vaccine continue to circulate. As accessible and essential health care workers, it is crucial that pharmacists are informed of the evidence related to effects of the COVID-19 infection and vaccinations on reproductive health care. Menstrual cycle changes have been noted owing to COVID-19 infection, pandemic stress, and COVID-19 vaccination. COVID-19 infection and vaccination have not been shown to influence female fertility, pregnancy rates, and lactation. The use of exogenous estrogen may further contribute to an increased risk of thromboembolism with COVID-19 infection, and differences in the risk of cerebral venous sinus thrombosis appear to exist between the types of vaccines. The benefits of COVID-19 vaccination outweigh any risks. Shared decision-making is necessary when discussing vaccination with patients. Pharmacists play a vital role in dispelling misinformation and disinformation related to the impact of COVID-19 illness and vaccination on reproductive health care.

Hypertension: Are Current Guidelines Inclusive of Sex and Gender?

Background: Hypertension (HTN) accounts for one in five deaths of American women. Major societies worldwide aim to make evidence-based recommendations for HTN management. Sex- or gender-based differences exist in epidemiology and management of HTN; in this study, we aimed to assess sex- and gender-based language in major society guidelines. Materials and Methods: We reviewed HTN guidelines from four societies: the American College of Cardiology (ACC), the American College of Emergency Physicians (ACEP), the European Society of Cardiology (ESC), and the Eighth Joint National Committee (JNC8). We quantified the sex- and gender-based medicine (SGBM) content by word count in each guideline as well as identified the gender of guideline authors. Results: Two of the four HTN guidelines (ACC, ESC) included SGBM content. Of these two guidelines, there were variations in the quantity and depth of content coverage. Pregnancy had the highest word count found in both guidelines (422 words in ACC and 1,523 words in ESC), which represented 2.45% and 3.04% of the total words in each guideline, respectively. There was minimal coverage, if any, of any other life periods. The number of women authors did not impact the SGBM content within a given guideline. Conclusions: Current HTN management guidelines do not provide optimal guidance on sex- and gender-based differences. Inclusion of sex, gender identity, hormone therapy, pregnancy and lactation status, menopause, and advanced age in future research will be critical to bridge the current evidence gap. Guideline writing committees should include diverse perspectives, including cisgender and transgender persons from diverse racial and ethnic backgrounds.

Mechanisms of action of currently available woman-controlled, vaginally administered, non-hormonal contraceptive products.

Woman-controlled, vaginally administered contraceptives offer women discreet, self-administered, and reversible options. This brief report summarizes the mechanisms of action (MOAs) of currently available, woman-controlled, vaginally administered, non-hormonal products, excluding those that need to be fitted by a healthcare provider. MOAs of three general types of contraceptives will be reviewed, including pH modulators, spermicides, and barrier methods. The recently approved vaginal pH modulator (lactic acid, citric acid, and potassium bitartrate) has a non-hormonal MOA, acting as a buffering agent in the presence of alkaline semen and resulting in sperm immobilization. In contrast, spermicides, such as nonoxynol-9, act by lysing sperm membranes, resulting in sperm death. Barrier methods, such as the diaphragm and female condom, prevent sperm from entering the uterus. In addition to their varying MOAs, each woman-controlled, vaginally administered method has different instructions for use, efficacy, side effects, and availability/insurance coverage, thus providing a range of characteristics to fit different needs and preferences.

In Vitro Nephrotoxicity and Permeation of Vancomycin Hydrochloride Loaded Liposomes.

Drugs can be toxic to the fetus depending on the amount that permeates across the maternal-fetal barrier. One way to limit the amount which penetrates this barrier is to increase the molecular size of the drug. In this study, we have achieved this by encapsulating our model antibiotic (vancomycin hydrochloride, a known nephrotoxic agent) in liposomes. PEGylated and non-PEGylated liposomes encapsulating vancomycin hydrochloride were prepared using two different methods: thin-film hydration followed by the freeze-thaw method and the reverse-phase evaporation method. These liposomes were characterized by their hydrodynamic size and zeta potential measurements, CryoTEM microscopy, loading and encapsulation efficiency studies, in vitro release measurements and in vitro cytotoxicity assays using NRK-52 E rat kidney cells. We also determined the in vitro permeability of these liposomes across the human placental cell and dog kidney cell barriers. Vancomycin hydrochloride-loaded PEGylated liposomes (VHCL-lipo) of a size less than 200 nm were prepared. The VHCL-lipo were found to have the faster release of vancomycin hydrochloride and resulted in greater viability of NRK-52E cells. In vitro, the VHCL-lipo permeated the human placental cell and dog kidney cell barriers to a lesser extent than the free vancomycin hydrochloride. The data suggest a reduction in nephrotoxicity and permeability of vancomycin hydrochloride after encapsulation in PEGylated liposomes.

Vancomycin Pharmacokinetics in a Pregnancy Rat Model.

Vancomycin usage is often unavoidable in pregnant patients; however, literature suggests vancomycin can cross the placental barrier and reach the fetus. Understanding the mass transit of vancomycin to the fetus is important in pregnancy. We aimed to (i) identify a relevant population pharmacokinetic (PK) model for vancomycin in pregnancy and (ii) estimate PK parameters and describe the mass transit of vancomycin from mother to pup kidneys. Pregnant Sprague-Dawley rats (i.e., trimester 1 and trimester 3) received 250 mg/kg vancomycin once daily for three days through intravenous injection via an internal jugular vein catheter. Vancomycin concentrations in maternal plasma and pup kidneys were quantified via liquid chromatography-tandem mass spectrometry (LC-MS/MS). Multiple compartment models were fitted and assessed using a nonparametric approach with Pmetrics. A total of 10 vancomycin-treated rats and 48 pups contributed PK data. A 3-compartment model adjusted for trimester fit the data well (maternal plasma Bayesian, observed versus predicted R2 = 0.978; pup kidney Bayesian, observed versus predicted R2 = 0.999). The mean rate constant for vancomycin mass transit to the pup kidney was 0.72 h-1 for trimester 1 dams and 0.75 h-1 for trimester 3 dams. Median vancomycin concentrations in pup kidneys from trimester 3 were significantly higher than those in trimester 1 (8.62 versus 0.36 µg/mL, P < 0.001). Vancomycin transited to the fetus from the mother and was; kidney accumulation differed by trimester. This model may be useful for a translational understanding of vancomycin distribution in pregnancy to ensure efficacious and safe doses to both mother and fetus.

Impact of a hormonal contraceptive training program for pharmacists.

BACKGROUND: Several states have passed legislation allowing pharmacists to prescribe hormonal contraceptives in an effort to expand access to family planning options for patients. OBJECTIVE: The primary objective of this research is to evaluate participant knowledge and perception, attitudes, and preparedness regarding pharmacist-prescribed hormonal contraception before and after completion of the American Pharmacists Association's interactive online training program, "Increasing Access to Hormonal Contraceptive Products: A Training Program for Pharmacists." METHODS: Training program participants were assessed on their knowledge after each module, and they were invited to participate in a pre- and postsurvey about practice environments and opinions related to hormonal contraceptive prescribing. Descriptive statistics were calculated for categorical survey responses, and means and standard deviations were calculated for program knowledge assessment scores. Pre- and postsurvey responses were analyzed using the Wilcoxon signed-rank test or McNemar's test according to the type of response options. RESULTS: More than 450 participants completed the Hormonal Contraception Training Program; 61% completed the presurvey and 39% completed the postsurvey. Participants had an average score of 86% across modules for both surveys. Comfort level increased statistically significantly in all areas surveyed after program completion. Survey results identified statistically significant changes between pre- and postsurvey in the belief that pharmacists are trained and educated to counsel on and initiate hormonal contraceptives (P < 0.001 and P < 0.001) and that prescribing hormonal contraceptives should be within a pharmacist's scope of practice (P < 0.001). Most respondents (83%) agreed that pharmacy schools should expand content on contraceptive prescribing, although more than half (56%) reported that their pharmacy school taught them the requisite hormonal contraceptive clinical content. CONCLUSION: Training programs play an important role in preparing pharmacists for prescribing roles by providing knowledge and increasing confidence and generally positively affecting perceptions of and attitudes toward prescribing hormonal contraceptives.

Curricular Considerations for Preparing Student Pharmacists to Prescribe Hormonal Contraception.

In 2014, the pharmacist's role in the United States expanded to include prescribing hormonal contraception, and this practice is currently addressed by policy in 14 states and the District of Columbia. Training and education requirements for this expanded scope of practice vary between states and are changing rapidly. The objective of this review is to examine how student pharmacists are taught to provide contraceptive care, specifically for prescribing ongoing hormonal contraception and emergency contraception, and to identify potential gaps in the United States pharmacy curricula related to contraception. Despite steady adoption into community pharmacy practice, there is sparse literature assessing educational methods used to teach contraceptive care. This review offers recommendations to promote consistent and comprehensive student pharmacist education in providing contraceptive care across institutions, regardless of state policy status.

Less common bacterial, fungal and viral infections: review of management in the pregnant patient.

This review is a comprehensive summary of treatment options for pregnant patients with less common bacterial, fungal, and viral infections. It offers guidance to clinicians based on the most recently published evidence-based research and expert recommendations. A search of MEDLINE (inception to March 2021) and the CDC website was performed. Liposomal amphotericin B is the preferred therapy for cryptococcosis, histoplasmosis, oesophageal candidiasis, and coccidioidomycosis, especially during the first trimester due to teratogenic concerns with azole antifungals. For oral candidiasis, clotrimazole troches or miconazole mucoadhesive buccal tablets are recommended. A ß-lactam antimicrobial is preferred over doxycycline for various manifestations of Lyme disease and the drug of choice for Pneumocystis pneumonia is trimethoprim/sulfamethoxazole. Acyclovir is the preferred antiviral for varicella zoster virus. Fluoroquinolones, macrolides, and aminoglycosides should be avoided if possible and there are alternate agents available for an effective treatment regimen. There is a scarcity of clinical data in pregnant patients with less common bacterial, fungal and viral infections. This population lacks definitive recommendations in many clinical practice guidelines. The key to optimizing therapy is a comprehensive review of the available evidence and a careful balance of risks and benefits before final treatment decisions.

Can buprenorphine be used for opioid use disorder during pregnancy?

ABSTRACT: New clinical studies indicate that buprenorphine can be a promising alternative to methadone for treating opioid use disorder (OUD) in pregnant women. Various benefits for the mother have been identified with buprenorphine's unique pharmacokinetics, effect on clinical outcomes, and convenience for the patient. With the growing problem of OUD in pregnant women, clinicians must be aware of treatment options and their associated advantages and disadvantages.

Pharmacists' Perspectives on Prescribing and Expanding Access to Hormonal Contraception in Pharmacies in the United States.

INTRODUCTION: Pharmacist prescribing of contraception is becoming increasingly available in selected states. The objective of this study was to assess US community pharmacists' perspectives on expanding access, barriers, and facilitators since states have begun pharmacist scope of practice expansions for prescribing contraception. METHODS: A survey study of US community pharmacists' support for expanded access models, pharmacist prescribing practices and interest, and importance of safety, cost, and professional practice issues for prescribing was conducted. RESULTS: Pharmacists are generally supportive of pharmacist prescribing and behind-the-counter models for hormonal contraception and generally opposed to over-the-counter access. A majority (65%) are interested in prescribing hormonal contraception. The top motivation for prescribing contraception is enjoying individual patient contact (94%). Safety concerns (eg, patients not obtaining health screenings) remained most important for pharmacist implementation, followed by cost (eg, lack of payment or reimbursement for pharmacists' services), and professional practice (eg, pharmacist time constraints and liability) issues. CONCLUSION: This study provides an updated understanding of attitudes toward models of expanded access to hormonal contraception, interest in prescribing, and barriers and facilitators to this service among community pharmacists. Many barriers such as time and reimbursement remain unchanged. This information can inform policy and implementation efforts.

The Proportion of Women Authors and the Inclusion of Sex and Gender Content Among the American College of Cardiology Clinical Practice Guidelines, 2008-2018.

Background: Sex and gender, two important factors affecting health care, should be routinely taken into consideration in clinical practice. Members of the Sex and Gender Health Collaborative Scholarship Committee reviewed clinical guidelines published by the American College of Cardiology (ACC) from 2008 to 2018 to determine if the number of women authors on the writing committee influenced the presence of sex- and gender-specific content and recommendations in each guideline. Methods: We reviewed 33 ACC clinical guidelines from 2008 to 2018 and determined the number of women authors on the writing committee for each guideline. We then reviewed each guideline to identify specific content on sex and/or gender differences as it pertained to the guideline's subject cardiac condition. Results: The median proportion of women authors among the 33 ACC guidelines was 22.2% (interquartile range 4.4-81.1). Only two guidelines (6%) had writing committees with >50% women authors. Overall, 25 of 33 guidelines (75.8%) contained sex and gender content; however, the depth and detail of the sex and gender content varied widely among guidelines. The proportion of women authors was not associated with the presence of sex- and gender-specific content. Conclusions: Our findings demonstrate continued gender disparities in authorship, and changes should be made to increase the inclusion of women in clinical practice guideline writing committees. We propose selecting a sex and gender champion for guideline writing committees and/or including a specific section on sex- and gender-related content in each guideline to ensure inclusion of sex- and gender-specific recommendations in clinical guidelines.

Factors Affecting Contraception Access and Use in Patients With Opioid Use Disorder.

Maternal opioid use disorder increased > 4-fold from 1999 to 2014 and is associated with poor maternal and fetal outcomes. Women with opioid use disorder are at 2 to 3 times greater risk for unintended pregnancy than the general population and may face additional barriers to accessing and effectively using contraception compared to women without opioid use disorder, particularly highly effective long-acting reversible contraception. Additionally, women with opioid use disorder tend to use less effective forms of contraception such as condoms alone. Barriers to contraceptive access include patient misconceptions or knowledge gaps regarding reproductive health and family planning, cost, intimate partner violence, fear of criminalization, difficulty accessing care, comorbid health conditions, and health care provider misconceptions or practice limitations. Strategies that may assist women with opioid use disorder in achieving their family planning goals include colocation of family planning services within opioid treatment facilities, optimization of patient care services to minimize the need for costly and/or time consuming follow-up, increasing provider education and awareness of best practices in family planning and opioid use disorder treatment, and providing patient-centered family planning education and counseling. Additional research is needed to identify and develop strategies that empower women who use opioids to effectively access and use their preferred contraceptive method.

Effect of a Simulated Activity on Student Ability, Preparedness, and Confidence in Applying the Pharmacists' Patient Care Process to Contraceptive Prescribing.

Several states now permit pharmacists to prescribe hormonal contraception. Consequently, some schools of pharmacy now incorporate activities intending to prepare students to offer this service. This study aimed to assess the impact of a simulated activity on student pharmacists' readiness for, ability to use, and confidence in applying the Pharmacists Patient Care Process along with the United States Medical Eligibility Criteria to a patient seeking contraception. Students completed a contraceptive-prescribing simulation with standardized patients. Scores were analyzed for safe and appropriate prescribing practices. Pre- and post-workshop surveys measured confidence and perceived preparedness. Chi-square and Mann-Whitney U tests were used to analyze categorical variables and Likert-scale data, respectively.The mean activity score was 86% (median 90%), with significant change in student confidence of ability to complete the process (p < 0.0001). The majority of students at baseline (52.2%) and follow up (53.2%) reported needing more practice during advanced pharmacy practice experiences (APPEs) to feel prepared. There was a significant change pre/post in students who agreed that their curriculum prepared them (15% to 28.7%, p = 0.0014). This study suggests that students are able to safely and appropriately prescribe contraception in a simulated activity. The activity increased student reported confidence and moved some students towards readiness for contraceptive prescribing.

Hormonal contraception prescribing by pharmacists: 2019 update.

OBJECTIVES: Empowering pharmacists to prescribe contraceptives could help alleviate barriers such as the accessibility of medical centers and the availability, inconvenience, and cost of appointments. Several states have enacted legislation authorizing pharmacists to prescribe hormonal contraceptives. This manuscript provides an overview of each of the states' laws and highlights differences among the states. The objectives of this study were to (1) list the states in which pharmacists currently have the authority to prescribe contraceptives and (2) compare the differences among those states. DATA SOURCES: The authors assembled state statutes and regulations on pharmacist prescribing of contraceptives and conducted a literature review for research on pharmacist prescribing of contraceptives using PubMed. SUMMARY: Nine states, plus the District of Columbia, authorize pharmacists to prescribe hormonal contraceptives autonomously under a statewide authority, and each state differs in their policy. CONCLUSION: For pharmacists to take full advantage of this opportunity and to expand their clinical role, the quality, consistency, and sustainability of these initiatives must be assessed.

Pharmacist self-perception of readiness to prescribe hormonal contraception and additional training needs.

INTRODUCTION: Our objectives were to describe pharmacist perceptions of training and preparation to prescribe hormonal contraception (HC), identify training gaps, and elicit preferred training methods. METHODS: In this cross-sectional survey, pharmacists in the United States (US) completed an online 29-item survey. Descriptive statistics were used to analyze responses. RESULTS: Of 823 participating pharmacists, 58% felt they received adequate training to prescribe HC. Prescribing any medications within the last five years or completion of residency training were significantly associated with more participants feeling adequately trained. Of those who indicated HC was not covered in their pharmacy school curriculum, most (78%) felt they were either not adequately trained or unsure. Only 36% were aware of the Centers for Disease Control and Prevention US Medical Eligibility Criteria for Contraceptive Use (CDC MEC). Residency-trained pharmacists were statistically more likely to have used the CDC MEC and feel comfortable prescribing for adolescents. Most participants desired more training about switching between products (80%) and patient specific product selection (72%). Preferred methods for additional training were basic (

Faculty insights regarding incorporation of gender- and sex-related differences in the PharmD curriculum: Phase 2.

BACKGROUND: While pharmacists should be aware of gender and sex-related differences in treatment related decisions, this is not a required doctor of pharmacy curricular component. A regional pilot study demonstrated that approximately half of pharmacy practice faculty discussed these differences in their content area. The aim of this study was to evaluate the extent of inclusion of gender and sex-related differences on a national level in doctor of pharmacy curricula and to determine if faculty are comfortable teaching the topic. METHODS: An electronic message with a link to an online survey was distributed to 7250 faculty members at 139 colleges of pharmacy. The survey remained open for three weeks and potential participants received weekly email reminders. The survey was voluntary, and responses were de-identified. RESULTS: Overall, 641 faculty participated in the survey (8.8% response rate). Most respondents indicated that they do not teach about gender or sex-related differences (54.9%). Of those faculty reporting teaching gender and/or sex-related differences, 28% indicated that it was addressed in one clinical topic, while some (7.7%) indicated that the content was included in up to five topics. Half of faculty (53.6%) indicated that they believe this topic is somewhat important. CONCLUSIONS: Results of this study suggest that gender and sex-related differences are not adequately addressed in current pharmacy curricula.

Evaluation of Fetal and Maternal Vancomycin-Induced Kidney Injury during Pregnancy in a Rat Model.

Previous literature suggests that maternal vancomycin crosses the placental barrier to the fetus. Further, early animal studies indicated that kidney injury was not observed in the progeny. These studies were conducted prior to the availability of sensitive biomarkers for kidney injury. Therefore, a previous finding of no renal damage to the infant may be misleading. Vancomycin was administered intravenously to pregnant rats at a dose of 250 mg/kg of body weight/day (N = 6 per trimester) on three consecutive gestational days (GD) during trimesters 1, 2, and 3 (T1, T2, and T3, respectively) in three independent cohorts. The dams carried to term and delivered vaginally on GD 21. Kidneys were harvested from dams and pups and homogenized. Samples were prepared by protein precipitation and injected in a liquid chromatography tandem mass spectrometer, and vancomycin was quantified. The kidney tissue homogenate from dams and pups were analyzed for kidney injury molecule-1 (KIM-1). As trimesters progressed, the quantity of vancomycin increased linearly in the kidneys of both rat dams and pups (P < 0.0001 for T1 and T3, P < 0.0001 for T2 and T3, and P < 0.0001 for T3 and T3 control for both rat dams and pups). KIM-1 concentrations in pup kidneys were significantly higher when dams were administered vancomycin in trimesters 1 (P = 0.0001) and 2 (P = 0.0024) than in controls in trimester 3. Data demonstrate persistence of vancomycin in maternal and rat pup kidneys in all three trimesters of pregnancy with associated damage to the kidney, as indicated by expression of KIM-1.