Addressing Culturally Based Hidden Bias and RacisM (A-CHARM) Using Simulation Experiences, Nik's Story: A Quasi-Experimental Study.

BACKGROUND/PURPOSE: Racism and hidden bias experienced by underrepresented nursing students contribute to a loss of confidence and anxiety. The A-CHARM nursing project developed virtual simulation experiences for nursing students to practice how to address racism. 'Nik's Story' virtual simulation was created as part of the A-CHARM project. The purpose of this study was to examine the effectiveness of an education intervention, that included Nik's story, on cultural humility and cultural diversity awareness. METHOD: This quasi-experimental study included a convenience sample of final year nursing students. After informed consent, participants completed a pre-intervention questionnaire that included the Cultural Humility Scale "context for difference in perspective" subscale, and the Cultural Diversity Awareness questionnaire to assess baseline knowledge. Students participated in an education intervention that included a lecture, Nik's story virtual simulation experience, a debrief and then completed a post-education/simulation questionnaire that included usability/learner engagement questions and the Cultural Humility Scale "context for difference in perspective" subscale, and the Cultural Diversity Awareness questionnaire. RESULTS: Forty-seven students consented and completed the pre/post intervention questionnaire. Participants rated the effectiveness, engagement and usability of the simulation experience highly. There was a significant positive change in cultural humility "context for difference in perspective" subscale (pre-scores = 6.9, SD = 3.3; post-scores = 31.0, SD = 3.8, p < 0.001), and cultural diversity awareness (pre-scores = 95.4, SD = 8.9; post-scores = 103.4, SD = 9.8, p < 0.001). DISCUSSION: This intervention was effective in improving cultural humility and cultural diversity awareness in nursing students. CONCLUSION: Simulation experiences regarding racism in the clinical setting provide a strategy for students to learn how to professionally navigate unwanted experiences.

Formation of a statewide community pharmacy practice-based research network: Pharmacist opinions on research participation and engagement.

OBJECTIVE: To gather the insights and opinions of pharmacist stakeholders to inform the creation of a community pharmacy practice-based research network (PBRN) in Pennsylvania. DESIGN: A stakeholder advisory board of pharmacists, patients, and researchers was established to guide this research. This was a qualitative study using a semistructured interview guide. SETTING AND PARTICIPANTS: Community pharmacists from the Pennsylvania Pharmacist Care Network. OUTCOME MEASURES: Themes were identified that describe pharmacist insights and opinions on research participation and preferences for engagement in the PBRN. RESULTS: A total of 16 pharmacists participated in the study. The pharmacists believed that participating in research would help demonstrate their value and commitment to improving patients' health. Enhancing patient-pharmacist relationships and driving innovation were additional benefits that were reported. The pharmacists believed that they could effectively leverage their relationships with patients to engage them in research opportunities. The pharmacists reported that they would like to share research ideas and successful research practices with other members of the PBRN. CONCLUSION: Gathering pharmacists' opinions on participating in research was an important step in developing a community pharmacy PBRN that meets stakeholder needs. The results of this study can help others who seek to form community pharmacy PBRNs that facilitate stakeholder-driven research.

The pharmacist's role in supporting people living with cystic fibrosis.

OBJECTIVES: To describe the critical need for pharmacists' involvement in outpatient care for people living with cystic fibrosis (CF). DATA SOURCES: Not applicable. SUMMARY: CF is a pulmonary condition that affects more than 30,000 children and adults in the United States and 70,000 people worldwide. Various complex medication regimens are given to patients with CF, some depending on the type of mutation they have in their CF transmembrane conductance regulator protein. With complex medication regimens and the increased number and variety of treatments that have become available, the medication use burden intensifies for individuals living with CF and their caregivers. Young people living with CF have a particularly difficult time adhering to medications and other therapies as they begin to rely less on their caregivers and assume greater medication management responsibility for their care. Adolescents report low adherence rates from about 40% to 47% for airway clearance methods and even lower for nutritional recommendations, about 16% to 20%. In inpatient settings, pharmacists have been successful in making medication use recommendations that have improved adherence for patients with CF while in the hospital. However, limited research has explored how provision of pharmacist supportive care and patient education in outpatient settings can improve medication adherence and quality of life for people living with CF. CONCLUSION: There is potential for provision of outpatient pharmacy clinical services to increase medication adherence and overall quality of care for patients with CF. Higher rates of medication adherence in patients with CF could in turn improve patient outcomes and reduce overall health care costs as a result of fewer rehospitalizations. Pharmacies can implement programs designed to provide comprehensive support services and medication management from pharmacists and staff that are trained in CF care.

A phosphorylation switch controls the spatiotemporal activation of Rho GTPases in directional cell migration.

Although cell migration plays a central role in development and disease, the underlying molecular mechanism is not fully understood. Here we report that a phosphorylation-mediated molecular switch comprising deleted in liver cancer 1 (DLC1), tensin-3 (TNS3), phosphatase and tensin homologue (PTEN) and phosphoinositide-3-kinase (PI3K) controls the spatiotemporal activation of the small GTPases, Rac1 and RhoA, thereby initiating directional cell migration induced by growth factors. On epidermal growth factor (EGF) or platelet-derived growth factor (PDGF) stimulation, TNS3 and PTEN are phosphorylated at specific Thr residues, which trigger the rearrangement of the TNS3-DLC1 and PTEN-PI3K complexes into the TNS3-PI3K and PTEN-DLC1 complexes. Subsequently, the TNS3-PI3K complex translocates to the leading edge of a migrating cell to promote Rac1 activation, whereas PTEN-DLC1 translocates to the posterior for localized RhoA activation. Our work identifies a core signalling mechanism by which an external motility stimulus is coupled to the spatiotemporal activation of Rac1 and RhoA to drive directional cell migration.