Report of the 2023-2024 Strategic Engagement Standing Committee.

The American Association of Colleges of Pharmacy has long emphasized the value of strategic engagement, recognizing that it is critical to the success of pharmacy education, contributing to the expansion of pharmacy and public health practice, the fulfillment of institutional missions, and the meeting of programmatic needs. The 2023-2024 Strategic Engagement Committee was charged with operationalizing advocacy champions, creating an advocacy resource guide to support advocacy champions in their engagement with diverse public and private stakeholders, offering formal training to advocacy champions in the form of a new connect community and webinar series, and conducting focus groups at the 2024 Annual Meeting to determine strengths of the advocacy guide and opportunities to support advocacy champions further.

Ghosts and Ghosting in Digital Communications.

Ghosting, professionally and personally, occurs when there is an abrupt end to communication between 2 individuals without any explanation or when an individual does not follow through on commitments to others associated with their communication. The increase in the available communication channels and speed at which messages can now be transmitted between individuals is resulting in a greater incidence of ghosting or perceived ghosting in our colleges/schools of pharmacy. The impact of ghosting is the disruption of effective communication and communication strategies that are essential to the development of positive and thriving cultures and subcultures in our institutions. The causes of ghosting (real or perceived) in our pharmacy academy could be attributed to increased workload and speed of communication, increased workload and productivity expectations, and increased workload and information volume. The consequences of ghosting in our colleges/schools can result in decreased psychological safety in our cultures, adversely impacting individual well-being, resiliency, grit, and satisfaction and adversely impacting student academic performance and success. There are simple steps that individuals and institutions can implement to minimize ghosting or the perception of ghosting that may occur with online communication channels used by our faculty, staff, students, and outside individuals.

Shackleton's Successful Failure: Lessons for the Academy.

Leadership is many things. It is fun, exciting, rewarding, and oftentimes, it can be challenging. Those challenges, especially within higher education and pharmacy, have been well documented and the turbulent times are likely to continue. It is therefore important to consider how leaders learn to lead. Within this article, the authors explore learning leadership and applying the leadership principles of a leader who led what can best be defined as a successful failure, Ernest Shackleton's Endurance expedition to the South Pole. The well-documented journey of the Endurance did not meet its goals but instead endured a nearly 2-year odyssey during which survival was the goal. The success was measured in that not a soul was lost during this 2-year period. The success of the Endurance measured by the return of the entire crew has been linked to the leadership of Ernest Shackleton and his approaches to leadership as relates to his attributes, work with individuals, and work on the culture of the crew. The leadership lessons from Shackleton can provide useful insights toward successful leadership in contemporary higher and pharmacy education.

Pharmacists must take an active role as citizen scientists.

Science is a process by which society advances knowledge of the physical and natural world through observation, experimentation, and testing of theories based on evidence. This process forms the foundation of the biomedical, clinical, and social sciences, which together provide an ever-changing knowledge base for health care professionals, like pharmacists, to use to provide evidence-based care to patients and communities. Yet, despite the essential and integrated application of science to improve health-related knowledge and care delivery, the utility and viability of science itself are under threat. Science as a broad discipline continues to be subject to politicization, misinformation, and persisting inequities among its beneficiaries. Science remains the subject of disparate perspectives regarding its societal benefits and expected roles. Pharmacists, given their education, training, and earned trust, can help to address these challenges by engagement as citizen scientists. Citizen scientists, through involvement with related initiatives, promote and advance all aspects of the public good, which are essential to the continued smooth functioning of our society. Pharmacists are well positioned to be engaged in various citizen scientist roles available in their communities that promote the public good economically, politically, and culturally. Involvement in citizen science activities is not without personal cost. This can be challenging, depending upon the level of involvement. It might take time away from other desired activities and generate perceived deficits of self-efficacy. Yet pharmacists who engage in the process of scientific discovery at any level as citizen scientists can experience personal and professional benefits, engage with other members of their communities, and provide an opportunity to serve as role models to others considering a career in pharmacy.

Recommitting to AACP Engaged Governance for the Common Good: Report of the 50th Anniversary Commission to Reimagine the AACP House of Delegates.

The 50th Anniversary Commission to Reimagine the American Association of Colleges of Pharmacy (AACP) House of Delegates (HOD Commission) was charged to consider and recommend changes to the AACP Board of Directors and AACP HOD regarding a broad range of issues related to the HOD. The 2021-2022 HOD Commission met virtually many times throughout the year as 2 sub-groups and a full commission, using Basecamp for shared documents and timelines, and it provided interim reports to the Board of Directors in November and February. A survey of 2022 delegates was developed and administered; responses from 163 delegates informed final recommendations as described in the report. The HOD Commission affirms the need for and purpose of AACP's HOD and urges that all schools/colleges of pharmacy recommit to engaged governance for the common good.

Envisioning the Future of Student Success: Report of the 2022-2023 AACP Student Affairs Standing Committee.

Over the past several years, traditional metrics have indicated declining student success within colleges and schools of pharmacy. Though students may be less well-prepared for professional school than in years past, once candidates are admitted to our institutions, we have a responsibility to effectively support their progression through the program. The 2022-2023 Student Affairs Committee was convened to evaluate and advance the construct of student success within Doctor of Pharmacy programs. The Student Affairs Committee was charged with identifying environmental factors affecting the ability of pharmacy students to be successful; determining how colleges and schools of pharmacy are currently meeting needs related to student progress; conducting a literature review to determine what academic support measures minimize attrition; and developing innovative suggestions and recommendations that better support student success. To accomplish this work, we conducted an extensive literature review and synthesis of evidence, engaged in professional networking across the Academy, and administered a wide-ranging student success survey to all colleges and schools of pharmacy. In this report, we explore the complex and interacting systems that affect learning behavior and academic success and offer a novel, comprehensive description of how the Academy is currently responding to challenges of academic and student success. Additionally, we envision the future of student success, offering 7 recommendations to the American Association of Colleges of Pharmacy and 5 suggestions to members of the Academy to advance this vision.

Addressing an Uncertain Future With a Culture of Psychological Safety.

Faculty, staff, and administrators in our pharmacy colleges and schools work in well-known organizational structures that form the foundations for cultures and subcultures. The importance of promoting a positive culture and subculture is a frequent discussion in our own institutions and across the academy. However, the impact of these cultures and subcultures on individual and collective success and how they influence inclusion and innovation in our organizations are often not considered in these conversations. Psychological safety promotes an environment in an organization where an individual feels included in the culture or subculture; is safe to learn; is safe to contribute; and is safe to challenge the status quo all without the fear of being embarrassed, marginalized, or penalized in some way. Psychological safety is the foundation for enabling learning, innovation, and change in our colleges and schools of pharmacy. This commentary will highlight elements of cultures and subcultures, the importance of fostering a psychologically safe environment in our colleges and schools, and suggestions for success.

Advancing Systems Citizenship in Colleges and Schools of Pharmacy.

The pharmacy academy works collectively to serve the educational needs of diverse stakeholders by promulgating expectations for professional programs to achieve standards for both practice and professional development. Building systems thinking into the learning process, with its associative benefits to postgraduate preparation and lifelong practice, offers a pathway to achieve this educational mission. The concept of systems citizenship has been suggested as a process for helping health professional students incorporate a meaningful professional identity and responsibly seek out an understanding of the connections between patients, communities, and the larger institutions and environments that affect each. Drawing on the discipline of systems thinking, the student and pharmacist learn to be effective locally by thinking globally. Systems thinking, a basis for effective citizenship, is a proactive and shared approach to problem-solving that integrates professional identity with the goal of closing gaps in care. Pharmacy colleges/schools provide an opportune forum for educating professional students and postgraduates with the knowledge, skills, and abilities critical to becoming valuable and contributing systems citizens.

Considering Retention and Curricula in Reframing Pharmacy Enrollment Challenges.

Enrollment in pharmacy education has been a topic of extensive discussions as the number of applications has declined. Some pharmacy programs have either not met enrollment goals or decreased incoming class sizes. This Commentary poses two questions that we must ask ourselves as an Academy. First, is it possible to realistically do more to recruit our way out of this situation in the next three to five years and beyond. Second, how, if possible, will pharmacy colleges and schools avoid the significant and transformative forces that could impact higher education in the future. Forces that are impacting higher education include changing demographics, transitioning from an industrial-based economy to a knowledge-based economy, and the continuing advances in technology with increased globalization as a component of all three of these forces. To address these questions, the concepts of student retention and success as well as considerations for reframing current curricular and pedagogical models and beliefs are challenged. In that pharmacy enrollment challenges are not likely to be easily resolved in the next few years, the Academy must place additional emphasis on issues related to student success and the design of our educational models and programs.

The Privilege of Providing Patient Care.

Pharmacists are in a unique place to provide care to those in need. The pharmacist is sought after by patients and/or their family members to help them achieve positive health outcomes. The pharmacists providing this care in various practice settings are struggling with issues leading to stress, burnout, and decreased valuation of the profession. To help pharmacists and future pharmacists deal with these challenges, I propose the concept of the privilege of care and explain how the privilege of care, from the perspective of a pharmacist or healthcare provider, is the privilege to provide care and help those in need.

Reducing Repeat Blood Cultures in Febrile Neutropenia: A Single-Center Experience.

Background: Limited data exist to guide blood culture ordering in persistent febrile neutropenia (FN), resulting in substantial variation in practice. Unnecessary repeat blood cultures have been associated with patient harm including increased antimicrobial exposure, hospital length of stay, catheter removal, and overall cost. Methods: We conducted a single-center study of adult hematology-oncology patients with ≥3 days of FN. The yield of blood cultures was first evaluated in a 2-year historical cohort. Additionally, a pilot pre-/postintervention study was performed in non-stem cell transplant (SCT) patients following a change in our population clinical practice guideline from a recommendation of daily blood cultures to a clinically guided approach. The primary outcome was cultures collected per days of FN after day 3 of persistent FN. Results: One hundred forty-six episodes of ≥3 days of FN in 108 patients were identified during the historical period. Day 1 blood cultures were positive in 23 of 146 (16%) episodes. Blood cultures were drawn on 374 of 513 (73%) subsequent episode-days (day 2-12) and were negative in 366 of 374 (98%). After the intervention, a 53% decrease was observed in the rate of total blood cultures collected (1.4 preintervention vs 0.7 postintervention; P = .03). Blood cultures obtained after 48 hours rarely yielded clinically significant organisms. Conclusions: Repeat blood cultures are low-yield in persistent FN without new clinical change. A pilot intervention in non-SCT patients successfully reduced the frequency of blood culture collection.

Minimizing the Reorganization Energy of Cobalt Redox Mediators Maximizes Charge Transfer Rates from Quantum Dots.

Light-induced charge separation is at the very heart of many solar harvesting technologies. The reduction of energetic barriers to charge separation and transfer increases the rate of separation and the overall efficiency of these technologies. Here we report that the internal reorganization energy of the redox acceptor, the movement of the atoms with changing charge, has a profound effect on the charge transfer rates from donor quantum dots. We experimentally studied and modelled with Marcus Theory charge transfer to cobalt complexes that have similar redox potentials covering 350 mV, but vastly different reorganization energies spanning 2 eV. While the driving force does influence the electron transfer rates, the reorganization energies had a far more profound effect, increasing charge transfer rates by several orders of magnitude. Our studies suggest that careful design of redox mediators to minimize reorganization energy is an untapped route to drastically increase the efficiency of quantum dot applications that feature charge transfer.

The effects of avoiding extended antimicrobial drain prophylaxis on Clostridioides difficile and postprocedural infection rates: a 5-year retrospective.

OBJECTIVE: Postprocedural infection is a consequential complication of neurosurgical intervention. Periprocedural antimicrobial prophylaxis is routinely administered to prevent infection, and in some cases, continued for extended periods while surgical drains remain in place. However, there is little evidence that extended antimicrobial administration is necessary to reduce postprocedural infection, and extended antimicrobials can be associated with harm, such as Clostridioides difficile infection. The authors sought to evaluate whether shortening the duration of postprocedural antimicrobial prophylaxis would decrease the incidence of C. difficile infection without increasing the incidence of postprocedural infection. METHODS: In this retrospective study, two general neurosurgical cohorts were examined. In one cohort, postoperative antimicrobial prophylaxis was limited to 24 hours; in the other, some patients received extended postoperative antimicrobial prophylaxis while surgical drains or external ventricular drains (EVDs) remained in place. Rates of infection with C. difficile as well as postprocedural infection after surgery and EVD placement were compared. RESULTS: Seven thousand two hundred four patients undergoing 8586 surgical procedures and 413 EVD placements were reviewed. The incidence of C. difficile infection decreased significantly from 0.5% per procedural encounter to 0.07% with the discontinuation of extended postprocedural antibiotics within 90 days of a procedure. Rates of postprocedural infection and EVD infection did not significantly change. Results were similar in subgroups of patients with closed suction drains as well as cranial and spine subgroups. CONCLUSIONS: Discontinuation of extended antimicrobial prophylaxis was associated with a significant decrease in the incidence of C. difficile infection without a concomitant change in postprocedural infections or EVD-associated infection. This study provides evidence in support of specialtfy-wide discontinuation of extended postoperative antimicrobial prophylaxis, even in the presence of closed suction drains.

Implementation of a Rapid Phenotypic Susceptibility Platform for Gram-Negative Bloodstream Infections With Paired Antimicrobial Stewardship Intervention: Is the Juice Worth the Squeeze?

BACKGROUND: Implementation of the Accelerate PhenoTM Gram-negative platform (RDT) paired with antimicrobial stewardship program (ASP) intervention projects to improve time to institutional-preferred antimicrobial therapy (IPT) for Gram-negative bacilli (GNB) bloodstream infections (BSIs). However, few data describe the impact of discrepant RDT results from standard of care (SOC) methods on antimicrobial prescribing. METHODS: A single-center, pre-/post-intervention study of consecutive, nonduplicate blood cultures for adult inpatients with GNB BSI following combined RDT + ASP intervention was performed. The primary outcome was time to IPT. An a priori definition of IPT was utilized to limit bias and to allow for an assessment of the impact of discrepant RDT results with the SOC reference standard. RESULTS: Five hundred fourteen patients (PRE 264; POST 250) were included. Median time to antimicrobial susceptibility testing (AST) results decreased 29.4 hours (P < .001) post-intervention, and median time to IPT was reduced by 21.2 hours (P < .001). Utilization (days of therapy [DOTs]/1000 days present) of broad-spectrum agents decreased (PRE 655.2 vs POST 585.8; P = .043) and narrow-spectrum beta-lactams increased (69.1 vs 141.7; P < .001). Discrepant results occurred in 69/250 (28%) post-intervention episodes, resulting in incorrect ASP recommendations in 10/69 (14%). No differences in clinical outcomes were observed. CONCLUSIONS: While implementation of a phenotypic RDT + ASP can improve time to IPT, close coordination with Clinical Microbiology and continued ASP follow up are needed to optimize therapy. Although uncommon, the potential for erroneous ASP recommendations to de-escalate to inactive therapy following RDT results warrants further investigation.

Synthesis of vulcanite (CuTe) and metastable Cu1.5Te nanocrystals using a dialkyl ditelluride precursor.

This study demonstrates that a dialkyl ditelluride reagent can produce metastable and difficult-to-achieve metal telluride phases in nanocrystal syntheses. Using didodecyl ditelluride and without the need for phosphine precursors, nanocubes of the pseudo-cubic phase (Cu1.5Te) were synthesized at the moderate temperature of 135 °C. At the higher temperature of 155 °C, 2-D nanosheets of vulcanite (CuTe) resulted, a nanomaterial in a phase that has not been previously achieved through thermal decomposition methods. Materials were characterized with TEM, powder XRD and UV-Vis-NIR absorbance spectroscopy.

Collaborative Antimicrobial Stewardship for Surgeons.

Antimicrobial stewardship efforts that include surgeons rely on healthy and open communications between surgeons, infectious diseases specialists, and pharmacists. These efforts most frequently are related to surgical prophylaxis, the management of surgical infections, and surgical critical care. Policy should be based on best evidence and timely interactions to develop consensus on how to develop appropriate guidelines and protocols. Flexibility on all sides leads to increasingly strong relationships over time.

Assessment of Pharmacy Manpower and Services in New England.

OBJECTIVES: This study assessed longitudinal trends in pharmacy staffing and services in the 6 New England states by comparing survey results from 2008 and 2013. METHODS: A validated 32-item survey was mailed in 2008 and 2013 to a random sample of 2000 pharmacists. Each sample represented approximately 15% (2008) and 13% (2013) of the active rosters. RESULTS: Response rates were 24% in 2008 and 23% in 2013. In all, 45% of 2013 respondents reported a pharmacist position vacancy in the past 12 months versus 62% in 2008. In all, 12% of 2013 respondents agreed or strongly agreed with a statement regarding pharmacists' shortage versus 77% in 2008. Disease management services were reported to be offered by 23% of 2013 respondents versus 28% in 2008. Reasons for not offering the services in 2013 included the lack of staffing (61%), expertise (28%), and reimbursement (29%). In 2008, these results were 74%, 33%, and 31%, respectively. CONCLUSIONS: The pharmacist shortage within New England was alleviated during 2008 to 2013. Participation of pharmacists in disease management services did not follow staffing trends as fewer pharmacists reported providing services. Key barriers to services provision persist and consideration of how to resolve them (medication therapy management reimbursement and additional education) should be explored.

Accidental acute alcohol intoxication in infants: review and case report.

BACKGROUND: Acute alcohol intoxication in children younger than 18 months old is both rarely documented and rarely fatal. Previous case reports suggest hypoglycemia and faster than normal rates of alcohol elimination found in children with acute alcohol intoxication compared with adults, but data are lacking. CASE REPORT: A 2-month-old infant presented with a decreased mental status after accidental ingestion of alcohol. He was diagnosed with acute alcohol intoxication, with a blood alcohol level of 330 mg/dL and was hyperglycemic (167 mg/dL). Alcohol elimination rate was calculated to be 21.6 mg/dL/h, similar to that in adults. To our knowledge, this case is the second youngest documented patient with accidental alcohol intoxication via ingestion in the United States. We present a rare case report of acute alcohol intoxication in an infant and a review of the literature. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although rare in the literature, poison control data suggests that alcohol poisoning in very young children is not rare. Emergency physicians should be prepared for the management of infants with alcohol poisoning. This case report and review brings attention to this subject and briefly discusses ethanol metabolism in infants.